Story and photos by Margaret High
DZAMA, MALAWI – Eliza Maxuwee sits in a crowded classroom writing with just the barrel of a pen. Her lightly ink-stained hands hover over three letters: HIV. She’s been writing them since she started year 3 at Dzama Educational Development Program in Malawi.
Eliza doesn’t know much English, but the three letters and what they mean are unavoidable to her. The teachers talk about it, her village chief worries about it, some classmates have it, and four of her uncles have died from it.
HIV has stained Malawi as deeply as the African clay on Maxuwee’s school uniform: a royal blue jumper and faded purple polo. It’s omnipresent.
Dzama Orphan Care and School was founded in 2004 by UNC Project Malawi and the Statistical Center for HIV/AIDS Research & Prevention in Seattle. The rural village 15 miles outside of the country’s capital has been hit hard by the HIV epidemic, which has left about 100 children orphaned.
“Our community group noticed that there was an inordinate number of AIDS orphans,” says Irving Hoffman, international director and co-founder for UNC Project Malawi. “This was during a time when there wasn’t access to antiretroviral medications. Most people with HIV died within 10 years of contracting it.”
UNC Project Malawi was started in 1990 through a collaboration of infectious disease research with UNC Medical Research members and the Malawian Ministry of Health. Hoffman and other researchers were able to receive grants and eventually grew UNC Project Malawi into a cancer research facility with the first pathology lab in Malawi.
As research advancements continued, UNC Project Malawi expanded its influence.
“Irving came with pictures of Dzama that showed a pile of bricks,” says Dr. Peter Gillian, one of the first donors to Dzama Orphanage Care and School. “Essentially, the village people had made the bricks to build the school for the children in the village, but they had no money.”
The first red brick building still stands in the middle of the mud-hut village. The school has the only clean drinking well and formal latrines in Dzama. Dzama Orphan Care and School started with 170 children but has grown to six classrooms and almost 1,000 students, including Eliza.
Eliza, 8, doesn’t have to walk far to get to class. She sits on the bare concrete floor, patiently waiting for a big plastic bucket of porridge to be carried in on the head of a volunteer.
The excited squeals of school children from ages 4 through 12 fill the dusty courtyard as they await the peanut butter-flavored porridge. For most, it’s the only meal they’ll eat today.
As she waits, the sound of a government-assigned teacher singing to her preschool class rings out: “Do you love Jesus? Oh yes, oh yes. Do you love the devil? Oh no, oh no.”
In the original building sit the youngest children, dropping fresh porridge on their stained and torn shirts. All 40 of them sit silently in their classroom and eat as they’re instructed in chairs with the word “smart kid” printed on them.
Now the classroom is composed of both orphans and non-orphans. The formal name has changed from Dzama Orphan Care and School to Dzama Educational Development Program.
“There are fewer AIDS orphans because now the antiretroviral program is spread,” Hoffman says. “Almost every woman that is pregnant and has HIV starts on antiretrovirals before delivery that allows them to have a child that is HIV free.”
The meal program and education of mathematics, English, Chichewa (the official language of Malawi) and religion has been constant since 2004, when there were an estimated 150,000 orphans in Malawi. It was around the same time Malawi started its first massive antiretroviral program.
“There was a lot of stigma at first and not a lot of awareness,” Hoffman says. “But because the prevalence was so high and the incidence so high, by 2000 almost everyone in Malawi had a family member or knew someone with HIV and experienced that trauma.”
While Eliza isn’t an orphan or living with HIV, many of her classmates are both. Mortality rates from HIV in Malawi are so high that the notorious “coffin street” developed in the capital of Lilongwe, a stretch about a mile long of coffin carpenters leading to Malawi’s main hospital, Kamuzu Central Hospital. Three-sided buildings crowd the space between the dilapidated road and sprawling farmland, filled with different colored coffins and funeral wreaths.
In 2015, there were an estimated 110,000 children living with HIV in Malawi. About 25 percent of children typically contract HIV by being born with an HIV positive mother or through breast-feeding. Because children already have undeveloped immune systems, most don’t live past 5 years old.
All the coffin makers sell small, four-foot boxes as well.
“I was going to a funeral every weekend,” says Deborah Demster Kamwendo, the associate country director at UNC Project Malawi. “It was really depressing. I had some great friends die.”
Since the first AIDS case reported in Africa in 1982, Malawi has been ravaged by the virus. Even though the life expectancy has increased by 20 years since 2000 to roughly 60 years old for both males and females, there are still an estimated 1 million Malawians living with HIV out of a total population of 18.62 million.
Everyone knew someone with advanced AIDS, whether or not it was acknowledged. When the epidemic first took hold of the nation, most families had upward of 12 children and were slowly killed off. Callisto Sekeleza, the communications coordinator at UNC Project, says he had four uncles killed by advanced AIDS. They had no access to antiretroviral medicines and usually died within 10 years of infection.
Even now, Sekeleza realizes some funerals he attended were for AIDS victims though no one outwardly said so. It’s traditionally been a stigmatized disease, especially because homosexual intercourse used to be punishable by law.
HIV can be spread in various ways, but the most common in Malawi is through sexual intercourse, another topic the conservative country doesn’t like to openly talk about.
But by 2000, the epidemic couldn’t be ignored any longer. International organizations started taking interest in Malawi and began steering the public dialogue. Especially when antiretrovirals became widely available, it was impossible to not talk about HIV.
Before, when someone was high risk for HIV, he or she never bothered to get tested because there was no point when medication wasn’t available.
Now, Eliza reads in her textbook about what causes HIV and how to protect herself, especially because she eventually will enter the highest risk population of 15-to-24-year-old females.
Mothers from Dzama say they appreciate that their children are educated about HIV because they hope for a generation not distraught with the disease.
“The HIV education and life lessons are my favorite part of the program,” says one mother. “It’s important to teach the children. They need to know about it.”
The Dzama patriarchal village chief says he can finally shift his attention from taking care of HIV orphans to other problems in the village.
So Eliza discusses in groups how mother-to-child HIV transmission occurs and how to identify risky behaviors.
“I think for kids, as soon as they’re able to apprehend what’s being taught to them, of course HIV information is very important,” Hoffman says. “What we focus on more though in Dzama is ways to be able to access adolescents, especially adolescent girls – which is a very vulnerable population in Malawi – and try to get them into health services and to stay in school, which are all factors in preventing HIV.”
Education and food security are two key stable constants in Maxuwee’s life that Dzama Educational Development Program provides in an effort to give her the tools she needs to avoid getting infected as she begins walking 10 kilometers to upper grade school in a couple years.
“My big hope is that one day the kids that are educated in these schools will be a doctor,” Gillian says.
For now, Eliza dances in a circle with her friends, laughing and clapping to the rhythm they create while the boys kick a wad of plastic grocery bags as their soccer ball. The HIV orphan and non-orphan all play together, simply being kids at school.
