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The Lost Children of AIDS

So,” I asked, “if Rotary is soliciting donations for food, clothing, and so on, what is the $8 million PEPFAR grant for?”

That’s in the grant proposal,” she said, referring to Hope and Rotary’s application to PEPFAR. “It has direct costs and indirect costs,” and then she suggested I contact USAID if I wanted more information.

But USAID will not discuss the ANCHOR program. A Freedom of Information Act request I submitted to USAID in early August 2005 is still pending.


We wanted to do something on a huge scale,” explained Greg Ash, the white South African plastic surgeon who founded NOAH—or Nurturing Orphans of AIDS for Humanity—another South African orphan program that has received approximately $1.5 million from PEPFAR. “We acted as though the responsibility for every orphan in the country were ours.” I had been referred to Ash’s organization by a press officer at the US embassy in Pretoria. He said it was a PEPFAR success story—a truly indigenous South African organization that was helping thousands of children.

Ash hadn’t thought much about AIDS before he started NOAH. Like many white South Africans, he considered leaving the country after the ANC came to power in 1994. But then he was offered a job at a private hospital in Umhlanga Rocks, an exclusive beach community of swaying palms, oceanfront high-rises, and luxurious shopping malls, and he decided to stay. Having made a commitment to raise his own children in South Africa, he began to think more seriously about the country’s future, and that’s when he began to worry about AIDS orphans. “Apartheid,” he said, “gave us this feeling about ourselves, like we’re bad people. Maybe that’s why an amazing number of people want to do something for the first time. It’s relatively easy to get money for kids. People are just waiting for someone to tell them what to do.” In 2001, he approached officials at the US embassy with a scheme that he said would help a million AIDS orphans in South Africa by 2008, and in 2003 NOAH began receiving US government funding.

NOAH is a franchise organization. It funds the construction of “resource centers” in schools—separate buildings that, according to the plan, house a small library and five or ten computers, where orphans can stay after school and receive a free meal, read books, and learn how to use computers. NOAH is currently building twenty-two such centers—at a cost of roughly $1 million—and the plan is to build many more.

I asked Ash why it was necessary to build new buildings and buy computers when so many of the orphans I had met in South Africa seemed to have much simpler needs. “We need to break the cycle of AIDS and poverty,” he said.

Many of the schools in South Africa are, frankly, not very good, but in the future South African kids will have to compete for jobs with kids from Korea, from Shanghai…. They need that competitive advantage. And setting up some computers is easy, it doesn’t cost anything, and the kids teach themselves how to use them.

The resource centers have a staff of six people, and local volunteers are also recruited from the community to work with especially needy children.

One drizzly Wednesday morning in June 2005, I went to visit a NOAH center in a poor black township known as Nkobongo some thirty miles and a world away from Umhlanga Rocks. Nkobongo sprawls over the veldt behind the town of Shaka’s Kraal, named for the powerful Zulu king who conquered much of southern Africa in the early nineteenth century. By the early twentieth century, white settlers had forced the Zulus off the best grazing land into tsetse- and malaria-infested valleys and lowlands. Young men were recruited to work in the distant gold and diamond mines of the Transvaal, and the rural economy of small-scale farming and cattle raising that had sustained the Zulus for centuries was gradually destroyed. Today, most Zulus live in desolate rural homelands or impoverished townships like Nkobongo. Staggering levels of unemployment and poverty have further hardened these tough people. In village bars, drunk and rowdy men listen to booming rap music, fight about women, and sometimes kill each other. Even small children greet each other with gangster hand signals. A study conducted in a nearby area found that among adults in their twenties, around a third of all men and half of all women are HIV-positive.

The manager of the local NOAH program was not around when I arrived in Nkobongo, so I waited for him at the Nkobongo community center. The community center is on a hill with a view of the whole region: the neat rows of tiny box-shaped houses spread across barren hillsides, a latrine in each front yard. Right below the community center, I noticed that a large crowd had gathered. About two hundred people, young and old, men and women, were sitting around the periphery of a rain-soaked tarmac lot. “Those people really appreciate the bones,” said a woman I had met at the community center. “What bones?” I asked. Just then, a pickup truck arrived and parked in the middle of the lot. Two men got out and began off-loading stripped pork bones—refuse from a local abattoir—which they piled up in a heap on the tarmac. The crowd looked on keenly as the men began to distribute the bones—five or six to each person—until the heap disappeared.

Overseeing this extraordinary event was Charles Southwood, a retired white South African businessman who volunteers to help numerous charities in the area, including NOAH. He’d been distributing bones for a local Catholic charity for years, he said. When he started there would be such a mob when the bones arrived that they knocked Charles over several times, and almost overturned the vehicle once or twice. “I told them they had to sit down and form an orderly queue; otherwise there would be no more bones.”

According to the Ministry of Agriculture, roughly one third of all South Africans experience “food insecurity,” meaning that they live in fear of hunger. At a high school in Soweto, a teacher described to Jonathan and me how many of the students, especially those who were orphans, complained that they did not get enough food at home. Sometimes they would stare through the windows of the faculty room at the teachers eating lunch. “How do you teach a hungry child?” she asked us.12

South Africa is the richest country in sub-Saharan Africa. There are no wars here, no refugee camps; the country has a social welfare system, a free press, and regular peaceful elections. But the agrarian traditions that once sustained people here—the techniques they had developed over centuries of survival on the sandy marginal soils of Africa, and that one nineteenth-century European visitor said showed such a profound understanding of nature that they closely resembled a science—have been all but lost.13 Meanwhile, the industrial future has yet to arrive, and some three quarters of all adults in places like Nkobongo are unemployed.14 Although South Africa’s powerhouse economy, based on gold, diamonds, commercial farming, and services, is growing rapidly, it produces very small numbers of highly skilled jobs.

Charles Southwood introduced me to some of the people who worked at the Nkobongo NOAH resource center. The new building was still under construction, and the resource center was temporarily housed in a church. There was no library, although there was a kitchen where a daily meal was prepared. I was also shown a room with nine computers. The 150 children registered with NOAH love them, but because demand is so high, each child is allowed only one hour of computer time every two weeks. It seemed unlikely that this would break the cycle of AIDS and poverty that seemed to be churning so rapidly here.

Back in Soweto, Jonathan and I asked Elizabeth what she knew about NOAH. She said that one of their representatives—a tall white South African woman—had visited Sizanani some months before. After a series of meetings the visitor announced that NOAH would begin funding Sizanani, but in order to obtain the funding Sizanani would have to fire its entire paid staff and all of them, including Elizabeth, would have to reapply for their jobs. NOAH would rehire only six of the twenty-eight staff who worked there. “This is my dream!” she said. “I wasn’t going to let them kick me out!”

Unlike Sizanani, NOAH relies heavily on unpaid volunteers to provide care for needy children. Ash had hoped that these volunteers—“who are unemployed anyway,” he told me—would serve out of a sense of altruism, or “Ubuntu” in African terms. But as Elizabeth and Charles Southwood discovered, this isn’t so easy. Few people in this troubled place want to help AIDS-affected families for free. “They come for a few days,” Charles said of the volunteers. “Maybe a month. Then they realize there’s no salary and then you never see them again. Sometimes you go to visit a sick person and the volunteer will just stand at the door and not go in,” he said.

There’s an old black man who lives on his own. He’s blind and can’t walk. Someone stole his wallet and pension book. Some volunteers were supposed to go and feed him, but then I found last week that no one had been there for three days. Sometimes I think the Zulus think I’m mad. When I blow my top, as I did last week about the old man, they fail to understand what I’m angry about. They just don’t seem to care. They aren’t kind to each other. I don’t know why. I guess poverty disempowers people, makes them mean.

Some families don’t want my help,” a NOAH outreach worker told me. “Some of them swear at me, chase me away. Sometimes they tell the children to tell me they aren’t there. They embarrass me in front of the neighbors, say I am some kind of prostitute.”

When Charles finds committed volunteers, he tries to raise money to pay them from local churches or businesses or simply from people he knows. According to Ash this should have been easy, but Charles hasn’t had much luck. South African businesses may occasionally contribute food or toys that they can’t sell, and they are often keen to donate funds for buildings and computers and other infrastructure projects they can put their names or business logos on, but few will support the salary of a sympathetic human being even if that is what orphans need most of all. “Most of the white people in our country are totally unaware of the situation of poor blacks,” Charles said. “The whites around here avoid me; no one wants to know what I am doing.”

Before I left South Africa, I tried to visit two other NOAH sites in KwaZulu-Natal. According to the list I had been given by NOAH officials in Johannesburg, there should have been two NOAH community groups in a town called Mtubatuba that I happened to be visiting the following week. But when I arrived, I was told by a NOAH coordinator that they were not yet set up. There was not a single volunteer or community worker I could speak to.

In October 2005, UNICEF will launch a campaign to raise millions of dollars for AIDS-affected children. UNICEF, the US government, the World Bank, and many AIDS experts officially recognize the importance of supporting community-based groups like Sizanani. At present, there are far too few of these groups, and most of their funding comes from local sources, often from the poor themselves.15 The South African government supports only four such groups in all of Johannesburg, and there are none at all in many regions of the country. When Jonathan and I visited the UNICEF officer in charge of OVC issues in Pretoria, she said she had not had time to visit Sizanani or any of the other community-based organizations supported by the South African government. In her view, NOAH provided a better model for orphan services, although she showed no close acquaintance with its programs.

She repeated a common criticism of community-based organizations—that they were “unsustainable”—meaning they start with good intentions and then collapse after a while. Maybe she had a point, but it seemed hollow to us. Of course these organizations collapse if no one supports them, or if they are uprooted by larger organizations with millions of dollars at their disposal. As Elizabeth said, referring to NOAH’s takeover bid,

When the Americans come, we sing, we dance, they take our picture, and they go back and show everyone how they are helping the poor black people. But then all they do is hijack our projects and count our children.


The Lost Children of AIDS’: An Exchange December 15, 2005

  1. 12

    See http://land.pwv.gov.za/publications /news/speeches/didiza_telefood_concert _2march02.htm.

  2. 13

    Colin Bundy, The Rise and Fall of the South African Peasantry (University of California Press, 1979).

  3. 14

    See the Department of Agriculture and Environmental Affairs: KwaZulu-Natal Province, http://agriculture.kzn tl.gov.za/dae/index.aspx?ID=4.

  4. 15

    See Geoff Foster, Bottlenecks and Drip-feeds: Channeling Resources to Communities Responding to Orphans and Vulnerable Children in Southern Africa (Save the Children, June 2005).

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