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Number 179 - December 2017
At this time of year, celebrating Christmas is a reminder of God’s coming among us as a human person. The mystery of the Incarnation is a special source of inspiration for Medical Missionaries of Mary, who are committed to bringing God’s hope and healing to others. May we dedicate ourselves anew to bringing about the kind of world that Jesus dreamed of creating: one of peace, love, equality and justice for all.
A number of special themes are highlighted in December. They remind us that while progress has been made in areas such securing rights for the disabled and bringing about an end to HIV, gender-based violence and human slavery, much more needs to be done.
World AIDS Day is marked on 1 December. At the United Nations (UN) Sustainable Development Summit in September 2015, more than 150 world leaders adopted the Sustainable Development Goals (SDGs). In Goal 3, Member States committed to ending the HIV, tuberculosis and malaria epidemics by 2030. Despite recent improved access to antiretroviral treatment (ART)in many regions of the world, HIV remains a major public health issue.
UNAIDS works towards preventing new HIV infections, ensuring that everyone living with HIV has access to treatment, and protecting and promoting human rights. Its website, including the Fact sheet: Latest statistics on the status of the AIDS epidemic, states that globally in 2016: • 36.7 million people were living with HIV, including 2.1 million children under 15 years; 19.4 million of these were in eastern and southern Africa. • 19.5 million people living with HIV were on ART, up from 17.1 million in 2015; about 76% of pregnant women living with HIV had access to ART to prevent transmission of HIV to their babies. • 1.8 million people were newly infected with HIV, with eastern and southern Africa accounting for 43% of the total. • 1 million deaths occurred from AIDS-related illnesses; approximately 420,000 of these were in eastern and southern Africa.
Tuberculosis remains the leading cause of death among people with HIV, accounting for about one-third of AIDS-related deaths. Nevertheless, the impact of increased testing and treatment availability was shown when on 20 July 2017, UNAIDS announced that AIDS-related deaths worldwide had halved since 2005.
This year’s World AIDS Day campaign focuses on the right to health. The World Health Organization defines this as: ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.’ It includes the right to the prevention and treatment of ill health, to make decisions about one’s own health and to be treated with respect and dignity and without discrimination. Health is also dependent on adequate sanitation and housing, nutritious food, healthy working conditions and access to justice.
Access to justice is essential to fulfilling our right to health in the wider context, ensuring, for example, the right to a clean environment, the right to be free from violence and the right to education.
Ending HIV, and indeed other major public health threats, can only happen if all these rights are addressed as part of global health. Almost all of the Sustainable Development Goals are linked to health in some way.
On 2 December, International Day for the Abolition of Slavery keeps before us the disturbing realities of present-day slavery. It focuses on eradicating evils ‘such as trafficking in persons, sexual exploitation, the worst forms of child labour, forced marriage, and the forced recruitment of children for use in armed conflict’ (UN website).
The Thomson Reuters Foundation called attention to a resolution unanimously approved by the United Nations Security Council on November 21 that urged ‘tougher action to crack down on human trafficking and modern slavery worldwide’. The resolution called on countries ‘to adopt anti-trafficking laws, ramp up efforts to investigate and dismantle criminal networks and provide greater support for survivors of slavery.’
Emphasizing that trafficking is not just a crime, but also a development issue, the Foundation quoted UN Secretary-General Antonio Guterres as saying, ‘Preventing the situations that lead to trafficking means addressing poverty and exclusion in line with the 2030 Agenda for Sustainable Development.’
At any given time in 2016, an estimated 40.3 million people were in modern slavery, including 24.9 million in forced labour. Of the latter, 4.8 million were in forced sexual exploitation. Women and girls are disproportionately affected by forced labour, accounting for 99% of victims in the commercial sex industry; 1 in 4 victims of modern slavery are children. (Global Estimates of Modern Slavery: Forced Labour and Forced Marriage, Geneva, September 2017)
International Day of Disabled Persons is marked on 3 December. According to the UN website, the SDGs explicitly include issues involving disability and persons with disabilities. As part of ensuring their inclusion and development, they are mentioned in areas related to education, growth and employment, inequality, and accessibility of human settlements.
A day with an overarching theme including all the issues mentioned above, Human Rights Day, occurs on 10 December. It celebrates the day in 1948 that the United Nations General Assembly adopted the Universal Declaration of Human Rights. The UN website reminds us that this landmark document proclaimed the inalienable rights to which everyone is entitled as a human being, regardless of race, colour, religion, sex, language, political or other opinion, national or social origin, property, birth or other status. The Declaration is the most translated document in the world, available in more than 500 languages.
In this newsletter, you can read how MMMs deal with the reality of the HIV epidemic in Malawi. Others reach out in compassion to women caught in human trafficking in the USA. In Honduras, mindfulness exercises help young people to cope with the violence that surrounds them in their daily lives.
Thank you for supporting us in these challenging ministries. We remember you daily in prayer and wish you peace and joy at Christmas. Please pray for us, too.
Sister Carol Breslin, MMM
‘May the risen Lord break down the walls of hostility that today divide brothers and sisters....May he comfort those women who are the victims of violence in war zones and throughout the world. May he protect children who suffer from conflicts in which they have no part, but which rob them of their childhood and at times of life itself....May God sustain all those who day by day strive to combat evil with good, and with words and deeds of fraternity, respect, encounter and solidarity’ (Pope Francis,Vatican Radio, 23 November 2017).
The Reality of HIV in Kasina
Sister Cecily Bourdillon grew up in Zimbabwe. Trained as a physician, she has been based in Malawi for many years. Her current ministry in Kasina has made her acutely aware of the advances that have been made as well as the challenges faced by people and their families affected by HIV. In December 2016, NAM, a leading source of independent, accurate information on HIV/AIDS, stated that HIV prevalence in Malawi had changed little since national surveys carried out in 2010. Current prevalence is 10.6%, or about 900,000 people living with HIV.
Cecily said that when MMMs first came to Kasina Health Centre in 2005, antiretroviral therapy (ART) for treating HIV was not available to the community. People were dying from AIDS; the wards were filled with patients suffering from opportunistic infections and children were being born with HIV.
The country now has an excellent and well monitored HIV/AIDS programme and Kasina is a recognized ART site. In 2009, HIV counselling and testing was initiated and ART was introduced in 2011. TB control and treatment has always been a part of the national HIV/AIDS programme. Now, with the rise of drug resistant TB, a more intensive strategy has been launched.
Meeting global targets The UNAIDS website notes that in December 2013, its Programme Coordinating Board called for new global targets to scale-up HIV treatment beyond 2015. Ambitious but achievable goals were set to help end the HIV epidemic: • By 2020, 90% of all people living with HIV will know their HIV status. • By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy. • By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression (a viral load < 1000 copies per ml).
While results may differ somewhat according to the criteria and methods used for calculation, significant advances have been made in reaching these goals.
On 12 Dec 2016, NAM highlighted the progress made by Malawi. It quoted the results of national surveys released the previous week by ICAP at Columbia University, USA, showing that: • 72.7% of the population estimated to be infected with HIV were aware of their HIV status – 66.7% of men and 76.3% of women. • 88.6% of those diagnosed were on treatment – 86% of men and 90% of women • 90.8% of those on treatment had viral suppression – 87.9% of men and 92.3% of women
Further analysis according to gender revealed that not only was viral suppression higher in women than in men, it was also higher in women across all age groups. Of special concern was the result that of those tested in the 25-29 age group, three women are living with HIV for every man.
Achievement of the first of the '90-90-90' goals has not been possible partly because some of the population, mainly men, are still reluctant to be tested. This is reflected in the results above and is also Doctor Cecily's experience. She noted that men may be afraid to determine their status, suspecting that because of risk-taking behaviour they are probably HIV positive. Women are then at greater danger of being infected. Many women experience opposition when they suggest that their husbands or partners go for HIV testing.
Challenges remain Cecily said that the majority of the 570 people living with HIV in Kasina are now strong, working, and looking well, with an expected normal life span. Nevertheless, some die from AIDS and some suffer continued illness, needing constant care. Others suffer from the effects of treatment failure. In the last situation the antiretrovirals (ARVs) the patients have been taking for more than one year no longer control the infection and their viral load rises. They then show signs of AIDS.
She pointed out that the main cause of treatment failure is defaulting: patients stop taking their ARVs daily. The main challenge for people living with HIV is that they must take treatment for the rest of their lives. They must attend clinics regularly - one, two or three-monthly depending on their progress - to receive their medications. Some must travel great distances and often the bicycle is the only means of transport. The roads in rural areas, including Kasina, are poor and become almost impassable in the rainy season.
Pregnant women have another challenge. A mother might attend the antenatal clinic and discover she is HIV positive. She starts on ARVs but might have difficulty staying on treatment. Her husband does not know her status. She is afraid to tell him - afraid, too, that he might see the medicines. So she stops coming for them. This was addressed by requesting women to come with their husbands on the first visit so they could be tested together. If, as often happens, the husband refuses to come for testing, a woman might invite the rider who brought her to the clinic on the motorbike to stand in!
Many children living with HIV were orphans. Their mothers passed the virus to them during pregnancy or childbirth and then died from AIDS. Many guardians, often elderly grandmothers, either did not bring the children to the clinic for follow-up or did not give the children their medicines at home. As a result, many children had rising viral loads. Kasina Health Centre then started special clinics called Teens' Clubs on Saturdays for children going to school. Parents or guardians were requested to accompany the children.
The adults are given input on the importance of strict adherence to treatment. The children learn about their illness and treatment and are helped with life skills. They have time to play, to interact, to enjoy a good meal, and receive their medicines. This innovation has resulted in low viral loads and a great improvement in the children's condition. However, they need constant encouragement to take their treatment every day and they are expected to attend clinics monthly in all kinds of weather!
Another reason for some not attending for treatment is denial in the face of a positive HIV test. The person may take treatment irregularly or not at all.
Stigmatization is still a problem. Sometimes clients are prepared to travel long distances to treatment sites where they are not known. They do not disclose their status to spouses and partners, who are then unknowingly exposed to HIV infection. Yet when Kasina first began testing, some were disappointed that they were not positive because they lost out on the benefits available to those with HIV. Those benefits are not so readily available now.
Support groups have been formed in the villages for those living with HIV. They meet together, share their problems, and above all, and encourage each other to take their ARVs regularly.
The challenges of living with HIV are best illustrated by the stories of those affected. Cecily told us about Chisomo.
Chisomo’s story 'Chisomo (not her real name) first came to Kasina Health Centre with severe facial burns resulting from falling into a fire during an epileptic fit. She received much treatment from the referral hospital, including eye surgery and medicines for her epilepsy. She discovered that she was HIV positive during her first pregnancy. She then had a second child.
Her challenges were many: having to attend the monthly clinic to receive ARVs and treatment for epilepsy; coping with a husband who seemed careless about taking his own ARVs and who depended upon her for his food; caring for her children; having to beg and search for food, some of which was taken to feed other family members; and the control of severe epilepsy, which still occurs even though she is taking many pills.
'Chisomo knows all about the medicines she is prescribed and takes them diligently. She works on the land but sells her maize and then begs for more to feed her family. She certainly knows the importance of adherence to treatment. Her children are HIV negative. She also is aware of her right to basic needs and is not afraid to fight for them. Her children are plump and healthy – a sign that they receive the care and love that they deserve from their mother. Chisomo is a woman who has gallantly fought the battle against HIV, epilepsy and other adversities.'
An ongoing struggle Sister Cecily wrote, 'We can see that even though great progress has been made in the fight against HIV in Malawi, the challenges for those infected are many and great. The greatest challenge to the eradication of HIV infection may be the attitude of acceptance of HIV as part of life, with effective treatment available. So there is little effort to change behaviour and actively work to prevent its spread. There is still much work to be done!'
Bakhita House: A Place Where Love Heals
International Day for the Abolition of Slavery on December 2 is integrally linked with International Day for the Elimination of Violence against Women, highlighted in our November 2017 MMM e-newsletter. In his Message for Peace in 2017, Pope Francis pleaded with urgency ‘for an end to domestic violence and to the abuse of women and children.’ Many of the same issues are involved in discussing human trafficking and gender-based violence.
It is important to point out that many men and boys are also the victims of gender-based violence, especially in conflict situations. So all of these cruel acts involve human rights violations. Raising awareness about these realities is part of the wider subject of human rights.
Nevertheless, the WHO website points out that: • Violence against women is a consequence of discrimination against women, in law and also in practice, and of persisting inequalities between men and women. • Violence against women impacts on, and impedes, progress in many areas, including poverty eradication, combating HIV/AIDS, and peace and security. • Violence against women and girls is not inevitable. Prevention is possible and essential. • Violence against women continues to be a global pandemic.
It also says that resources for initiatives to prevent and end violence against women and girls are severely lacking. The Sustainable Development Goals include a specific target on ending violence against women and girls, but must be adequately funded in order to bring real and significant changes in the lives of women and girls.
‘Just as you did it to the least of these...’ (Mt 25:40 NRSV) In 2014, Sister Kay Lawlor contributed an article to our MMM yearbook, Healing and Development. She had returned to the USA about a year previously after many years working overseas. She was adjusting to her new surroundings in Malden, part of greater Boston, MA, and had been searching for a ministry that would utilize her experience. She observed: ‘As has often happened in my MMM life, a new ministry found me!’
Kay met one of the Sisters running Bakhita House, a safe house for trafficked women and was invited to become a volunteer. While she had become aware of the problem of trafficking while in Kenya, she ‘naively thought it was mainly an international problem and one for developing countries. I had no idea of the scope of the problem in my own country. It is shocking!’ Almost all of the women who come to Bakhita House having been sexually exploited are from the New England area.
Over the past three years, Kay’s role has changed and developed. In 2016, she was asked to join the staff. She recently provided an update on this challenging work, which she says ‘has been a privilege and a real gift.'
Bakhita House ‘In 2001, the International Union of Superiors General Conference made a commitment to become involved in the issue of human trafficking. It was necessary for Sisters to be educated about trafficking and then to move to involvement. The Boston Unit of the Leadership Conference of Women Religious (LCWR) took the decision to set up a safe house. After a pilot project, Bakhita House was established. It is named for Saint Josephine Bakhita, a Sudanese-born former slave who became a Canossian Religious Sister in Italy and who is the patron of victims of human trafficking. It is a transition residence for women who have taken the initial steps to “leave the life”, as it is called.
‘The house is staffed by a team of four sisters: two Sisters of Charity of Halifax, one Sister of Notre Dame de Namur and one Medical Missionary of Mary. Congregations (members of LCWR) pledged funds to keep the house running and donations are added to this. Sisters on the staff are volunteers and we have supervision monthly. There is always a staff member present in the house whenever a guest is there. If necessary, volunteers are asked to relieve. The rules of the house protect the women, who are so vulnerable.
‘Perhaps the best way to explain what Bakhita House (BH) is and does is by sharing the stories of some of the women.’
Marcia’s story ‘Marcia (not her real name) came to BH from a local woman’s prison. She had been introduced by her family to prostitution when she was thirteen. She is currently twenty-five. She was often homeless whenever she ran away from her pimp. Beatings were common. Despite this she repeatedly returned to her pimp because she “loved him”. No one else held her or gave her gifts. She is presently being asked to testify against him and it is very hard for her.
‘She has a genetic auto-immune disease and has multiple health issues with it. Because of her prison record she has trouble getting good-paying employment and her poor impulse control makes it hard to keep a job. She left BH twice and was taken back. During one of these episodes we got a text from her saying she was scared. We found her at a local motel where she had forced a “client” to leave. She had found him on Craig’s List on the Internet and he wanted her to use drugs before sex. We got her safely back to BH. She is now being helped to live independently. It’s up and down. She keeps trying despite the obstacles that the system puts in her way. Temptation is great to return to “the life”.’
Maggie’s story ‘Maggie (not her real name) was referred to BH from a drug rehab program in northern New England. She was ready for discharge following treatment for opioid addiction. She had been introduced to the prescription drug by her sister. She had been in an abusive relationship with her “boyfriend” and ended up being forced into prostitution by him. She was often beaten. She stayed for several months at BH, during which time she received medical care for various infections, psychiatric care and counseling. Relationships with staff helped her to begin rebuilding some self esteem. She was able to get work and held a job as a waitress, getting good tips. She is now living independently, has a boyfriend she is learning to trust and is on the way to recovery. We keep in touch with her, encouraging each small step. She remains drug free six months after leaving Bakhita House.'
Part of the bigger picture ‘The stories go on. About fifty women have spent time at BH. Some are now doing very well and some are struggling to keep going. Some women take a step forward and often revert to previous behavior. They are wounded and many have post traumatic stress disorder. Drugs are a big problem and it takes a lot of courage and strength to stay on track and not go back to “the life”. As one woman said, “All I can get is less than minimum wage work. Prostitution is much better paid.”
‘We continue to send healing love to them and pray for them daily. Join us.
‘It has been humbling to live with these women, to hear their stories and accompany them on their journey toward healing. At times we cry; at other times we want to scream in anger at a society that has such low regard for women and a system that seems to be stacked against them. They touch our hearts and souls; they show us the power love has to break through the armor of trauma.’
‘I feel peaceful.’
Sister Danielle Darbro, from the USA, related how using stress-reducing exercises and meditation has provided a space for healing for young people in Choloma, Honduras.
‘We have been using meditation as a part of our Capacitar exercises to help relieve stress and bring holistic healing to our PIRE students. PIRE stands for Integrated Education Reinforcement Program. All our children come from poor communities and challenging situations. They live in an environment plagued by gang violence and corruption, and homes where domestic violence, abuse, and poor nutrition are common realities. The stress of their daily lives affects their ability to learn in school and their behavior. In our program, we strive to respond to the needs of our students and their families, using an integrated healing approach for mind, body and spirit. Meditation time is vital for this process and we had a special opportunity to begin because we had just completed our new chapel at Casa Visitación.
‘Forty students from first to sixth grade levels participate in an integrated tutoring program. All the children have been identified by their school teachers as having special needs. Some are struggling to keep up academically, while others have behavioral issues that make it difficult for them to focus at school. The classes are made up of just a few students so we can give them individualized attention.
‘The PIRE team includes Roger, who teaches Spanish and math; Sandra, a psychologist, who provides assessment and counseling services; and me. I teach human rights and Capacitar.'
A balanced day ‘Our classes meet in the morning at Casa Visitación, beginning with math and Spanish lessons. Then there is a recess time, which includes a nutritious snack. We come together after the break for meditation. Afterwards we often have a game or other exercise before starting the human rights lesson.
‘We have the meditation in our chapel each day from Monday through Thursday. At first I wondered if the children would like it, or if the giggles and the distractions would overtake our brief moments of silence together. Because the children range in age from seven to thirteen, the giggles and the distractions do come into play. Still, it was a surprise to me just how often the children seemed to naturally "tune in" to the silence within.
'I give a very brief input beforehand about the value of silence, of receptive listening to God, and a few tools to help us focus. We talk about how distractions are normal, and how when a thought comes along, we can choose to not chase after it or resist it, but merely to let it pass by like a leaf on a river. We talk about focusing on the breath, returning to our breath in each moment, and valuing the sacred moment of now.
‘I notice the changes in the students after we complete our meditation and move on to our human rights lesson. They seem to be more relaxed, alert, and more able to focus in class. Their social skills have improved. I see them being more patient with one another, giving each other space to speak, and demonstrating better ability to share their crayons.
‘"I feel peaceful." "There is nothing ugly.” "I don´t have any worries." "Nothing bad happens there." "God is there." These are some of the responses I hear from the PIRE students when I ask them how they feel about our meditation time. Their honest and direct way of speaking says much to me about their innate ability to connect with God through the silence within them.'
Signs of healing ‘Witnessing the students connect with their inner source is a pleasure for me. I imagine what these children´s lives could look like in the future if they continued to take a few moments each day to re-center themselves and if they allowed this sacred space to influence their daily life choices.
‘I am reminded of a quote from the Dalai Lama: "If every eight-year-old in the world is taught meditation, we will eliminate violence from the world within one generation."
‘From what I have seen from our PIRE students, I believe the Dalai Lama is right.’
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