Ten-year-old Stuart flits across the worn wooden plank linking the trench surrounding his family’s modest compound with the outside world. He halts briefly, before continuing running and jumping across the bumpy arid landscape, entertaining himself – an imaginary adventure only he understands.
From the doorway of her cramped two-roomed bungalow in Kampala’s Katwe district, Christina watches her grandson play, red dust swirling in his wake.
The 74- year-old shifts gingerly from her vantage point, casting an eye over the thin mattress on the floor at the foot of her chair. She wants to pick up a plastic bag a few feet away but can’t reach and calls Stuart. He rummages in the bag, producing an X-ray, holding it up to the light. Everyone in the room winces.
The bone is snapped, a clean break. It’s the reason Christina now spends her days shifting from mattress to chair and back again. She thinks the bone will never heal. She couldn’t afford the appropriate medical aftercare. She has 30 orphans to care for after all.
In Uganda, Christina and her husband Poe are not unique in this regard. The vast majority of people who die of Aids-related illnesses are able-bodied adults of childbearing age who leave behind children, often suffering the effects of the virus themselves, in the care of elderly relatives.
They die at a stage when ordinarily they would care for their children and parents, leaving the most vulnerable to depend on each other for survival.
Christina has lost seven adult children to the virus, over a period of time as long as the epidemic has battered Uganda itself.
When her first child got sick it was 1979 and the virus was new and largely unknown in the country dubbed the pearl of Africa by Winston Churchill. Their adult daughter was suffering so much that they could find no explanation other than witchcraft for what had befallen her.
They took her to hospital where shortly before she died she tested positive for HIV.
Over the following years, six more of Christina and Poe’s children displayed similar symptoms. Each time they took them to the hospital. Each time they tested positive, and each one died.
Following their deaths a new problem presented itself, the young children they had left behind. Six of Christina’s seven children had children of their own and, given that the average Ugandan woman has 5.8 children, it is no surprise the elderly grandmother was left with a large number of orphans to care for.
Breadwinning generation
The UN's humanitarian organisation for children, Unicef, estimates that families with elderly relatives experience poverty rates up to 29% per cent above average. In households robbed of the breadwinning generation by Aids, poverty is rampant.
Orphaned children living with elderly grandparents are significantly less likely to receive an education and only some of Christina’s grandchildren go to school.
The Ugandan government, with support from Ireland’s aid programme, Irish Aid, is attempting to tackle this issue.
A senior citizen’s grant offers a modest income to Uganda’s elderly population, providing them with a reliable means of support, though some consider the payment too small to promote any significant change
The payment of 50,000 Ugandan shillings, the equivalent of €13.34, is made every second month and was introduced in 2011. In 2016 there were 125,000 direct recipients of the grant with an estimated 610,000 family members benefitting from its implementation. The qualification age for the pension is 65, except in the country's most poverty stricken region of Karamoja, in the northeast, where it is 60.
"The evidence is showing that increasingly people are using that modest enough payment by way of education support [and] caring for orphans," says Frank Kirwan, head of co-operation at the Irish embassy in Kampala. In a number of cases the children concerned are orphaned because of HIV and Aids, he adds.
Elsewhere in the capital, HIV-positive 22-year-old Herman says his grandmother was the only thing that stood between life and death after his father died when he was eight.
He recalls that his grandmother told his uncle that Herman needed healthcare because he was HIV positive. “One of my uncles told her, ‘That one? Don’t bother, that one is going to die. Why are you wasting your time on him? You leave him,’” Herman says.
The memory of that pains him sometimes, he adds . “But my grandmum never lost hope”.
Extreme poverty
As is the case anywhere else, however, familial support is not universal. Extreme poverty changes attitudes and strains relationships.
In Karamoja life is tough. Extreme heat dehydrates the land and, coupled with occasional flooding, makes food production extremely difficult.
Sr Maria Eugenia, a Spanish Sacred Heart nun, has established a care centre there for families affected by HIV/Aids.
When she came to the region she heard that African children were “never orphans”, because of the extended family networks, but she subsequently realised that the truth was more complex, she says.
Life in Karamoja sees many orphaned children forced to work harder than biological children, and in many cases they receive less food.
“The uncles and aunties and the grandparents are there and they care,” Sr Maria says. “It is true that the family situations are not really good but it’s not easy, it’s a challenge for these orphans.”
Back in Kampala, Christina rests inside on her armchair while Poe sits outside, slouched forward on a rickety wooden chair, his weight supported on a wizened stick pressed into the ground in front of him.
During the day their compound is largely deserted. The children go to pray or help cook food if there is any available – HIV is just one problem they face, the prospect of starvation is another. Twelve of the 30 children are HIV positive.
“You should see this place during the night,” translator and local community worker Wilson says. “The floor is covered with children everywhere.” A last glance back at the compound reveals some of Stuart’s siblings have joined in his game. Their future remains uncertain but at least for now they have a roof over their head and a family to care for them.
– First article in a series of three. Tomorrow: The fight against HIV/Aids in rural Karamoja
– This article was supported by a grant from the Simon Cumbers Media Fund student scheme
