Swaziland stalked by an "alliance of ills"

by John Sparrow in Swaziland
Kaliba is very hot, very dry and very prone to disaster. A small rural community of 2,800 souls in southern Swaziland, it suffers the inter-related ills of poverty and pestilence. So much so that a cholera outbreak there has not caused much of a commotion. In a country ravaged by the combined effect of one of the world's highest prevalence rates for HIV/AIDS and enduring food shortages, people have other preoccupations.

It is no less serious for that. Nurses from the district's Baphalali Swaziland Red Cross clinic, who have dealt with a stream of cases since the end of December, point to the sources: households with no sanitation, water taken directly from dirty rivers and streams, and unhygienic practices. So far, known deaths have been few but for the Red Cross, such outbreaks are a worrying symptom of a wider picture.

Cholera is now endemic in much of Swaziland and, as communities suffer the onslaught of AIDS and food shortages, is one more factor helping to plunge them into a devastating downward spiral.

Poor access to safe water and adequate sanitation is part and parcel of what Renny Nancholas, Coordinator of the International Federation's Southern Africa Food Security Operation, describes as "an alliance of ills" undermining the region at community and household level. HIV/AIDS is the driving force, but deteriorating health care, ineffective agriculture and uncontrolled urbanization also play their part.

His words reflect growing Red Cross concern that in the complex disaster consuming southern Africa, a holistic community approach must be found to address the causes of deprivation. The slide into ever greater poverty only assists the spread of HIV, making people more susceptible to common disease and more vulnerable to disaster.

"The emergency is revolving in ever more vicious circles," Nancholas asserts. "How is it possible to reduce the number of new HIV infections when families in deepest distress and desperation are forced to prostitute their daughters? How can we expect a hungry person living in appalling insanitary conditions to prioritize changes in sexual behaviour?"

Officially some 38.6 per cent of adult Swazis are said to be HIV positive, although reality is likely to be higher. "The future is doomed here," says government nurse Dumsile Nxumalo, 32, who runs a rural clinic in parched country beyond the northwestern town of Pigg's Peak. "Most of the population is infected."

There are other problems. As in southerly Kaliba, diarrhoeal disease is rampant, and for similar reasons. The district the Mangweni clinic covers has an indequate water supply, and the prolonged dry spell ruining another Swazi harvest has left surface water sources ever more shallow and dirty.

Even the clinic takes its water from the nearby river. "We purify it," says Nxumalo, "but ordinary people cannot afford that. They say, 'We always have used the river so what's the problem?' Well, people wash in it, cows drink from it." Undoubtedly human and animal excrement also flows into rivers and streams when it does, occasionally, rain.

"There is just no money for boreholes," the nurse says. "There is one here but the pump was out of order. It was taken away for repair ... sometime last year I believe." It is a familiar story in Swaziland where financial restraint means poor maintenance, breakdowns and the abandonment of water projects.

Farmer James Msimango's family take its water from the river near the clinic. His wife walks five kilometres each way to fetch it because it is the closest source to their homestead. Diarrhoea, though, isn't high on the farmer's agenda. The water he worries about is that which should fall from the sky.

Msimango is not poor by local standards but like everyone around him he is deep in trouble. Farmstead grain stores are empty and the fields, normally harvested in April and May, look like producing next to nothing in this corner of the country.

There has been rain but, brief and sporadic, it has failed to support the crops. Much of the maize, promising at first, has burned in the sun, and the beans and the groundnuts have failed. Supported by the Federation's Southern Africa Food Security Operation, the Swaziland Red Cross has distributed bean and cowpea seeds, and fertiliser, but either the farmers have planted in vain or they are waiting for rain.

James Msimango is waiting. He planted his maize in December, lost it to the sun, and isn't risking the Red Cross stock. If he has to he will wait until the next planting season which would normally begin in October, selling a cow from time to time to buy food and medicine, and to pay for his children's schooling.

He is one of the fortunate. Most people have no animals and a third of the population relies entirely on food aid. The country has food but, having increased in price by 70 to 80 per cent over a one-year period, few are able to afford it. In a second consecutive year of poor yields, some 66 per cent of the population are now thought to live below the poverty line.

Some farmers sell cows to survive, a loss of precious resources. Others have begun growing sugar cane, a cash crop they say is hardier, but which can further depress food production. Eighty per cent of the population normally depends on the food they grow and already AIDS deaths have dramatically reduced the nation's output. Half the land is idle on some farms where the disease has hit those who should work it.

Swaziland doesn't need cholera.