Well, how should I start this witness? Words fail me to describe the whirlwind of emotions I felt, and the homesickness that is already pervading my heart. I waited days and even weeks to start writing this witness, at times out of fear, at times out of nostalgia. Each day I spend away from that land, I feel pain, but above all I feel homesick. It is something that come over me without asking to be allowed in, and determines how I feel, up to the point of dictating my dreams when I go to bed. I can’t describe what I lived, shared, loved, and above all what I have received. I loved and still love these folks as if they were family. Sincerely, how could I not? I was adopted and cuddled by all those who crossed my path, even though we were not speaking the same language, but this did not stand in the way of constant signs of love. In one of the visits to the barrio near the mission house I met a woman who immediately invited me to “mata-bichar” (have breakfast with them. When I realized it, I was surrounded by people who were watching me with great kindness trying to teach me their customs. My heart was shaken daily by the hospitality and love I felt, and by how we looked at one another and embraced with passion. I was at home.
I feel and think as I did when I stepped on that land for the first time and I cannot hold back my tears. The excitement to start, to know, to be, to help was such that the following Monday, two days after our arrival, I showed up to work at the ITIC. The night before I had hardly slept because of fear. I was wondering whether I would be able to deal with the kids who would show up in the infirmary to ask for help, whether all that I learned at the university would actually work, and whether I could adapt to the means at hand. There were many “Ifs,” insecurities, but of one thing I was sure, that I would give the best of myself from morning to evening.
I organized papers, reorganized the prescriptions shelves, but above all I dealt with the students in all their needs. I gave myself without fear, I remained after hours in that cubicle within those four walls, and filled my heart. I was always surprised when the students would look for me just to say Hi, to “give me a happy day,” as they would say.
The way I connected with those boys was indescribable, as if with a simple gaze we had established a pact of mutual protection. I felt intensely the illnesses and worries of each one, and dealt with each one as if they were the only ones, with all the love I could hold in my breast. Many times, when some of them were sick and had to sleep in the infirmary, it cost me to go home. I couldn’t think of anything else except of ways to make them get better rapidly. Very often I spent afternoons with them, playing games on the cold floor of the infirmary, taking their temperature every 30 minutes, or simply watching them sleep.
Some days were easier than others, but all of them were a constant challenge. Each day He helped me survive and realize that our obstacles only exist in our head. Very often I felt disoriented and knelt before Him, and He spoke to my heart showing me how he would overcome my difficulties.
One of the many situations I lived was the first time I saw the faces of those girls I was going to help in their studies. Each gaze entered my heart so intensely that I will never forget them. They were trying to learn by themselves, without books or anyone explaining things. They were motivated by an indescribable interior strength for wanting to be more, to reach a better future. Each one carried in her eyes stories and experiences that I will never forget, but always with a contagious joy and love.
I had the opportunity to help in the community clinic and there I understood that I belong to those people. I went for too much time avoiding to confront the health situation of the Makua and the pain it would give me. But in the end I rolled up my sleeves and went. I simply went. I covered all the branches, from the HIV patients, to the women patients with still undisclosed diseases, the maternity, the pediatric ward, ending with the TB department. I knew I was placing my health at risk, but I was sure of one thing, He was watching over me, and so I would not let this fear interfere with my helping people.
Endless lines would form at the entrance of the center, the screams of the children filled the corridors, and everyone awaited their turn. At times, language was a barrier in explaining how to take a prescription and the care that was needed, but I always made an effort to convey the message. I thank God who gave me strength daily in order to be able to help those people in need, and because a feeling of powerlessness never took over me.
With each passing day, the ties were growing stronger and my anxiety about returning home was constant. I knew that my place was there, that I belonged to them. This is the family God chose for my mission. And I loved them more every day, so that it was impossible to say good-bye without promising that I would return. With all my heart I am grateful for how they received me and for the love they gave me.
The best of this mission was not only the people I met, the smiles I saw, and the tears I shed, but also how God took over my heart daily without my knowing it. The need to talk daily with Him, was an intrinsic part of my routine, and the kind way He answered me was beyond description. I am sure that, without Him, I could not put up with my weaknesses or avoid my anxieties. How beautiful it was to discover God in this way!
The Comboni Missionary from Burgos, Jesús Ruiz Molina, was ordained on November 12, 2017 auxiliary bishop of Bangassou in the Central African Republic (CAR). The celebration took place in Bngui, because his own place can only be reached by helicopter. In fact, the political authorities and other guests did not want to be taken to Bangassou, due to the state of insecurity prevailing in the region. After passing through Chad and for the CAR’s city of Mongoumba, Jesús Molina has accepted to be assigned to a place which is afflicted by an endless guerrilla in order to work with Bishop Juan José Aguirre Muñoz, another Spanish Comboni Missionary, in trying to find ways to peace and reconciliation and to serve the poor.
After 25 years in Africa, they make you a bishop…
It was a cold shower, practical icy, because I neither feel worthy nor find it humanly attractive. By the end of this year I was planning to return to Spain and work in vocation promotion and in Justice & Peace while, at the same time, be with my aging parents and rejuvenate myself in all fields. Trusting in God I said yes and this has completely changed my life, which is already tied to this people to the end in a sacramental way.
Is Bangassou the most complicated place in which you have been?
I spent 15 years in the savannah of Chad in a difficult environment with famines and wars. I spent my last nine years in the forest with the pygmies and with extremely poor people. Currently, Bangassou is one of the most conflicted areas of Africa. You can only get there by air. The 12 parishes we have there have been looted by the 14 armed groups who are fighting to dominate the country. Violence and massacres are a daily affair. The majority of the population is displaced. The majority of the priests and of the sisters have fled. In the cathedral we haven’t said Mass for four months because we have been housing 2,100 Muslim refugees that the anti-balaka want to kill. No State employee wants to come here. This is why we decided to celebrate my ordination in Bangui. My people of Bangassou will not be able to attend, but on December 8 we will celebrate a Mass of thanksgiving to celebrate the fact that God does not abandon us in our sorrow.
What do you think the mission of a bishop must be in a place like Bangassou and yours in particular?
I have no preconceived plans. I am going in order to stand with people who suffer. For me, to be a bishop is not a promotion, but rather trust in the One I love who is inviting me to follow him on the journey to Jerusalem: “Come, follow me.” I never studied to become bishop, so people will have to teach me. The bishop is the shepherd who, when the wolf comes, does not abandon his flock, but watches over all, both those who are outside and those who are inside, who denounces the death brought by injustice and proclaims salvation which is life in Jesus Christ. Today in Bangassou we need peace, a lot of peace in order to heal the many bodily wounds and, above all, those of the spirit. We need reconciliation and forgiveness. We need to build together a future for this traumatized population. We will keep it up for them making an effort to keep the schools going, to cure the sick, to care for the poorest and most abandoned, standing by the weakest, working for justice, the only way to true peace, and through it all we will continue to proclaim the Good News of Jesus, who came that we may have life and have it in abundance. Today, this life has been snatched from my people.
You have Juanjo Aguirre and Card. Nzapalainga as points of reference…
There is no doubt that we keep Aguirre and Card. Nzapalainga as points of reference who daily give flesh to the Gospel, they give me breath and stimulation, the novice that I am. But there are many other teachers as well who stimulate me, from the sisters working from morning to dusk surrounded by enormous amounts of violence, to the priests who risk their lives to save a few. The Christians who live by mercy on a daily basis… The people of God is the greatest source of stimulation for a shepherd, they teach us to be shepherds.
You have always been with the poor. Is this your preferential option?
This preferential option for the last, those who do not count, the discarded as the Pope says, comes from Jesus of Nazareth. Jesus showed us and impartial God who leans freely and lovingly towards those whom the world despises. Being the unsatisfied searcher that I am, curiously I discovered that it is in those who are despised by the world that we find the true face of God. The poor, the humble, the hungry, those who cry, the persecuted, those who cry for justice… they are the Bible in the flesh. I was given this great treasure of being able to serve them a little, and I am happy to be the one who greatly benefits from it, because it is the poor who give me God.
As a Comboni Missionary your ties to Africa are very strong. Is it still the forgotten continent in our time?
In the economic organism of the world Africa does not count. The terrible attack in Barcelona was world news, while the hundreds of people murdered in my diocese on that same day did not deserve one line in the press. An underhanded neocolonialism is taking over Africa today. The world’s powers unscrupulously fight over its riches causing wars, destroying cultures, exterminating entire populations… But Africa is life with capital L. The origin of humankind is in Africa and I dare to say that its future passes through Africa.
It was a dream that turned into reality! It all started the first time I listened to the witness of a missionary priest and I marveled at the intensity of his love lived and shared. I was an adolescent and at that time my great wish to be able to love like that was born.
Time went by and I almost saw the dream disappear into my routines, responsibilities and job. But God knows what he is doing and could not possibly let such a rich dream die. He was able to lead me along the right path, on the journey of Faith and Mission that helped me grow closer to him, to know myself more deeply and to realize that I was called to do something more. So that, with a million fears and desires he wanted me to go even farther and lived this month where I could learn and savor a bit of the missionary life.
After the preparation, the gathering of funds and the good-byes, I only accepted that it was real when I saw myself in Nampula. So I got off the plane, picked up my camera to take some pictures and a security guard stopped me. There I discovered that this was not the world I had grown in and to which I was used.
On the journey to Carapira, I realized that I was living a different life. On the paved road, without painted lines and stretched to infinity I had the chance to see the reality of living in Mozambique. From the window I could see the scenery along the way, the little markets where they were selling a bit of everything, many women with their babies on their back and others carrying buckets of water or other things on their head. The red soil, the local trees and the infinite plain with some mountains in the distance completed the scenery. In some areas you could see straw huts and inhabited areas.
We arrived in Carapira and the warm welcome reminded me of my familiar world. The place was rather similar to what I had been imagining.
The first days gave me the opportunity to get to know the place where we would spend most of our time, the houses of the different branches of the Comboni family, and the work they were all doing. Tasks were assigned to the entire Faith and Mission community, mostly related to the Technical Commercial Institute (TCI) of Carapira and with the girls at the Comboni sisters’ boarding school.
We developed our assignments during the course of the month adapting them to the local rhythm of life. Time is relative and there is no hurry, always finding time for a chat whenever we were going from one place to another.
Every day we took part in lauds and vespers held in church together with the Comboni community. At first it was not easy to wake up so early for lauds, but as I entered into the rhythm of life I rarely missed any of the prayers. It was a time to stop and join Him and remember all the reasons that had brought me there.
Besides the tasks initially assigned, I had the opportunity to visit a community outside Carapira together with Sr. Eleonora. There I had the chance to “inculturate” myself by eating with the community. I also said the rosary in Makua in a barrio of Carapira and to accompany Sr. Maria José on her visits to the sick. These times gave me the opportunity to get to know a bit the customs and the life of the Makua. They were always happy to hear us use their language, as little as it was.
Marvels happened as time moved on. And each day had a special touch that made me enjoy being there where nothing else mattered. Even though I missed Portugal, the desire to stay was growing with every passing day.
Slowly I was learning more and more, especially with the girls at the boarding. From the first time I met them I was captivated by their smiles, songs and contagious joy. My heart was always full when I was with them! They endeared themselves to me with their simplicity and, even though my job was to teach them and help them in their studies, I felt that I learned from them even more. They were teaching me Makua words and always had a good laugh when I tried to pronounce them.
When I already was feeling my heart warmed by so much love and I thought it could not get any better, there appeared a little one who wanted to talk to me alone. I confess that I harbored many thoughts and some fears, together with much curiosity. What does she want to tell me? Finally the proper time arrived and the question was very simple and expressed very sweetly: “Would you like to be my friend?” I was unable to react and was speechless. I was not expecting such a small question but loaded with so much feeling. I hugged her and told her that we were already friends without having to ask for it. But this little heart was going to surprise me even more. Even after I tried not to accept it, she came with a gift for me. I know that we have a lot and they have little. How was it possible? It was a small notebook with something she, herself, had written. During the month, the little attentions of this child moved me in a very special manner, turning upside down also my world and my way of thinking about love. After all, it is so simple!
All this helped me see life in a simpler way, stopping to value some of the things I have and reflecting over this love almost wordless but very communicative. This is how God took me into the desert and spoke to my heart…
There can be no keener revelation of a society’s soul than the way in which it treats its children (Nelson Mandela). This quotation is a wakeup call for the importance we need to attach to children and the young people in the various work that we do including our own homes.
When I look through the many postings on our renowned blog, I realize that many of us work in schools, hospitals or health centres, communities where we have children and adults who are living with terminal illness so commonly; HIV/AIDS or cancer to some extent. For the purpose of this discussion, we shall limit our focus on children. We have very many partial orphans where a child is living with one parent or total orphans where both parents have died. Many of these children are under the care of relatives, good Samaritans and others live on their own no matter how old the elder (care-taker) one is. This brings challenges and many times such children end up being brought up in orphanages or some sick bays where they live with no certain future for themselves. They depend on the care givers who can give them hope and life for the future through education, medical care and all the personal needs. What I am going to share may be applicable in African setting; however, it is applicable in any part of the world where our missionary work is needed.
Many times we volunteers move to our places of assignment when we have high hopes of doing the best we can for these children but we get limited when it comes to medical needs where the medical personnel is not available at that time we need them. This can come into situations; for example, convulsions, when the child is not taking daily medications and when the health of the child is deteriorating rapidly, when the child looks depressed and out of place and among other conditions. Many of these children live with HIV/AIDS and cancer directly if they are infected and indirectly if their beloved parents or siblings are suffering from HIV/AIDS and cancer, epilepsy, sick cell disease, mental retardation, mental sickness like depression leading to drug abuse and many others.
In 1990, 18-year-old American hemophiliac named Ryan White died of an AIDS-related illness. He had been diagnosed with HIV at 11 years. At the time, AIDS was seen as a deeply stigmatized ‘gay disease’. Ryan and his family were regularly subjected to abuse and excluded from community life. Their astounding acceptance, even forgiveness of this treatment was truly humbling. This fact might have happened sometime back but it is still happening now and many children and their families are carrying this burden individually or as a family.
Many of the children get HIV infection from their parents during birth, at breastfeeding, some are infected with direct blood injection by some rude people, others get it through rape, defilement, consented sexual intercourse due to peer pressure and others leave their homes due to domestic violence and come to streets since they have never felt loved in the whole of their lives. So these children have a whole history behind them as concerns their past life and cannot be easily handled without patience and determination.
This always brings about frustration when we see our efforts seem not to yield fruits. However, this is not true as the needs of a terminal sick patient is not only on medicine but on Holistic care where a person is looked at as a whole involving physical needs which include diseases a person suffers from like malaria, tuberculosis, anaemia and many others. Psychologically, the patient is tortured at the breaking of the bad news that he/she has an illness that is not going to get cured and so feelings of uselessness, rejection come up and they no longer see meaning in life. Socially, they become isolated and see no need of being in the company of healthy people with the view that they are not worth their company as their own self esteem goes down completely. Spiritually, they see the hand of God in their sickness, for the crimes they believe they have committed or their parents committed for which God has punished them. Some see God as a distant judge for whom they are not worthy to come so close to him as he is going to send them to hell. This makes them not to fear committing crimes as they are aware that even if they do or not, God will still judge them harshly. Economically, many of them or their parents are out of formal employment or businesses and so the care for the siblings or self-become challenging and in the end others are forced to become beggars on the streets, resort to stealing, hard core criminals, prostitution and lesbianism and many more social evils committed in the society. Some of these children who stay with their parents have never experienced love in their life, are abused by their care givers or even biological parents, teachers, neighbours, strangers and become infected with HIV in the process of such abuses. Such a child will not always be interested in the environment and their school performance drops drastically and they do not perform well even if teachers give special attention to him/her.
Children and adolescents make up the bulk of population in many developing countries with its challenges of parenthood, care and up bringing faced by parents and care givers. Many times we are frustrated of not understanding why the children we care for are not behaving in a good way especially the older children. It is important to understand why some characters develop in children as they grow. My own children including those I take care of sometimes behave in ways that used to make me disappointed but the time when I came across what you are about to read, it made me to understand them.
Adolescents are people between 10 and 19 years of age and Adolescence is a phase of life that is defined differently across cultures. Other commonly used terms are “youth” or “young people,” which have slightly different definitions. It is confusing and there is no definite age mark for children and adolescents. There are very young children who will show characters of adolescents and there are adolescents who will show characters of children. So who fits where is looked at on individual basis for proper management and care.
Age range (according to WHO)
Adolescents 10–19 years
Youth 15–24 years
Young People 10–24 years
Key Changes during Adolescence
Development of breasts
Appearance of pubic and underarm hair
Widening of the hips
Menarche or menstrual body changes
Development of the vulva and pelvis
Growth of the penis, scrotum, and testicles
Appearance of pubic, underarm, chest and leg hair
Development of back muscles
In both females and males
Accelerated growth and increase in body size and shape
Increased perspiration or sweating in the body
The presence of acne or pimples on the face
Face has characteristics of young adult
Change in tone of voice
Sexual desire activated
Initiation of sexual activities
These changes are good to know in order to start planning their care and management. In terms of body hygiene, they need to be told the importance of frequent bathing to minimize or remove body smell that makes it uncomfortable in the company of others. Girls can be prepared and given hygiene talks of body care in terms of menstruation and letting them know there are going to be times in a month when they need to take extra precaution to prepare themselves for menstruation which is very normal. There are some girls who take very long time to start menstruations and so it is very important to counsel them that it is normal and it happens and prepare them psychologically as they may be stigmatized by other girls for not being normal. For the boys, waking up in the morning with stiff erection is normal and this sometimes makes some boys think they are abnormal. Having wet dreams always excites some boys to start living what they dream of; it is then proper to counsel them that it is okay to feel that way but our life is sacred and the temple of God and has to be used well to please the Lord. They must learn to control their body emotions and not live under emotions but learn to rule the body emotions
Adolescents also experience psychosocial and emotional changes like
Insecurities, fears and doubts
Behavioural expressions of emotion, which may include withdrawal, hostility, impulsiveness, non‐cooperation
Feelings of being misunderstood and/or rejected
Interest in physical changes, sex and sexuality concern about body image
Concern about sexual identity, decision‐making and reputation
A need to feel autonomous and independent
It’s very important to note that adolescents undergo rapid growth and development, resulting in both physical changes and changes in thinking, social skills, problem solving, and relationships.
These changes influence how adolescents interact, behave, and process information and so the major cause of some ways they behave in society and homes. Our role in this is very important to understand them and letting them know the way they behave is normal and letting them accept that it is bad to behave that way and they must try to control it and live in harmony and learn to forgive and move on with life in happiness and peace with others
Stages of Adolescent Development
Adolescence can be categorized into 3 overlapping developmental stages: early, middle, and late.
The ages given are approximate; maturation is more important than specific ages.
Maturation occurs in fits and starts.
Growth in each category of change can occur at different
HIV impacts maturation in many ways.
No Longer Children, not yet Adults distinguishing characteristics of adolescents may include:
Energetic, open, spontaneous, inquisitive
Unreliable and/or irresponsible
Influenced by friends
Less influenced by family
Looking for role models (often outside the family)
Embarrassed to talk to adults about personal issues
Desire to be different from parents and previous generation in general
These characteristics are generalizations — they are not all applicable to every adolescent client. This clearly points out why our children often find it difficult to open to us and why we need to build more trust with them so that they can easily open to us and approach us in case of any problem. This is an inborn thing but the trust we build will make it possible for them to open to us. This generational gap is the cause of agony in families and bringing the child to the Priest to be prayed for is not a solution enough but it has to do with the culture of the family and upbringing.
How Adolescents Differ from One Another
Adolescents are a heterogeneous group and may differ from one another in many ways, meaning they have different characters and personalities in one person or more in a group. This is brought about by;
Stage of development
Home or family situation
Relationship or marital
Status of health or social status
Experience with stigmaand discrimination
Counselling and education should meet the unique needs of each adolescent and each child in front of you is a representation of the past life experiences that are either good or bad. The way this child will behave in front of you will depend on your reception of the child which can either make the child to like you or hate you. Here, we always need to apply the golden rule, do to others what you would expect them to do to you. Ask if you were in that situation yourself, how you would love to be treated, and then apply your own expectation to that situation to the person in front of you.
All that said applies to all children whether sick or not sick. Now when it comes to a child with terminal sickness, it becomes worse than what a child without terminal illness would go through. This normally brings a lot of stigma and discrimination to all of them from the child to the care givers who are equally affected positively or negatively with the reaction of a child with terminal illness.
Who are the Children infected by HIV/AIDS
Are neglected in the society
Some sexually abused by even their biological parents
Some have deep wounds of HIV infections they struggle to live within their hearts
Have lots of fear especially those without care takers
Never being listened to
Ever have broken love relationships
Not given time and chance to play with children
Segregated in some families
Forced into early marriages and sex for survival
Never get rights to school, health care, free association, food and shelter
Have no proper knowledge of their disease and medicines given at every clinic visit
Have lot of stigma and discrimination from the family and society
Lack proper feeding versus taking medications
Take drugs every day
Easily attacked by diseases
Have too long waiting hours in the clinic visits
Never given attention in schools
Suffer from dilemma in relationships and disclosure challenges
Is difficult for parents, care takers and health workers to talk about their disease
Have dilemma of their sexuality
Dilemma with relationships
Have nicknames given to them like malaria, moving skeleton, moving dead body…
Such instances make them live very unbearable lives, live in denial, and blame their parents to have infected them or blame themselves for their past reckless life that has made them to be infected with HIV. If you properly understand all this, it will be very easy to have a personal rapport with the child and learn what hurts him/her much in order to find a way out of what he/she is going through.
Common Psychosocial Issues
Psychological distress at illness and at the prospect of death is so stressing to the child being exposed to high risk of being orphaned leading to;
Lack of parental nurturing
Lack of basic needs
Loss of inheritance
Need to work
Less education and skills leading to social isolation
Stigma of living with HIV/AIDS
Effects of the physical condition of the body (e.g. chronic coughs, disfiguring skin conditions, body parts eaten up by HIV/AIDS)
In the end, this makes it very difficult for these children to believe that someone else can ever believe in them and accept them for all that they are going through in life. This is where our witness to Christ in the skin of the sick child starts from. St Mother Teresa of Calcuta showed us that it is not the profession but the heart for a sick person whom she said is Jesus in disguise that matters. These patients only need someone to talk to them and feel loved and accepted in the way they are matters to them the most. Sometimes we think we need to take something to eat and drink to the sick in the hospital, homes, but sometimes they have no appetite for food or drink but want to feel someone very near and close to them to listen to and hold their hand and pray together with them.
When we meet them and start talking to them in schools, orphanages and other areas, we may think they are all from great families and homes but the opposite is very true.
Who do some of these children live with?
Child headed families
Live in streets
The person they stay with will either make them to adhere well to medications or not. Some of them move from one place to another which affects their follow up on care and treatment and this brings about poor treatment outcomes. Some of them who find strangers to stay with end up being abused sexually or even killed for ritual reasons.
As we look at the places and people they stay with, it becomes clearly important to know their own feelings of living with HIV and Cancer. When we know their expectations, it becomes easy to help them in all that they are going through like their feelings concerning their HIV/AIDS and cancer disease which they live with;
Some feel it’s a curse from God for being with HIV/AIDS or cancer for their sins or the sins of their parents
They feel useless, lonely and deserted and feel the world has collapsed on them and life no longer holds meaning for them
Some get scared of marrying or fear someone will never accept to marry them with their HIV/AIDS and cancer and so no hope of getting any future partner
Some blame themselves for not listening to what their own parents were telling them not to indulge in living reckless life
Others regret why they were ever born and see how they will live with such life. We need to appreciate that it is very normal to feel and express such feelings and if they are talked to, a person who can listen to them and understand them can lead to healing of hurting memories
Some are so frustrated at their own parents for infecting them with HIV
Others conclude that they will not die alone and so will also infect as many others as they can after all someone also gave them the HIV virus
Others report lose in self-esteem and so cannot express themselves in front of others as they feel unworthy of recognition
Some feel rejected and useless how life will go on with no meaning to them as their future dreams are shuttered
Others cannot take the fact that letting someone so close to them know that they are HIV positive is possible as they will be stigmatized everywhere they go and fear such people will tell others about their HIV positive status
Knowing that they have HIV/AIDS makes them short tempered and easily involved in numerous fights when provoked and others do not have friends or cannot even maintain one if they make any in their life as they do not trust anyone.
Therefore, we need to encourage them so much that knowing and acknowledging their negative feelings is the best way to get healing in life. This will make them to recognize and manage their negative feelings to live a healthy life. This will also help them to overcome the misconceptions from the society about baseless judgment about them;
Some misconceptions we commonly meet in our care and treatment include;
Denial that one has sexual rights and feelings and so they let themselves live a life of opinions of others about themselves
Being haunted of the past life whether of their own making or being influenced by the friends to live a nasty past life
Looking at themselves as a living corpse with countable days, seeing no meaning in life and living anymore and so there is no need to take medicines and follow up anything suggested for positive living. Therefore, there is no need to go to school and get education just to die at the end of it all
They feel they are the worst sinners in the world as they are always blamed by pastors and even some Catholic priests for living a bad life and blaming them for spreading HIV to others when actually some of them really do not live that kind of life. This makes them not to turn to anyone else apart from themselves and that is why many of them end up killing themselves
They feel ugly and out-casted. This is made worse when some parents and care takers refuse disclosing HIV positive status to some children thinking the children will feel bad and yet the children already might have known they are HIV positive and keep on lying to them that they are taking medicines for Syphylis or Pnuemonia… This brings a lot of anxiety and stress. Some families make it worse by claiming better care to the sick child and others get less care and attention, thereby bringing about sibling rivalry that brings too much stigma to the sick child when others come to know that so and so is HIV positive or has cancer.
Despite all the negative thoughts that move through their mind, the children still have what they expect when they come across someone who has come in the way to give them hope and courage. They will confide in you if you try your best to understand them and fit in their shoes
Expectations of teenagers and adolescents
Holistic care and support
They expect unconditional love from whoever comes in touch with them; a person who will not judge them for what they are and what they carry in their bodies
They need someone who can listen to them, give them full attention so that they share what bothers them that they have never spoken to anyone. So, if you give your time to such a child and take him/her away from the rest and just encourage them to talk, this will bring a lot of healing to such a child but expect a lot of crying from both of you as their stories are emotionally draining
They need someone who can understand them and give them solutions or talk to them to find a solution for the problems they go through
These children need physical touch especially handshake that makes them feel loved and appreciated. Even in our own life when we get a handshake, we feel happy and loved and that is the same situation they are in despite their skin that sometimes has sores all over, a pat at the back makes them feel happy.
With the terminal illness, they have their dream of having a family and producing their own children, feeling loved by a partner, being referred to as having a home but not a house. With their condition, they feel this is something that cannot be achieved any more
They need somebody to be patient with them as their condition may not make them to be reasoning fast and an environment that is calm is good for them. They therefore need someone who can encourage them in all that they do as they never get such encouragement from their past life
In some situations, some people treat them differently either very good or very badly making others to be suspicious why so and so is treated so differently
Therefore, these needs and many more others these children have can make us to know where we can be of help to them in our daily work with them. When a child is always crying, isolated, depressed, committing crimes, getting addicted to drugs including alcohol, it is an indication of underlying behavioral or psychosocial problem going on in the life of this child. It would therefore be helpful if we identify such children and give special attention to them out of such problem. Winning the confidence of these children takes time and effort and when you have won their confidence, it’s worth the effort.
The first reaction you show to a child is enough to bring to their memory all that they have gone through in the past. Sometimes what we are reminds these children about their past. An example could be if you dress untidily and move about with uncombed hair, it could make them to remember the same man who looks like you that raped them. Likewise, over shouting reminds them of the stepmother, father who used to abuse and beat them at home and this will drive them into their world totally withdrawn from you and the rest. In a catechism lesson, God is our loving Father and so we must love him… a child put up his hand and said, if this God you tell us is our Father, I rather do without him, he is just like my father who beats me all the time… and he just moved out of the lesson. So, our outward appearance tells a lot about us to others in their own perceptions and this will affect the way we interact with them.
Always pay special attention to a child who is always isolated, not interested in what others do and has very flat moods. This shows lack of love from the family or environment they come from. This can be the behaviour of children both HIV positive and HIV negative. We shall talk more about the HIV positive children who sometimes are also found to be suffering from cancer.
Let us focus our attention now on the HIV/AIDS and Cancer patients:
They have the following expectations to be an ideal person. All these feelings affect the adherence of these children to medications and encouraging them to get hold of their negative feelings and knowing that such feelings are very normal brings about positive changes in their positive living process. Encouraging them to treat themselves physically, treating their mind, treating their body and soul is the way forward. Someone with full anger needs therapy from all the holistic angles. Encouraging the child to get a note book or exercise book to write down all that annoys him/her every time and going over that list with someone paying attention to them is very helpful in finding out what bothers them so much. Accepting HIV positive status is not very easy and it takes time and effort.
In a study done in Uganda about the adolescents, A. Barbara et al (2014), found out that about 130,000 adolescents (10-19 years) are living with HIV/AIDS with limited services among adolescents in Uganda. The study carried out between January to March 2013 with quarterly facility records found out that the 122,510 of the adolescents were counseled, 119,426 (97%) accepted to be tested. 2,937 (2.5%) of them tested HIV positive and 87% of the positives enrolled into care. Only 12,695 (29%) of the 43,333 eligible adolescents living with HIV in Uganda are on antiretroviral drugs way below 80% of the country’s target. This is only a very small representation of the problem faced by the adolescents world over.
This shows our need to look at them in a way that can help them to live a better life with HIV/AIDS.
For those who are on medicines for HIV/AIDS, we need to monitor that they take them well, the right medicine, right dose, right time, right route and right child in case they are many in care. Being in touch with the health workers where the children get care and treatment is good to find out the instructions for each child to be followed well at home/care centres.
What matters most to these children?
To be listened to
Equal treatment with others
Having their own families/marriage
Appreciation for anything that they can do
Help them to identify life skills and career opportunities. This includes activities that they can do to earn a living from, like farm work, handcrafts, good behaviour and prevention of physical harms, moral uprightness and many others you can positively identify in them to learn or improve.
Giving time and concern to children is what matters most to them. Providing basic needs for living is good but the children feel loved and appreciated if someone gives them quality time to play and tell stories and listen to them as they express their inner most feelings.
What they think about sex
They think sex is;
Procreation- for producing children
Act to strengthen relationship
Satisfy natural demands
Source of entertainment
So natural demand
Gift from God
Something to prove manhood
Source of income-employment
Medicine for pimples
Exercise to lose weight
When we look at what the children discuss about sex, it is amazing to understand why they move uncontrollably with immoral life. No wonder many girls get raped by boys and men who have such above thoughts, thinking you need sex when you are stressed, have pimples on your face, wanting to lose weight. Our help and guidance to the children is very important in the world of today which is so challenging. Putting these young people in focus group discussions to understand what they think locally in their surrounding concerning the above issues will make you get real spot on solutions for them. Many children find comfort in their peers which makes them to get into troubles and diseases including sexually transmitted infections and HIV/AIDS and so wherever we are, we must be an eye opener to them to guide them through the turbulent storms of life.
Risk‐Taking as a normal Part of growing up
Adolescents take risks as a normal part of growing up and this involves them getting into risky adventures. Risk-taking is the tool adolescents use to define and develop their identity. Healthy risk‐taking is a valuable experience as they are always adventuring in all that you do.
Healthy risk‐taking includes participating in sports, developing artistic and creative abilities, travelling, making new friends and contributing constructively to one’s family or community.
On the other hand, curiosity, sexual maturity, a natural inclination towards experimentation, and peer pressure, can lead to unhealthy/negative risk‐taking. This includes:
Drinking, smoking, using drugs
Unsafe sexual activity
A sense of powerfulness, feelings of invulnerability, and impulsiveness can lead to a lack of future planning.
Risk‐taking can be caused by a lack of knowledge.
In some cultures, young men are encouraged to take risks as a way of proving their masculinity.
This calls us to be vigilant in all that we interact and see with the adolescents as we interact with them on day to day basis. Where we see they are going off tract, it is helpful to come in as a counsellor and move forward with a solution.
Types and Consequences of Unhealthy Risk‐Taking Behavior
Unhealthy risk‐taking can result in:
Poor adherence to ARVs or HIV care and treatment
Experimentation with alcohol, marijuana, etc. Can interfere with judgment and adherence
Can suppress the immune system; can make a person more vulnerable to diseases, can compromise body’s response to ART
Can adversely interact with HIV medications, causing illness
Can reduce inhibitions and affect decision‐making
In a Botswana study, heavy drinking was associated with unsafe sex, sex with multiple partners, paying for sex, and intergenerational sex. Much as this study was done in Botswana, it is a common problem in many developing countries that needs to be tacked well. Some of these vulnerabilities include but not limited to the following;
Young people, particularly young women, are more vulnerable to STIs than adults.
The cells lining the inside of the normal adolescent cervical canal are more vulnerable to infections than the cells that line the mature cervical canal of adults.
All people living with HIV/AIDS including children are particularly vulnerable to nutritional and caloric deficiencies, due to the increased energy demands HIV imposes on the body.
HIV can contribute to compromised physical and psychological development, including stunting and slower than normal growth
Social, Psychological, and Emotional Vulnerabilities
Psychological factors that put many adolescents at increased risk of physical harm including a general sense of invulnerability, the desire to try new things, and a willingness to take risks.
Adolescents’ family situations may offer little social and material/financial support.
Mental health problems can increase during adolescence.
Adolescents often lack maturity, assertiveness and good communication skills, difficulty making good decisions, articulating needs and withstanding peer pressure
There are often unequal power dynamics between adolescents and adults; adolescents are more vulnerable to abuse.
The need for money often increases during adolescence as they always compare themselves with those who have and will do anything they can to get money. We need to watch these activities from our children we care for
Lack of access to money or employment can lead adolescents to steal or take work in hazardous situations.
Economic hardship can increase health risks in which basic needs of life may not be accessed.
Adolescents are more likely to experiment with drugs and alcohol, and disadvantaged adolescents are at greater risk of substance abuse.
Young women are particularly vulnerable as they can be turned into prostitution with too much sexual abuse
They often face gender discrimination that affects food allocation, access to health care, adherence to care, the ability to negotiate safer sex, and opportunities for social and economic wellbeing.
Some marry very young to escape poverty with the hope that marriage will help solve their problems but end up into more problems of early teenage pregnancies with very high mortality rates
Many adolescents are at risk due to other socioeconomic and political reasons where they can be deceived for sex slavery, cheap child labour and being recruited into child soldiers which is so common in our African settings
Some common challenges faced by parents and caregivers of these children
We also meet regularly with the parents and guardians and care takers of these HIV positive children on treatment and the some of the challenges they face include;
They are always very busy and have no time to monitor these children on how they take their medications and their feeding at home is left to domestic care takers in which it is not done well some of who do not know why such medicines are given to the children
Time factor when a child is given twice in a day pill and they may manage to give morning pills but evening pills are either not given or given very late and this affects the treatment outcome of the child negatively
Some of these children are mobile moving from one relative to another thereby affecting their routine medication taking
Some of the children have very poor appetite that affects their medicine interaction in the body leading not eating the available food the family can afford
Some children are not explained to why they take these daily medicines which makes them to refuse taking medications as they do not know they take them
It is very important to understand these few and many other reasons why some of the children get problem with their medications so that you can personally understand and come to help the family cope with the burden of caring for their children. The best approach is holistic in which different people can be brought on board to tackle some of the identified problem for the good health of the affected child.
How to communicate with the children
Communication should specifically address the concerns, fears and questions of the child. Children should not be forced to tell their story.
If a child cannot communicate verbally about something, there will be good reasons why that is the case including:
Tradition and cultures: In African tradition, children are ‘seen but not heard’.
Children in African cultures are not allowed to disagree with adults. They are brought up and always instructed to be quiet and humble and never to talk when adults are talking.
Children feel embarrassed to discuss HIV/AIDS with adults because it relates to taboo subjects such as sex.
Children might fear hurting adults. They might fear and hide their feelings in order to protect their parents, particularly if parents or guardians are unhappy.
Effective Communication with Children
Insist on child-focused, not parent-focused, sessions.
Talk with the child, rather than to or about him/her.
Handle the likely reactions and questions during the process of consultation/counselling.
Assure confidentiality or be honest beforehand about anyone who will be told what the child confides in.
Avoid a commanding tone or judgmental attitude (prejudice).
Avoid imposing adult values on children.
Avoid comparing the behaviour of children under stress to other children.
Don’t make empty promises and follow up what you promised.
Characteristics of Youth-Friendly Services
In order to serve adolescent clients with HIV prevention, care, treatment, and support, and related health services,
All environments for interacting with children must be able to attract, meet the needs of and give confidence to these children.
Specially trained/oriented staff about child care no matter what they do in the facility or place where the children stay
All staff display respect for youth regardless of what they are and what health conditions they are in
All staff should maintain privacy and confidentiality to the highest degree and get rid of people who cannot keep confidentiality
Enough time for interaction with the child especially when they have accepted to open up to you
Special times when young people can receive services or seeing children with special needs
Convenient hours for seeing them
Convenient location away from the rest
Adequate space and privacy
Comfortable, youth‐friendly surroundings
Peer Educators available to talk to the children and share their own experiences to the children as testimony from someone like them is more powerful than a spoken or researched material
What can we do as we move on with them in such emotional journey of care and support?
Let us focus on their concerns and develop very good rapport to know more of what hurts them most and what they always feel sharing with someone so caring to them
We need to empower them in accepting their own status and know that having HIV/AIDS does not mean end of life dreams and what they can do with what they are going through
Find out if it is possible to develop treatment partnerships with the different significant people in the life of the child may be at home, in the caring centre. This therefore calls to form a team with different people who can handle different aspects of the needs of the child physically, psychosocial, economical and spiritual
Endevour to follow up all the programs you propose to implement or plan to do
Some children who have recovered from your efforts can be empowered with basic knowledge and skills to start following other children (peer model of care) and they always believe a lot in the testimony of their own peers who has recovered from a similar situation they are going through and putting them in focus group discussions to share and advise each other is very helpful in the long run to overcome stigma and discrimination. This will also bring full community involvement in the care of these children and sustainability of such programs in case you move away to another place of assignment as a missionary
Teachers and matrons, wardens all need to be assessed to rule out stigma and discrimination which easily comes from them due to failure to control emotions, or ignorance and working with the teachers, matrons, school nurses, care takers in orphanages is paramount in making life comfortable for these children to cope with their status of livelihood.
We encourage equal treatment for all work they are supposed to do unless if medical advice demands the children to be kept away from doing some work like in cases of asthma or allergy to the child, chest problems which can all affect the wellbeing of such a child. This will stop the feeling of loneliness and isolation which they feel most of the time. This also can let them open up to their friends who prove to be understanding so that they can easily help them to cope with treatment and care procedures to remind them of their next appointment taking their daily pills
Allocating them to lead some groups doing activities improves their self esteem
Be open to them and encourage them not to fear you and encouraging them to join in playing football, netball, or any activity they can do. Please be cautious in getting into close contact in case of bleeding and exchange of body fluids which can infect you with HIV or hepatitis virus. Much as we care, let us also be careful as prevention is better than cure
Encourage them to tell you anything that happens to them anytime, anywhere like rape as soon as it happens
Never blame them for anything that happens to them currently or part of their past but instead support them in any way you can. Having a positive care attitude to a sick child has a very huge impact on their recovery from sickness and wellbeing.
Encourage them to change themselves but not their friends because at the end, it is their own life not of someone else
In teenage and adolescent care, take them as they are, understand them, be in their shoes, be their best friend, remove care shoes, come down to their level even if it means sitting down on the floor with them, that would be very beautiful. Reassure them on what they are going through, sit down and cry with them, laugh with them, cheer with them, eat with them
Life skills training on choice and self-esteem
As put clearly we need to empower adolescents on how to make choices and how they can have self-esteem which has already been eroded by negative public opinion. This is a very creative, educative and interactive session for the adolescents where they are given opportunities to share their understanding of the concepts of both choices and self-esteem in their life. It makes to challenge them on what they can do when alone, in the group of friends, family and what they can do when they are faced with challenging situation of fight or flight, or making a life and death choices they face.
Reasons why adolescents, like any other person, need to have life skills
Make good decisions
Understand themselves selves
Develop better relations with others
Solve day to day programs daily problems including money, relationship, personal management and hygiene, jobs and career development and many others
To develop communication skills so as to be well understood
To attend school regularly
To keep good hygiene at all times both the environment and the personal hygiene and to be very smart in dressing and body
Respect for every person and property
To pray every day
To avoid using abusive language at all times
Self control and self understanding programs
Behaviour with adults, elders, opposite sex, drinking
Channels of acquiring life skills
Person to person interaction
Education in forms of seminars, workshops, prayer groups and many others
And other Social interactions
Adolescents need to be handled separately well since they are going through a rapid change of behaviour, identity disturbances and strong emotions which are always confusing to the society. In order to build their confidence, there is need to associate more with their peers since they are the ones they trust. Interaction with the service providers and parents are very essential since adolescents are often vulnerable to negative peer pressure.
Taking care of the adolescents need a multi disciplinary team of different professionals who bring their different backgrounds for the good of the young people and inter-linking with other organizations for services you cannot give is very essential.
The author, Eric Ezati, works with Reach Out Mbuya Parish HIV/AIDS Initiative in Mbuya Parish Kampala, Uganda
The time has come to share what is in my heart after one month into my mission experience in Carapira. I have some difficulty in organizing my ideas and in getting started, because I have many emotions in my heart. I will try to describe a bit how I have grown throw this experience.
First, I will tell you about the daily routine. We had moments of prayer every day. We always started and ended the day with prayer, both with the pastoral community and in our community.
At the very beginning we were made aware several activities where our cooperation was needed and we built our daily routine around these activities both at the Technical Industrial Institute and at the boarding run by the sisters. We accompanied the missionaries in their visits to people and communities. We took part in the celebrations that were taking place at the time to remember the 70 years of Comboni presence in Mozambique, the 150th anniversary of the MCCJ Institute and the 25th of Bro. Alfredo Fiorini’s killing.
We also kept faithful to special moments in our community of Faith and Mission.
Two things filled my heart: the first was the feeling of being small; the second, was a great but joyful serenity. I felt small, light, happy and at peace.
I felt small because I was seeing the best and the worst in me. I learned a lot about myself, I knew myself better. I perceived my limitations and my gifts with more clarity. I found limitations I did not know and qualities I was not aware of. As I grew, I felt small. This was because I was discovering that the work we were doing, even though it was important and done with our full dedication, did not change the world as we would have liked. Because the difference consists in small gestures of friendship and of love that grow and bear fruit. I felt small, above all, because what I received than what I gave. This includes the apostolic community that welcomed generously, the community of Carapira, the communities we visited, the people we met, the children and young people with whom we spent a lot of time, at the Institute and at the sisters’ boarding, and the persons with whom we made community, the other members of Faith and Mission.
At the same time I felt at peace, because my heart was full. It was full of love and of joy. God filled it. With each passing day, I was realizing all the more that I was there because God had wanted to talk to me there. I felt him very near, in concrete moments, in prayer, while working, in the people who were touching my heart. And I realized that He was guiding me and helping me to know myself better. This helped me to be more aware, more genuine. More myself. The one God already knew but I did not – my true self…
I look at this journey. How I was at the beginning and how I am now at the end. How I have changed: how God stayed in my smallness, and how he took hold of this smallness and went on to build something beautiful.
How I was touched by Him. I am happy in seeing and knowing that I lived intensely. For knowing that I lived that time with a passion for Christ and for people. I want to continue this way, with a full heart, thankful for all the marvels that God has done, for all that I received from the people who crossed my path, the many witnesses of faith and love that touched me and made me grow.
Valdeci Antonio Ferreira is the founder of the Comboni Lay Missionaries in Brazil. He is 55 years old and 34 of them have been dedicated to prisoners.
After many years as head of the Assistance for the Protection of Prisoners (APACE) he is currently president of the Brazilian Fraternity of Assistance to Prisoners (FBAC). During this past weekend the daily paper Folhade São Paulo awarded him the prize of social entrepreneur for the system of humane incarceration.
Our sincerest congratulations to him and his cooperators.
May Comboni Always be the great intercessor in this journey towards Resurrection.
Valdeci Ferreira, of the FBAC, was given an award for the system of humane incarceration.
A volunteer for more than 30 years, Valdeci Ferreira of FBAC was recognized for the system of humane incarceration.
He is the leader of FBAC, a federation connected with APACS (Association for the Protection and Assistance of convicts). His mission is to spread this innovative methodology of resocialization of convicts, which aims at recovering the detainees, protect society, help the victims and promote restorative justice.
Receiving the prize, the entrepreneur said that, 34 years ago when he first visited a prison in Itaúna, MG, he could not have imagined receiving the main award of this evening. Visibly moved he said: “Life did not place rugs on my path for me to walk on, but rather stairs and today this is another stairway we are climbing. I need to share this moment with all those we were recovered by passing through APAC and with those who are still there and are the reason for our work and for what I had to give up in my life.”
One of them came up to the stage in his wheelchair. “Here in front of you is someone who went through APAC. I am a recovered individual and I believed in this man,” said Rinaldo Guimarães. “Valdeci always remembers a quote by St. Augustine: “Hope has two daughters: indignation and courage. Indignation is needed in order not to accept things as they are, and courage, like this man’s, to change things and make a difference,” he concluded.
In recognition of his work, Ferreira was elected as Social Entrepreneur of the Year among 100 candidates in the largest competition in the area of Latin America, organized by the Folha in cooperation with the Schwab Foundation.
It is estimated that more than 33 thousand Brazilian convicts have already passed through APACS, units of humanized prisons without arms or armed guards. This alternative system today houses 3,500 prisoners divided in 48 units across Brazil. This method is being tried in 19 other countries.
In 1972 this organization developed 12 elements such as work, the value of the person, legal assistance, family, meritocracy, and the principle of self-help in recuperation.
This method has suffered a mere 20% to 28% of recidivism versus the 85% of the common prison system with a cost of only one third of the regular prisons.
Ferreira ran for the grand prize against Bernardo Bonjean, 40, the leader of Avante, an organization offering credit and humanly acceptable terms for micro-businesses not accepted by the banks, and Ronaldo Lemos, 41, of the Institute of Technology and Society (ITS) which developed the application Cambiamos, a tool of direct democracy for the collection of digital signatures in favor of projects of popular empowerment.
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