Kampala, Uganda

To fight AIDS with medication in the Third World is simply and tragically unfeasible. The monthly costs for AIDS drugs used by many Americans and Europeans is significantly higher than the monthly incomes of most people in nations like Uganda.

So Rebecca Wasswa, director of the Luke Society of Uganda, and her staff must instead spend her time fighting the related diseases to which her 400 HIV-positive patients are especially vulnerable -- pneumonia, tuberculosis, malaria, and skin and respiratory infections. The workload can be overwhelming, but Rebecca shrugs this off, saying, "We always praise the Lord. Working in this environment is not easy, but working with AIDS and tuberculosis, not one of us has caught either disease."

Accompanying Rebecca on visits to the homes of some of her AIDS patients, I see the compassion she has for them and the dedication to easing their suffering. The first woman we visit has been a patient of the Luke Society for four years. She's been bed-ridden for a week with a bronchial infection and was unable to open her eyes as she drew a line down her chest with a finger, describing her pain. Rebecca and her staff are constantly making house calls like this and training local volunteers how to care for the chronically ill.

It's been raining, and the roads in Lubya Parish, one of Kampala's poorest districts, have become nearly impassible as we drive from house to house. At one point, local children help us push the Luke Society van out of the soft red mud.

We get out and walk down a muddy footpath to see another patient. Noelena Kulabako lives in a small dark hut, sharing a room with her three children. The roof leaks, and there is little ventilation. She had no sheets for her bed until the Luke Society provided some. The rent is less than three dollars per month, but she often has to rely on relatives to help pay it; she's usually too sick to work. AIDS has left her immune system unable to cope with herpes, tuberculosis, an enlarged spleen, chronic pain, breathing problems and frequent bouts of malaria.

The effect of AIDS in Lubya goes well beyond medical concerns. The disease has devastated a generation of Ugandans, leaving widows with little income and children with no family. The East African Monitor reported in 1999 that 1.7 million children have been orphaned from AIDS. The current number is probably much higher.

Since Rebecca began working in Lubya in 1996, she's lost 100 patients to AIDS and seen 200 children orphaned. Orphans are usually sent to live with relatives who often don't have the money to feed them well and send them to school. In a recent survey, Rebecca found that 19% of the children in Lubya were not in school, and three-fourths of these were orphans. One child said of his caretakers, "When I fall sick, they do not care to take me to the dispensary, they do not give me any medicine, I am left to heal like a cow."

The Luke Society of Uganda currently supports 23 of the neediest orphans with tuition and medical care, though Rebecca would like to do more. Tuition can cost as much as $300 per year. During holidays, the children come to the clinic for a time of prayer and singing and meeting with their friends.

"We want them to recognize the presence of God in their lives," Rebecca says.

One of the boys, 12-year-old Baker Musoke, says he hopes to become a doctor, "because in our country, people are suffering." His father died in one of Uganda's wars, and his mother died from AIDS. The Luke Society has been helping him with school fees and medical care since 1996.

Rebecca can uniquely relate to those struggling with AIDS, their children, and those caring for AIDS orphans. In 1995, she lost her brother to the disease. He left 18 children without a father, and Rebecca helps pay for their food and school fees. Three of the 18 have since died from AIDS. The youngest of the children, 10-year-old Jonathan, is the same age as Rebecca's son, Jonah, and lives with Rebecca and her husband, John.

"The fact that my only brother died from AIDS," Rebecca said, "definitely increased and encouraged my desire for nursing."

As AIDS decimated families throughout the 90s, it had a dramatic economic effect on those widowed, and many families found themselves with the added burden of providing for nieces, nephews and grandchildren. Realizing this, Rebecca began a program of micro-business loans for needy women. She started with 10 women, and now 55 women are providing for their families through small businesses such as raising poultry and livestock, selling fruits and vegetables, making bricks and sewing dresses.

Before they get loans, which average about $100 each, the women receive training on how to manage a business. For the most part, these women have consistently paid back their loans and received new ones to expand their businesses. Many in the program are HIV-positive and without an income might have been tempted into prostitution to feed their families, further spreading the disease in the community.

Pauline Nalongo proudly displays her livestock. With her first loan, she began selling firewood. She has taken out three more loans and repaid them all since then, expanding her income with three chickens, two pigs and a milking cow. She showed us that there was room for another cow in the pen and said she'd like to build a better place for the pigs. Her optimism and gratitude were evident as she told us that she was much better prepared now to take care of her grandson who was orphaned by AIDS.

Before coming to Lubya, Rebecca worked under the Luke Society's first director in Uganda, the late Dr. Henry Kyeyune. As she started her own ministry, she quickly realized that to have an impact, she would need to get the community involved and excited about raising the level of health care in their neighborhoods.

Rebecca began training local women (and a few men) to serve as community health workers. More than 70 people have attended Rebecca's two-week training courses, and more than 80% are still actively involved in the ministry. Many have received additional training as traditional birth attendants, home care givers and community counselors. All of their work is done on a volunteer basis.

These health workers visit homes, educating mothers about environmental sanitation--building latrines and bathing shelters, washing food and dishes, and making sure sick relatives have clean sheets and proper care. They also share the gospel among their neighbors and meet together twice each month for a time of prayer.

"We pray for one another," Rebecca said. "Most of our prayers have been answered. Through this meeting, we stress serving the community."

Evangelism and discipleship are incorporated to all areas of the ministry. George Male-Mabirizi is the staff evangelist. The evangelism program has been extended into three local schools. George meets with local believers throughout the week in different parts of Lubya, and one Sunday each month, the Luke Society staff leads worship services at the Lusaze Church.

Despite the large ministry scope of the Luke Society of Uganda, its facilities consist of a converted shipping container with an attached shed. As the ministry has grown, the building has begun to limit its effectiveness. It is simply too small to conduct adequate clinical care, and it doesn't provide enough security to allow stocking it with more than the most inexpensive equipment.

The Luke Society is currently raising funds to build a new, larger clinic to better serve the community. The land has already been purchased, and Rebecca hopes to break ground before the end of the year.