ELDERLY CARERS: THE EXPERIENCES OF THE ELDERLY CARING FOR ORPHANS AND VULNERABLE CHILDREN IN THE CONTEXT OF THE HIV/AIDS EPIDEMIC IN CHIRADZURU DISTRICT, MALAWI BLESSINGS TAMANDA FLAURA MSUSA- KACHALE A thesis submitted in partial fulfilment of the requirements for the Degree of Doctor of Philosophy QUEEN MARGARET UNIVERSITY 2015 ABSTRACT PURPOSE: This qualitative study explores the day-to-day care experiences and livelihoods challenges of the elderly carers of orphan and vulnerable children (OVCs) in rural Chiradzuru district in Malawi. The study aims to highlight the impact of AIDS mortality on Elderly Households’ livelihood assets. METHOD: Using case study approach data was collected from 43 cases comprised of 23 individuals and 3 Focus Groups. The main study participants were elderly-headed households caring for OVCs. Data was collected and the evidence converged using the Sustainable Livelihood Framework (SLF) to analyse findings. FINDINGS: The main ten study participants were between the ages 55-90+ caring for thirty-eight OVCs; seven of whom were single females caring for OVCs aged between 2-16 years old- some of them caring for second generation of orphans (great grandchildren). Although this is crisis-led fostering, most of the elderly have accepted the responsibility regardless of their capabilities. This highlights the value of family based care in these families. Six of the ten elderly carers had lost a significant number of assets to AIDS sickness and death of family members. A few had given up their wage earning livelihoods to care for OVCs while for the very old (71-90) their physical old-age disabilities affected pursuance of livelihoods impacting their food security and acquisition of basic needs. There was mutual reciprocity between the OVCs and their carers to pursue livelihoods which increased household resilience. Conclusion: The elderly in Chiradzuru need social security support so that they must not give up care of their children to alternative care arrangements which can contribute to trauma on OVCs. Elderly, OVCs, AIDS livelihoods, care i DECLARATIONS I Blessings Kachale hereby declare that this submission is my own work and that, to the best of my knowledge, it contains no material previously published or written by another person nor material which to a substantial extent has been accepted for the award of any degree of the university or other institute of higher learning, except where due acknowledgement has been made in the text. Signed …………………………………………………… Date……………… ii ACKNOWLEDGEMENTS First and foremost am indebted to God, the Father of Our Lord Jesus Christ who has been my source of Wisdom, revelation and knowledge throughout my life’s journey. He has seen me through the ups and downs the PhD process, and this far He has taken me. Secondly I am indebted to the following people: My supervisors Dr Carola Eyber, Senior Lecture, School of Health Sciences, Queen Margaret University and Ms Suzanne Fustukian, Head of studies in Institute for International Health and Development, (IIHD) Queen Margaret University for their on-going support, direction, constructive feedback and critical challenge throughout this research study. Their moral and academic support and continuous encouragement over the entire period of my study was very critical to the completion of this thesis. Their emphasis on coherence of ideas, succinctly, deeper analysis throughout the write- up stage of this thesis raised the standard in me for critical thinking. They have a new person that I am now. My appreciation also goes to my fieldwork academic supervisor Mr Eric Umar for guiding me in planning for my field research and for advice in Malawi on Ethical approval process. My appreciation also go to Godfrey Chimenya, the Research Assistant for your support critical thinking during translation of research tools, and the study process, for your passion, to see the research process through. To Mr Dereck Liwewe, for your great work to review data translations and correcting errors, your commitment to the entire process is greatly appreciated. I appreciate very much the assistance and support of Richard Walker, Alison McDonald and my husband Thokozani Kachale for proofreading drafts of my submitted work. I value your support. I also wish to acknowledge the generous partial funding I received from SORSAS, which really eased the burden on payment of International fees, iii and to Sheila Adams, and the Vice Principle for considering me to benefit from SORSAS funding, God Bless you greatly. Many people around me during my time of study in Edinburgh, My friend and colleague Dr. Kennedy Lweya whose inspiration and guidance helped me remain focused, IIHD staff body- Professor Barbara McPake (in absentia), Oonagh O’Brien, Bregje de Kok, Karina Kielmann; Alison Strang, Anul Kapilashrami, Ijeoma Edoka, Fu-Min Tseng; for the staff and student seminars and presentations that you organised which added value to my thesis and my understanding of global health issues. My gratitude also go to the IIHD administrative staff- Jardine Kyoko, Janice Burr and Michelle Hart for attending to me when I needed your support. To my fellow students Nicole, Kevin, Isa, Sveta, Usar, Doosuur, Justine, Eddie, and Nina for your encouragement and presence which made me draw strength to sojourn To Fiona Coutts, the Dean of school for Health Sciences for your continuous support to the IIHD.I would also like to thanks the Library and Assist staff for their support all the way through to the end, special thanks goes to Sheila Williams. The research participants who consented to be involved in this study and who generously gave up their time to participate in the interviews. I wish to thank them for their willingness to actively engage with the research, their openness and honesty without which this study would not have been possible. To: Thokozani, my husband for your enduring patience, encouragement and support. My Children Arthur, Khasu, Mwambi and Atikonda who endured years of being left alone sometimes without my support as I pressed on to finish my PhD, my loving family of the Kachale, for your financial and moral support to me and my family when we needed financial and moral support the most. To My Parents (John Martin and Esnath Ruth Msusa) who have been my source of encouragement to aspire to achieve the highest standard of education, as I did this, mum and dad you suffered my lack of physical and iv financial support, thank you for your patience and understanding. My bothers Andrew and Khwesi who took over to support and care for our parents morally, physically and financially, I am forever grateful to you guys. The Malawi Community in Edinburgh, the local churches of EWG and Emmanuel Church, friends in Clermiston for your spiritual, moral support and advice without which this journey would have been but a dream. v GLOSSARY OF TERMS Fisi A traditional practice whereby when a girl has gone through initiation process, a mature man is identified to cleanse her by sleeping with her to initiate the girl to adulthood, for a boy after initiation has to also prove his adulthood by identifying a girl to sleep with. Yao A local language commonly spoken in Chiradzuru District- the study area; a name of tribe that goes by that name Malawi Kwacha Malawi’s local currency Ganyu A local name used to describe seasonal wage labour Elderly Persons from the age of 50 above Chichewa Malawi’s national language Banja singular a local term in Malawi to describe a clan Mabanja plural term of “banja “to mean clans Nakanga a local Yao name for an elderly woman who initiates girls at initiation ceremonies Namkungwi a local Chichewa name for an elderly woman who initiates girls Ndaghala a secluded place usually in a bush where boys are imitated Mulanje one of the districts in Malawi bordering with Chiradzuru the study area Umoyo meaning good health or wellness Henzi AIDS vi Amakhala akulawalawa meaning a man cannot just have one woman, where he goes he finds a woman Mchere meaning a job in this study as was used, but literary means salt Mwana wamzako ndiwako means when you take care of your friends’ child, they might yemwe ukachenjera manja look after you when you are in need so long as you were udya naye able to offer flexible helping hands Likuni Phala a soya bean corn flour mix used to prepare porridge for growing children Kuchuluka ndikwambwino a proverb in Malawi highlighting that there is strength in kuipira m’bale numbers to draw on labour resource, however it is hard to share meagre resources in households where resources are few and household members are many Juju a local name to describe traditional medicine which is used to perform tricks Galu wamkota sakandira meaning that an old dog does not dig in vain, usually they pachabe did because they have smelt something Kanyenya a local take away in Malawi which usually Agogo a local Chichewa name for an elderly person Abiti A Yao name for daughter of or ‘Miss’ usually used as a respectful way of addressing a girl, lady or woman vii ACRONYMS ACA 2002 Adoption and Children Act 2002 ADB Africa Development Bank AIDS Acquire Immune Deficiency Virus ART Antiretroviral treatment/therapy ARV Antiretroviral BSGHF Bingu Silver- Grey Hair Foundation CA 1989 Children Act 1989 CA 1989 Children Act 1989 amended by CA 2011 CCPJA 2010 Child Care Protection and Justice Act (2010) CFPs Child Feeding Programmes CHH Child Headed Households CR Child Rights CS Case Study CSD Case Study Design CSR Case Study Research CWPC Children Without Parental Care CYPA