In Ethiopia, burial societies also tend to the living

ADDIS ABABA, Ethiopia -- When a family buries its dead in this Horn of Africa nation, burial societies -- some older than a century -- traditionally have organized everything from feeding the mourners to digging the graves.

This timeworn rite is now under threat. AIDS is killing so many people here that the societies, known as idirs, are struggling to pay for all the funerals. Some have shut down recently, leaving families to fend for themselves.

But a program run by the US-based charity Family Health International has given many idirs a new purpose. The groups have expanded their services to take care of the living, sending volunteers into homes to feed, bathe, and comfort those who are bedridden.

The societies of death are becoming societies of life, as well.

''It's a great challenge for us," said Endalikhew Assefa, 35, a member of an idir committee in the Janmeda Akabi area of Addis Ababa. ''We decided we had to start trying to save lives. Many women here have five, six, or seven children. If a mother dies, she leaves so many orphans. That places new burdens on all of us."

Idirs operate on simple financial principles. A household contributes between 50 cents and $1 a month, and that money is pooled to pay for funerals in the community. The caregiver program doesn't fund the burial societies, but the idirs have embraced it for two reasons: Community members see it as an important service; and if people live longer because of the care, the financial burden will lessen. FHI and local charities also are giving health care training to the caregivers.

In Assefa's idir, 10 volunteer caregivers attend to more than 100 chronically ill people, most with HIV or AIDS. They visit patients two or three times a week.

''They are cooking my food, washing my body, and taking care of my children," said Demeku Teshome, a 26-year-old mother of two who has tuberculosis.

The caregiver, Aster Gezahega, 26, had been coming for more than two months to Teshome's one-room corrugated metal shack. ''I live nearby," said Gezahega, who graduated from high school but has been unable to find a paying job. ''I feel it is my responsibility to help my neighbors. So I watch over this woman."

Caregivers are reluctant to talk to patients or their families about HIV and AIDS because the mere mention sometimes triggers anger from patients; the stigma of the disease is great. But Ato Derso, 45, who oversees a network of 345 idirs in the northern part of Addis Ababa, said he is talking more about AIDS. ''A good friend of mine, a neighbor, died of AIDS, leaving four kids behind," Derso said. ''That was really a turning point in my life. After that, I saw the same thing happening with lots of idir members, leaving kids behind as they died. So I've decided to speak out about it."

Francesca Stuer, Family Health International's country director in Ethiopia, estimated that HIV-positive patients account for 85 percent of those being helped. Ethiopia, with a population of 73 million, was estimated to have 1.5 million people infected with HIV at the end of 2003, the latest available UN statistics. That translates into 4.4 percent prevalence among adults age 15 to 49.

The country's widespread poverty hinders its ability to fight the pandemic.

''The only way to actively help people is to involve community groups on a large scale," Stuer said. ''It was a good moment to approach the idirs because some were questioning their mandate and some have been going bankrupt."

The FHI program is running in 164 idirs across 14 cities. The group said the program has assisted more than 90,000 people in the last year, counting patients' family members.

The cost is low. A month of visits in to an Addis Ababa patient costs about $30, or $3 a visit. The US Agency for International Development has funded the program for two years at $2 million annually.

But recently, according to Stuer, USAID officials in Ethiopia have told her the funding would not continue next year. Elissa S. Pruett, spokeswoman of the Office of the US Global AIDS Coordinator in Washington, said no final decisions have been made for any program. Stuer is scrambling for new donors just in case.

In the meantime, caregivers perform countless small acts of kindness for the sick each day, spoon-feeding porridge, offering words of encouragement.

For Masresha Metekiya, 30, who had lost 40 pounds in three months from his already slender frame, such help includes a caregiver helping him walk to a taxi, which was taking him to a nearby hospital. For several weeks, a caregiver had urged him to take an HIV test, and Metekiya had finally agreed to do so. ''Everything is painful for me," Metekiya said after arriving at the hospital recently. ''I thank God that he gave me life, even if it's just to this age, and I thank him for these people who are helping me."

John Donnelly can be reached at donnelly@globe.com