A Discussion with Karen Sichinga, Executive Director, Churches Health Association of Zambia

With: Karen Sichinga Berkley Center Profile

February 12, 2014

Background: Karen Sichinga is a dynamic, life-long health practitioner working in a dynamic and difficult African setting. She is a strong advocate for service to vulnerable people, pioneering practical, workable solutions. Her life path was heavily affected by the HIV and AIDS pandemic that was unfolding in Southern Africa while she was a student in Canada. Determined to contribute to reducing the disease burden due to HIV and AIDS in her native country, Zambia, she began working with Zambia’s Church Health Association (CHAZ), in 1991. She served there in different capacities there, most recently as its executive director. This discussion with Katherine Marshall and Nava Friedman took place during her February 2014 visit to Washington, D.C. to help present a report on the work of faith-linked groups on family planning.

How has the HIV and AIDS pandemic shaped your life and career?

My family and I have been deeply affected by HIV and AIDS.

I was studying in Canada during the period when the enormity of the pandemic was becoming clear but I felt the full, dramatic effect when I got home. And again it hit home. My brother’s wife had died before him while I was in Canada and my brother was ill. Their son was 3 years at the time of his mother’s death. I remember that I called my brother the day before he died. He had been sick, but was strong only a few days earlier. When I called, his son, who was 8 years old at the time, answered the phone and said that his father was very sick and could not come to the phone. I told him to get the phone to him. He did but was so weak all of a sudden that he could barely speak. I asked if he needed me to come pick him up and bring him to Lusaka where I lived, and he said yes. For him to agree to have me pick him up—I knew something must be seriously wrong. Sadly, he died the next day, before I got there. However, I had the opportunity to tell him an hour before he died, that he did not need to worry about his son because I would care for him. So I took his son, now my son, into my family, treating him like own biological son and sending him to the same school where my girls went.

Not surprisingly, the boy was deeply traumatized. He barely uttered a word for the next two years. His teachers were concerned but very supportive. I knew I needed to talk to him about what had caused the deaths in his family, to help him deal with the loss of his immediate family. For some time I was concerned about how he would react. I must admit that I was not sure how to go about it, as I had not myself completely come to a closure to his death. I suppressed my grief, as the eldest of the girls in my family, because I had to be strong for my mother and ensure a decent burial for my baby brother.

But after a year or two, I sat the young man down and told him that we needed to talk about his father. He immediately burst into tears; he cried the whole night and the next day. I gave him time to cry, then opened the discussion again. He said that he hated his father for leaving him. I explained that his father had died of AIDS; it was not his desire to abandon his only surviving child. The boy burst into tears again. He explained that he was crying because he had judged people with AIDS. He asked why he had not been told earlier of the cause of death for his mother and father. He felt very sad. Then we talked about his younger brother, who had also died of AIDS two year earlier. He said that he thought he was responsible for his younger brother’s death because they had had a fight a month before he died. Of course this was not true; his brother had suffered from one opportunistic infection after another throughout his young life. He died at age 8. I explained that his younger brother was born with the HIV infection and had also died of AIDS. The sad part about this little boy’s death was that we looked everywhere for the medication to treat the AIDS related meningitis but could not find it. Eventually, we decided to procure it from Johannesburg in South Africa. It was supposed to arrive on a Monday but it did not arrive until Tuesday. But this was too late for him, as he died on Monday, a day before the medication arrived.

I lost my three siblings (of the 10 of us) to AIDS. Losing my siblings was painful but worse because of the circumstances around AIDS. The three of them died before treatment for AIDS in our country became free for all. My family could simply not afford treatment for any of my three siblings, as it cost $1,200 per month per person at the time. It was painful to watch them die slowly.

The situation is different now and a lot of progress has been made by our government to reduce the impact of AIDS and reduce the infection and its effects. However, in the early 1990s the AIDS situation in my country became a real crisis and an emergency! There were sick people and funerals literally everywhere. It seemed like some sort of a punishment. The HIV prevalence rate in Zambia was at 22 percent, the highest in the region. We heard and read about treatment in the West and in South Africa but most of our people in Zambia could not access it! It was beyond our reach and it felt as though we were being condemned to die.

Before America’s PEPFAR [President’s Emergency Program for AIDS Relief], we had to pay for all of our treatments. We are very grateful to the American people for creating PEPFAR. And I would not do justice to this discussion and also would be failing in my duty as a person representing an organization (CHAZ) in Zambia receiving support from the Global Fund to fight HIV and AIDS, Malaria, and Tuberculosis, if I did not acknowledge the contribution of the Global Fund and many of our partners at the country level such as CRS, CDC, and the Joint Country Program in this regard.

Can you tell us about your own background? Where are you from?

I was born in Luanshya a town on the Copperbelt province of Zambia. It was then (as it is now), more developed than other parts of Zambia (except Lusaka, the capital). The Copperbelt was a diverse and dynamic region. There were many people of different nationalities from neighboring countries and overseas, including white people who worked in the copper mines.

I come from a family of 10 children, five boys and five girls; I was the fourth born and the first of the girls, after three boys. My parents were devoted Christians with impressive leadership abilities both in the church and in the community. My father came from a poor family. He married very early and after he and his wife, my mother, Namukonda, had had three boys, he decided that he needed to provide a better life for his children and left what was then Northern Rhodesia (now Zambia) to search for a job in South Africa. He returned to Zambia after six years. In those days, men who left our country for “greener pastures” did not only leave their families behind for a time. Often they never returned to their home countries. But my father came back; I have a lot of respect for my late father in this regard. He did not abandon his wife and his three children. This is the legacy my father left. We cherish his commitment to his family and it has become part of our value system in my family. He died at the age of 77, when I was in Canada. Sadly I could not afford to return home to bury him.

When he returned from South Africa, my father briefly worked on the Copperbelt. He then left formal employment to establish a general store. He sent me to Catholic schools. He told me they were the best schools but that was there only for my education; I was not to become Catholic. I did not like this because I wanted so badly to become Catholic when I was in school but because I had so much respect for my dad I dared not disobey him! One time he was very angry with me when I came home with a rosary. I realize now that my father did not dislike the Catholic Church, but was only scared that if I became Catholic I would automatically become a religious sister and would never get married. My father simply wanted his first daughter to get an education, get married, and have children! I do not blame him. I understand his feelings and reasoning now that I am a parent myself.

How did you get your university education?

I went to the University of Alberta, in Edmonton, Canada for my undergraduate and later to the University of Leeds in England for my graduate school.

My undergraduate school was a struggle. My husband and I had no money and lived below what was then defined as the poverty line by to Canadian standards. My husband was awarded a Canadian government and University of Zambia scholarship for his graduate work (master’s and Ph.D.). I myself had been promised sponsorship. Sadly for me, this never materialized. When I inquired into the case, I was told that my employment records, popularly known as the “file,” had been misplaced at the Ministry of Health. Therefore my sponsorship application could not be processed; and because I was already out of the country it was difficult for me to pursue the case in person. We paid my first (winter) semester’s fees using the extra money from my husband’s monthly living allowance, which was remitted monthly by the University of Zambia. As fate would have it, this stipend was also short-lived as it suddenly stopped coming due to Zambia’s currency depreciation against the United States dollar and other major currencies, including the Canadian dollar. This was after my first term in university. For a while all hope to earn a university education was gone.

But then I decided to share my predicament with a friend of mine, June, at Church. I attended Sunday church service regularly at South Minister Congregation of the United Church of Canada. I helped out in the Sunday school and belonged to the ladies fellowship. I shared with my co-Sunday school teacher my intention to drop out of university because I could not afford the tuition fees, let alone differential fees as a foreign student. I mentioned to her that my scholarship from my country had not come through. I did not think much of it when June when she said she would look into the matter and make a few consultations regarding my issue. She said I should wait before I quit university. Little did I know that she would present my case to a committee in the same church which oversaw sponsorship and support of foreign students across Canada! I had no idea that such help existed in the congregation. Our congregation at that time supported a handful foreign student at across Canada, particularly refuges and students from conflict-zone countries. My friend June told the congregation about my problem. The church responded immediately, promising to support my education plus a little pocket money until I graduated. My God is truly faithful; this I testify. My church paid for the rest of my schooling. And I give God all the glory and honor for South Minister Congregation of the United Church of Canada in Edmonton, Canada. The church gave me a rare opportunity and I will forever be grateful. To me, this was truly divine intervention!

In Canada in the 1980s to mid-90s, by law foreign students were not allowed to have employment. Although we needed the money, we did not dare take the risk of being deported for disobeying the laws. We had two very young daughters and in order to survive and ensure that there was food on the table, I asked if informally I could help clean the houses of some members of the congregation who would pay in kind. It was all arranged before I knew it I was booked every Friday afternoon (after class) and occasionally, on Saturday mornings as well. The ladies in my church were all very nice and willing to help me and my family. Often I would clean alongside the lady of the house and they would pay me in kind for the work done. This helped; at least I was able to take my little girls to McDonald’s once in a while. My older daughter recalls situations when I would only buy one Mac for them to share, or two but I myself would say “no, I am full.” I was also given old clothes by the ladies, including winter clothes (I never had to buy any winter clothes for me and my little girls for nine of the 10 years we were in Canada).

I graduated in 1985 with a bachelor of science in nursing (BSc.N) degree. However, I was always interested in community health/public health. I had a passion for disease control since high school. Fortunately for me, the BSc. program at the University of Alberta’s Faculty of Nursing prepared me for public health. The program was comprehensive, with both prescribed course and electives from other faculties in the University. The beauty about the North American (Canada and the United States) undergraduate university system is that it is not narrow but offers you a general university education. In this regard, I could have taken any career path, such as nursing education, research, public health and community health, and of course clinical nursing practice! I settled for a career in public health.

After I graduated, my church congregation offered to pay for my master’s degree if I were interested in continuing my education. I declined the offer because I felt that a post graduate degree would be a luxury in my situation at the time. In my opinion, the church could surely sponsor another undergrad student who was in need. After I graduated, I volunteered at my little daughter’s elementary school as a Girl Guide and Brownies leader, and I also volunteered at a nursing home and at the Cancer Institute. In 1988, Canada relaxed the policy on foreign students’ employment and we were finally allowed to work in our area of specialization. After this policy change I got a full time job at the Grey Nuns General Hospital and a part-time one at the Good Samaritan Care Centre in Edmonton, Alberta, Canada.

What brought you back to Zambia?

In the early and mid-1980s, news about AIDS in Africa was everywhere: on Canadian Broadcast Cooperation, CNN, and other major media houses. The focus was first on Uganda but not long afterwards on Zambia. We started to get letters from relatives at home saying that people were getting sick. I heard that my brother’s wife had been diagnosed with AIDS. The doctor had told her that she had AIDS. She wrote to me, “I have AIDS but my husband and I have been faithful.” She suspected it had been contracted through a hypodermic needle at one of the private for profit clinics. She had been attending antenatal clinic at an unnamed private for profit medical center that did not have disposable needles. According to my late sister in-law, needles were reused many times and she suspected that they were not properly sterilized. My sister-in law passed on in 1989 before my return to Zambia. I was saddened by her death. As if this was not enough, shortly after this loss, we were informed of my brother-in-law’s AIDS-related illness. He too died in 1989.

It seemed like Africa was burning from AIDS. It felt as if my country and southern Africa were on fire! This was scary but it also increased my appetite for public health and to want to contribute to the fight against AIDS in my small way. I became more and more determined to help. We definitely wanted to return to Zambia even though our country’s economy had totally collapsed at the time! My husband and I felt the need to come home and contribute to the development of our country. Suffice it to mention that many of the African students who went overseas to study those days, did not return home. It was a huge brain drain for our countries. The decision to go back home was a difficult one, particularly that my 11- and 8-year-old daughters, who had been raised in Edmonton, Alberta, Canada (from age 1 for my older daughter; the second one was born there). Canada was the only home they knew. They had formed relationships and were doing well at school.

As we had expected, my daughters went through a big cultural shock when we arrived in Zambia with some degree of permanent consequences (come to think of it, both my girls have really not forgiven us for uprooting them from a culture they were both so comfortable with and bringing them to a totally “strange” culture). A decision to go home was also very difficult because I had anxieties about my career development in public health. Furthermore, there were anxieties because we had been away from home for many years. How would we acclimate? Inevitably, change had taken place in us individually and as a couple!

These were my humble beginnings, that took me to a fantastic and fulfilling career in public health. Fulfilling, in the sense that in public health, you can measure the impact of your efforts personally and collectively. You are a change agent and you can see the difference you make in the lives of the people you serve!

And what brought you to CHAZ?

I think I found that job through divine intervention! I can simply say that the job was God’s perfect plan for me. The Churches Health Association of Zambia (formerly the Churches Medical Association of Zambia) had advertised for an assistant AIDS coordinator in one of the public newspapers in July 1991. I was unaware of this job opportunity, but my new friend (at the time) Esther happened to see the job announcement and told me about the job. But the posting was two months old at that time, and I told her, “you must be joking,” the job must have been filled already! She insisted again and again that I apply. So I did. The very next day, I got a phone call inviting me to come for an interview. After the interview, the driver from CHAZ was asked to take me home. On my way home, CHAZ’s General Secretary’s office buzzed on the driver’s walkie talkie to tell me that I had been offered the job and they wanted me to start immediately, although I had no experience in public health and AIDS work in particular! I truly had never anticipated that this could happen. I accepted the offer, very excited! When I reached home I shared the good news with my family. As usual, my daughters Towela and Tamara sang a joyful song for me. This was my humble beginning in CHAZ.

While some of the church hospitals had been around for more than 80 years, long before Zambia became independent, the CHAZ Secretariat itself was very small at that time. There were only three professionals including myself, and a total of eight members of staff, compared to the current number of 167. We only had two sponsors for our AIDS program: NORAD [Norwegian Agency for Development Cooperation] provided us with two vehicles and built five houses for program staff in mission hospitals in rural areas, and the World Health Organization (WHO) global program on AIDS (GPA) that provided money for AIDS education/sensitization and counseling. On the very first day I started work, my new supervisor informed me that he was leaving for England the following day to study for a year to get his master’s degree, but that he was sure I could manage! And so I did.

When I joined CHAZ we had very few mission health institutions doing something on AIDS. My passion was to go around the country persuading each of the mission health facilities to join the fight against AIDS and inform them that we had funding from WHO to do this as long as they accounted for it. We also mobilized funding for our new sexually transmitted infections project from a Canadian donor, SAT, with support from the Canadian Public Health Association and the University of Manitoba, Canada. I also felt that CHAZ should be doing something to control further transmission of STIs [sexually transmitted infections]. SAT sent an expert, Dr. Peire Plourde, who helped us set up the STI program.

In 1992 CHAZ was awarded a grant from the Danish government through Danish Church Aid (DCA) to implement its HIV prevention, care and support program. This was our biggest grant ever in the history of CHAZ. We agreed that they would ship disposable needles, syringes, gloves, and HIV test kits from Denmark and we would distribute them to mission hospitals. This really was the beginning of our comprehensive AIDS program. We were also implementing a strategy of home-based care. This program was an urgent need as the hospitals were overflowing and did not have the capacity to care for all the people with AIDS.

We were also keenly aware that when parents died, their children were left alone. I wanted us to take care of those children. In 1995, we got more money from DANIDA [the Danish International Development Agency] to start an orphan program.

In 1999, I was asked to act as health programs manager for CHAZ. At that time we also had programs for TB, leprosy, malaria, and an eye program. In order to do the job properly, I had to get my master’s degree. While we were negotiating a new project with DANIDA, my boss insisted that I go with him to Denmark to defend our proposal for the new grant, because he claimed that the ideas in the CHAZ proposal to DANIDA were largely mine. The proposal included some money for graduate studies. While we were in Denmark, we were asked why we should include the funds for overseas study. DANIDA asked what guarantee they could have that we would return to Zambia after completing our studies. If there was one thing I enjoyed those days, it was defending a funding proposal and grant negotiating! I did it convincingly and with passion. This truly was God’s gift to me for the benefit of his people through CHAZ.

I argued that DANIDA was working with the government to strengthen health systems, and CHAZ worked very closely with the government, so why would they not want to strengthen our capacity? They asked what guarantee they had that I would return. My answer was that for us at CHAZ the work was not a job but a calling. Time alone would tell whether we would return. I was determined to contribute to the development of my mother country, Zambia, in a small and humble way. I told them that I wanted to work within a Christian organization because for me it was the right thing to. In addition, it was a church in Canada that sent me to school, and this was the only way I knew to pay back. Most of all I saw CHAZ as the only vehicle through which I would achieve my personal ambition of serving the poor and underprivileged.

DANIDA approved a grant worth $1.5 million, much larger than any we had before. I went to England for my master’s in public health and returned to serve CHAZ in the health programs department. I have never at any time considered leaving until I retire.

How and when did you become the executive director?

In August 2008 Dr. Mphuka passed away suddenly. I was in India at the time of his illness but returned seven days before he passed on. Before and after his death, I found myself in the midst of all that had to be done. His wife asked me to deliver the message of his passing to his children. This was very hard for me, to tell their children that their father was no more. That day was a public holiday in Zambia, so I was surprised when I got a call from the office saying the staff was all at the office waiting for me. When I got there, everyone was crying and waiting for me to address them. We said prayers, sang hymns, and mourned. To my amazement, the CHAZ board requested me to act as the executive director.

I was very hesitant to take on the role of executive director. I viewed myself as an implementer and not a leader or politician. I told the board that I would act as executive director for them, but only until they found somebody else. After the position was advertised, the board asked me why I wasn’t interested in the position. I said that I didn’t like politics. I knew that public health was about politics, but the executive director position involved a different kind of politics. It called for mingling with people from all walks of life. The problem is I like to speak my mind and I didn’t want the sort of job where I could not.

However, the pressure began for me to apply for the job. The minister of health at the time, Dr, Brian Chituo, wrote to the board chairperson supporting the Board’s choice for my acting executive director position. Some Church leaders, including the Catholic bishop responsible for health in the Catholic Church, Bishop Mpezele, and others also wrote to the CHAZ Board chairperson expressing similar sentiments. I could handle the pressure from outside, but then my email box at work became clogged with letters from the staff telling me that I was the only one who could do the job. They said I was the only one who would not misappropriate the money CHAZ had. It was humbling. I went home every evening and cried because I had ever dreamt of such a change. Never in my wildest dreams did I aspire for this kind of job in all my years in CHAZ! I did not doubt my capacity to do it, but it was the responsibility that accompanied the job that I was not interested in. I did not like to be in the limelight, but most of all to take responsibility for wrongs I did not personally do. I didn’t want to do all of the politics. I had been working at CHAZ for 17 years and had never aspired to the leadership position. I asked how God had never let me know well in advance that I was headed for that position! I had always loved working on projects (project design, implementation, and monitoring and evaluation) and negotiating grants on behalf of the organization. That was what I was made to do, I believed at the time. How could my God blindfold and take me to such a big position, I wondered. I truly felt that I was not the one and certainly not deserving it!

A conversation with my first daughter Towela, who was in San Francisco at the time, helped me to change my mind. She asked bluntly what was wrong with me. She said I was acting like Moses. She reminded me of all I had done and all that I loved to do. I had overcome so many hurdles in my life, she said. I reminded her that she knew I was dyslexic and stammered at times (though people do not notice it when I am speaking). Why, she asked, were you a prefect and captain in high school, your class representative in your graduate program at the University of Leeds, England? She reminded me that all through my life, I had always been a leader. She insisted that I take the position. My second daughter, Tamara, also believed in her mom to do the job. She is an introvert, and would not speak much but she is very sincere in her comments. So I decided to apply for the job and did the interview. The board told me I actually scored the highest with a distinction in my score. So I became executive director and I am still at it now!

And what year was that?

My predecessor died in August 2008 and they gave me the job in November 2008 but I formally started in January 2009. I had asked them for some time to think about the offer and prepare before I took on the challenge. This is my sixth year in the job.

Women often seem reluctant to take on leadership challenges and you seem to fit the mold! Too often women, especially those with religious ties, seem to favor invisibility. Has your vision changed, now that you are indeed less invisible?

That is true! I think most of us (women) still prefer invisibility. You have to understand, it is still a man’s world. How many countries are ready for female heads of state, for example? Very few men have respect for female leadership. I can go on and on, but I have taken on the role and appreciate the opportunity to lead. Some part of me has changed indeed. I am not shy to speak in public, for example. However, I have had to rely on the Scripture: Joshua 1:5-6, “be strong and brave,” and trust that God is directing my path. I have learned that when you are a leader, you not only have to do the right thing, but you need to be strong and brave to defend every decision you take. You need to ask God for wisdom and have the knowledge to be on top of things in order to make the right decisions. I find myself on my knees often, seeking God’s counsel when I have to make a tough decision. As a woman of faith and a leader, this is where my strength comes from. As I look back, I think I also draw lessons from my parents, who were both good leaders and good role models.

In my opinion, a university education alone is not enough for you to lead. Not at all! You also have to rely on many years of experience. I have to do that as well.

How is CHAZ evolving? Is it getting bigger or smaller? What direction is the organization going in?

It is definitely getting bigger. It is no longer the simple organization it used to be back then. It is now complex. I have a good team, hardworking, and committed to the cause. CHAZ started growing larger when we became a principal recipient of the Global Fund. We want to remain focused on our core business that of serving all people but with a bias towards the poor and underprivileged people in rural and hard reach areas in Zambia with holistic quality health services that reflect Christian values. We are determined to remain the FIO of choice in the health sector, with the capacity to deliver and maintain our position as second to the Ministry of Health and Community Development, Mother and Child. We are exploring ways in which the organization can be sustained if donor support stopped. We have a very supportive board at the moment, which has given us space to innovate while they focus on oversight and policy formulation.

So the overall funding level has increased. But are there new clinics being built which are part of CHAZ?

It is that true funding in CHAZ has increased, but this is earmarked funding for control and case management of diseases of public health concern, such as HIV and AIDS, malaria and tuberculosis. Therefore, this funding is not for infrastructure development. We are careful not to misappropriate donor funding and would not use these funds for something else, no matter how critical. We need donors with “systems thinking.” Perhaps we could then have partners that are supportive of infrastructure development and other support to strengthen health service delivery.

Yes, we have new hospitals and clinics in the membership. We have a new hospital now in Lusaka owned by the Catholic Church. It is small right now but it has the potential to be a referral hospital for all the Catholic hospitals and clinics. This hospital was long overdue. We are all very excited about this new development in Lusaka. We have other new clinics that have been built by other churches, particularly the traditional Protestant churches.

Are there church-run facilities that are not part of CHAZ? For example, Pentecostals? How is the picture changing for the faith-linked hospitals?

Unfortunately it’s just the traditional churches that established and have continued to build health facilities. The Pentecostals rarely do so. The main actors who work on health are the Catholic Church and all traditional Protestant churches: the Adventists, the Salvation Army, the Methodists, and the Baptist groups. It is the very traditional churches that have been involved in health care in Zambia, some for over 100 years. The evangelicals have about three hospitals. The Pentecostals, I cannot even think of one! They help us in public health messages and that kind of thing but are rarely involved in health service delivery apart from HIV and AIDS related programs.

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