Spiritual care to people living with HIV and AIDS within the context of the Reformed Church of East Africa’s Plateau Mission Hospital (Kenya)
Thesis (MTh (Practical Theology and Missiology))--University of Stellenbosch, 2009.
The basic premise of this study is that a spiritual approach to care and support of people living with HIV, by means of a holistic pastoral model, would provide the Reformed Church of East Africa's Plateau Mission Hospital with an integrated dimension in their community-based care programme for people living with HIV/AIDS. This will go a long way in assisting the RCEA's diversification of the existing medical model, particularly in the Plateau Mission Hospital’s catchment area with its ever-increasing cases of infections, deaths, rejections, church-related stigma, orphans and vulnerable children. The researcher proposes the use of a spiritual model in dealing with PLWH in the Plateau Mission Hospital because this will help to address some of the unresolved theological issues that come to the fore when addressing matters concerning the health and illness of people living with HIV and AIDS. The researcher does this with acute awareness of the importance of integrating other approaches in the care and support of PLWH. For a holistic approach to be effected, the social development, medical, psychological and holistic systemic approaches to care must be considered. The holistic systemic approach used by the biomedical personnel and other caregivers should regard the person as a relational and social being acting within a cultural context. On the other hand, the biomedical model serves us with accurate diagnoses and sophisticated methods of treatment within which modern medicine is practiced. Similarly, the psychosocial model considers the influence of the social environment not only to the challenges that PLWH face, but also on the care they should receive. However, research has shown that there is an increasing need for holistic care in health care systems. This calls for the inclusion of spirituality within the developing bio-psycho-social approaches in addressing health and illness, particularly for people living with HIV and AIDS, in order for them to attain holistic healing. Plateau Mission Hospital, being a church-based institution within the jurisdiction of the RCEA’s southern presbytery, can be an effective vehicle for pastoral care of people living with HIV and AIDS. The organization is strategically placed and has the capacity (resource persons) to engage in a holistic ministry. The paper also aims at unlocking the RCEA’s resources to become more involved in all rounded existential issues of PLWH in the hospital’s catchment area. In this study, it is presupposed that, although the Hospital has a history of medical and social development work and chaplaincy office, it lacks emphasis on the spiritual dimension, and yet this focal point is important in terms of the immediate HIV/AIDS context at Plateau. The researcher established that the training that the personnel at the medical facility have undertaken promotes a clinical approach to all issues of health (prevention and treatment after prescription), even to people living with HIV/AIDS. Methodology. The first methodology for data collection that the research employed was literature review. In this case, library and church documents were reviewed to gather information on related matters. The areas reviewed were related to spirituality, care and healing in the context of HIV, pastoral care and theology in the context of HIV, and biomedical approaches in relation to the care of PLWH, and documentation (Plateau Hospital Reports, the RCEA’s constitution and Care Departmental Reports) on the RCEA’s approach to Hospital care to PLWH by means of the CBHC programme at the Plateau Mission Hospital in Eldoret. The websites were also consulted for purposes of data collection. The second method was conducting specific oral and written interviews with the Hospital’s CBHC staff, PLWH, congregational and church leadership on matters of the proposed spiritual care of PLWA. The areas interviewed were for the spiritual needs, those involved in the care and support of PLWH, improving existing interventions, the challenges encountered in the care for PLWH, the unfulfilled needs of PLWH and how spiritual care could improve the quality of the lives of PLWH. The third method of data collection was participant observation. The researcher was involved in the activities being studied. This method entailed participant observation during normal diaconal care activities in the RCEA’s Plateau parish congregations that the researcher implemented, for instance visiting people living with HIV/Aids, taking gifts to children affected by HIV. In meeting with volunteer caregivers during visits, while joining the CBHC team during follow-up meetings with PLWH in their homes, data was collected. The researcher had patient consultation during days for voluntary counseling and testing and informal meetings with volunteer caregivers. Presentation of the Thesis - Outline of Research This study is divided into five parts. Chapter 1 will examine the background to the study considering the problem statement, research questions, research objectives, hypothesis, justification, the scope of the research, the methodology used, limitations and delimitations. In Chapter 2 the paper will explore The Kenyan Scenario: Medical work and the involvement of the church within the community. This will cover the Kenyan national HIV updates, Uasin Gishu updates, Ainabkoi divisional statistics, the background to the Reformed Church of East Africa, Plateau Mission HIV ministry covering the psycho-social approach to community-based care of CBHC in the Reformed Church of East Africa in the Plateau Hospital catchment area. The paper will examine the medical care offered to people living with HIV/AIDS, such as the treatment of opportunistic diseases, administration of anti-retroviral drugs and the prevention of mother-to-child transmission and voluntary counseling and testing. The paper will also examine the social and developmental activities and services rendered to PLWA and the orphans and vulnerable children by means of compassionate care. CBHC networking with congregations, and Moi Teaching and Referral Hospital will also be highlighted. The paper will also highlight the gaps experienced as a result of the focus on medical and social developmental approaches to the care and support of PLWA and OVCs. Chapter 3 is largely the analysis of interview responses, and presents the findings of field research at the RCEA Plateau Mission Hospital’s selected area of study. This will indicate the seriousness of the unattended needs in this case the spiritual needs and the magnitude of the problem in the health facility but, by implication, affecting the church. This will need a change of stance, namely that of regarding HIV as a medical problem that the hospital needs to address, and view it as a collective need for all key players in church, hospital and community. Chapter 4 will look at the challenge HIV poses to the spiritual care of PLWH in Plateau Mission Hospital. The chapter will contain a literature review on the holistic approach in the care and support of people living with HIV. The section will look at understanding the needs of people living with HIV, pastoral care of people living with HIV, practical theology, biomedical and bio-psycho-social models in the care of PLWH. The study will also examine the relevance of God-images, systems approach, the role of the church and a spiritual care approach in the holistic healing for PLWH by means of pastoral care. Chapter 5 will conclude the paper and will shed light on the importance of the proposed approach to be integrated into the current strategy (pastoral care model with a spiritual-care approach). It is hoped that the recommendations that will be made at the end will strengthen the high demand for a holistic-care ministry to people living with HIV and the affected families in the RCEA Plateau Mission Hospital.