Overworked and poorly paid, volunteer caregivers in Swaziland struggling to cope with the growing numbers of bedridden patients with HIV, are faced with a hard choice: to quit or go hungry.

"I love helping people. It is the first time I have done anything out of the home. I do not do this for money. But I am in need of money to buy food for my children now that my husband has passed on," explained Sipiwe Matsebula, a home-based care worker.

The demand for their services is clear: one out of four adults in the country is HIV-positive, and the health system is faced with a growing workload and a shrinking workforce.

Increasingly, non-governmental organisations (NGOs) and government agencies that depend on volunteers are budgeting small monthly stipends to show some appreciation for long hours worked under difficult conditions. But these allowances can be as low as R60 (US$8) a week for a daycare centre worker and R200 ($26) a month for food distribution point workers.

Matsebula started her work as a caregiver at home, tending her HIV-positive husband. She was trained by a nurse from the Nyakeni Red Cross Clinic, 20 minutes north of the central commercial hub Manzini; and subsequently began to assist her neighbours' relatives who were bedridden with AIDS-related illnesses.

"I never had a job, and it felt good to have the responsibility and respect, and get out of the house. My husband had some disability pay from work, and our needs were met.

"I learned to treat people wearing rubber gloves, and supervise their taking the ARVs [antiretrovirals], and help their young ones change bed sheets and wash the very sick ones," she related.

Facing reality

The overwhelming number of AIDS cases in her area and the rising deaths due to AIDS-related illness have not diminished her enthusiasm for her work. But now comes the hard reality of supporting her family, and this means finding a paying job - amid Swaziland's depressed economy.

"What will happen to the people I care for when I am working? I will have to try to see them at night, because at some of these homes there are only small children who can do nothing to assist the older sick people," she wondered.

Swaziland's nurses number about 3,000 and have pay issues of their own, which led to a work slowdown this month. Unresolved issues of security and unhealthy working environments continue to prompt work stoppages.

But volunteers like Matsebula also endure harsh conditions, and instead of ambulances, their transport is their own two feet. An allowance for bus fare is a luxury unheard of, as is a food allowance.

Matilda Simelane, a cook at a community care point for orphans and vulnerable children in Manzini, has no problem with food – her lunch is the beans, porridge and cabbage that she prepares for the centre's 300 children, augmented by occasional fruit.

"My problem is I depend on my working children for everything. My children are struggling. I cannot bear to leave these poor orphans you see at the centre without a cook, but I may have to go back to the market where I was a vendor before I started volunteering here," she said.

Like the pre-school teachers who volunteer at the centre's two classrooms, the two cooks and a grounds man receive R60 ($8) a week from the centre’s maintenance fund paid by a US-based Christian organisation. The volunteer staff has been promised an allowance increase for the past year - but their needs are now overwhelming their patience.

More than cheap labour

Jackson Dlamini, a voluntary HIV counselling and testing officer in Manzini, told IRIN/PlusNews: "In my opinion, volunteers are seen as cheap labour who can be counted on to do everything from taking head counts door to door for aid censuses to doing construction work. The philosophy is that these people who volunteer are helping themselves by helping to improve their communities, which is true. But it is also cynical to use this as an excuse not to budget for workers’ pay."

"The truth is, in the developed world when a school is built or a hospital is staffed, workers are contracted and paid. Nobody would do such work for free, and no one would ask them to. Why are the poor expected to do the same thing for nothing?" Dlamini added.

Going on strike is not an option. Instead, the volunteers drift off to find ways to sustain themselves.

"I would say all the volunteers I've worked with enjoy what they are doing, said Samuel Magagula, who holds a traditional post as chief's runner and who communicates community activities to a band of elders meeting at his chief's kraal.

"Even young men toiling with wheelbarrows full of sand, bringing these up from the river to a building site, they prefer this hard work to being idle, because there are no jobs in their community. But people need to eat, and those wheelbarrows can be heavy," he noted.