Life in Two Different Worlds

What I have found most striking about living in South Africa is the disparity that exists in almost every element of life.  When you are in the cities you find yourself in the modern world with most of the amenities you could ever want.  But then, not more than a couple miles away, you’ll find a township with few if any paved roads, thousands of tin shacks, garbage piled in the streets, inadequate sewer systems, and little to no electricity.  As you can imagine, bouncing between these two different worlds can make life here frustrating especially since it’s clear that the infrastructure for all of the necessary services exist, but they are poorly maintained and in some cases, not even utilized at all. 

Tin shacks and trash piled up on the outskirts of Ducats

The most gleaming example of a community that has been left behind is Ducats, which is a resettlement area outside of East London.  Being a resettlement area, most of the houses are government-built two-room homes meant to house people that have been moved from over-crowded communities.  Despite the fact that these houses were built within the last 5-7 years, most of them receive no upkeep from the government and as a result, are starting to fall apart.  Many people have erected tin shacks as supplement shelter or to make up for the limited space of these homes, leading the people in this community to revert back to living in the same conditions in that caused them to be “resettled” in the first place.  Compounding the poor structure of these homes is the facts that they were not built with any kind of sewer or water hook ups, forcing the people of this community to use communal taps for their daily water supply and communal latrines for sanitation.  Trash removal is rare, livestock freely roams the community and while there are outlined streets, no formal roads (dirt or paved) exist. 

Probably the most egregious oversight in the planning of this community has to be that there is no clinic.  The nearest clinic is about 5 miles down the road, so definitely not a walkable distance for anyone who is sick.  There are public taxis (minibuses), but that trip will cost an individual $3 each trip, which may not sound like a lot, but trust me, that’s a decent chunk of a person’s daily living expenses in this community.  At one point, Ducats was receiving health services from a mobile clinic, which in itself has its own limitations on the care that can be provided and the number of people that can be reached in a day, that used to come once a month.  This service has recently been suspended due to provincial cuts in the fuel budget for Department of Health vehicles, leaving the community with no local services at all. 

Ducats fieldworkers testing at a community events 

Despite all of these challenges, the community of Ducats is resilient.  They are so active within their community and are hungry for change.  They are constantly holding stakeholder meetings to voice their concerns about service delivery and even take it upon themselves to reach out to departments like social services to come and provide information to the community and host events to spread awareness.  Even the CMMB fieldworkers that were recently hired for the TB project are motivated to make a difference.  Aside from doing an amazing job providing door-to-door testing services, they want to make sure that their new skills can be utilized even after their contract with CMMB ends, and have thus made arrangements with the nearest clinic to continue to provide testing and other health services as volunteers for the clinic.  This is just one of the many reasons why I will always have a spot in my heart for the community of Ducats.

The TB project is taking off!!

CMMB Fieldworker giving HIV test results to a
client in Phakamisa 

While I realize that we are currently halfway through April, this post is going to be dedicated to the month of March, which was absolutely hectic!! As I have said before, the TB project I am working on has really taken off since January.  Each month our fieldworkers are reaching more and more clients with HIV and TB testing services and we couldn’t be more excited! 

Last month was spent trying to keep up with the pace of the project by making sure that as soon as testing was completed in one community, the teams had another area ready and waiting for them.  Aside from the fact that coordinating the movements of 5 teams is a daunting task in general, starting to work in a new area isn’t as simple as pointing to a place on the map and showing up.  Community entry has been one of the most difficult challenges of this project.  It involves working with community leaders as well as other stakeholders to spread the word about CMMB and what services we are providing and, ultimately, getting permission from each community to work in their area. 

Homes in "TB crisis" area of East London

As I am sure you can imagine, each community is vastly different.  They all have their own power structures and politics that play a role in their final decision.  Most communities are simple: we explain what we are providing, they like the fact that we are offering our services, so we start working in their area, no problem.  Other places have created a myriad of hassles causing us to start working, then getting chased away, then asked back because other community members really want our testing services, and then chased away again... leaving you feeling like you are in an endless cycle. 

On top of trying to keep up with all community entry struggles, it was decided that we should try and expand our project to the East London area. 

Homes in "TB crisis" area of East London

Many of the communities surrounding East London are what the department of health deems “TB crisis areas.”  They are densely populated and most have extremely substandard living conditions, which is only contributing to the problem.  I think this is a really great opportunity for the project to have a huge impact in an area that is truly in need of an intervention.  The process of getting everything set up and teams in place to offer door-to-door services is definitely not going to be a picnic but I’m excited for the challenge and to see what will happen over the next couple of months.

I think what I really love about this project is that even though its only been fully operational for 6 months now, we are able to see an impact.  The department of health has seen a dramatic impact on their TB indicators (the factors they use to measure the effectiveness of TB services in a given area) and they are

extremely pleased with our progress.   The communities are grateful as well.  Whenever I get to go out into the field, it is very apparent that most people really just don’t know anything about TB.  They don’t know how you get it, they don’t know how to prevent it and they don’t understand the importance of treating it.  The plus side is that, at least in my experience, many of our clients become extremely engaged in the conversations about TB.  They always have so many questions and by the time they are finished with the testing and education process it seems like they are walking away with a lot more knowledge then they had before.  The project may not be perfect, but at least something is clearly working, and that makes all the stress of work and being far from home totally worth it.

Young clients learning about HIV and TB 

IOU

It's definitely been a while since I had time to post, and in all honesty, I have no time for a legitimate post at the moment.  The project I am working on has been doing extremely well, with the number of clients served growing each month.  Needless to say, its keeping me busy.  In the meantime, I'm just going to share a link to the writeup CMMB did about my project for World TB Day a couple of weeks ago.  I think it's a really great overview and might give a good idea of what I am doing on a daily basis.  Enjoy!  I promise more posts soon!

http://cmmb.org/offers-door-door-tb-testing   

The Past 2 Months

Alright, so I know its been almost 2 months since I last blogged but in my defense it was the holidays and then the beginning of the year was quite hectic and I have barely had a spare moment… with an internet connection… to keep this thing updated.  So I think its best if I just dedicate this post to a semi-brief update for the last two months. 

Christmas Day on top of Table Mountain in Cape Town

Shopping at the Pan-African Market Cape Town

I spent Christmas and New Years in Cape Town with Krista, the other MVP in South Africa, and Winrose, a nurse from Kenya who works for CMMB’s Medical Male Circumcision project in KZN with Krista.  It required a 20-hour bus ride from King Williams Town, but it was totally worth it!  We had a BLAST!  Cape Town is easily one of the most beautiful places I have ever been and we spent our vacation touring around, laying on the beach, and of course, eating lots and lots of seafood.  Highlights included a Christmas Day on top of Table Mountain, Hiking out to Cape Point, seeing penguins, daily time on the beach, and a few days hanging out in Stellenbosch (wine country).  I think the general consensus by the end of the trip was if we had a choice, we would never leave Cape Town. 

South Africa Strategic Planning Meeting Group Shot

So all in all, the holidays were great but I was quickly snapped back into reality when the office opened in January.  The TB project that started in August had really been gaining momentum in December, and when we came back from the holidays we found that our fieldworkers had been working over the break and were ready and raring to go.  The beginning of the year also brought lots of planning for the projects and several meetings with all our partners and the communities we work with to prepare for the needs of the coming year.

TB Nurses ready for testing at Walter Sisulu University

The end of January brought a last minute invite to Pretoria for CMMB South Africa’s yearly strategic planning meeting.  The meeting consisted of the staff from the South African head office, project managers, MVPs, staff from the US offices, and regional directors as well.  The point of this week long meeting was for everyone to come together and make a plan as to what issues need to be addressed in the projects and how will CMMB SA as an organization move forward and develop during the course of the year.  The week was extremely productive and I personally really enjoyed the opportunity to collaborate with staff from different countries, specialties, and projects. 

Training on the new PIMA machine to do CD4 counts in the office 

Despite the fatigue following a week of all-day meeting everyone seemed to leave Pretoria ready and raring to advance our projects throughout the coming year.   As a result, February was insanely busy.  Per usual, the month was filled with community events and trainings.  I am really happy to report that our fieldworkers and nurses have really gone above and beyond this month, providing services to more clients than any other month the project has been running.  Of course reaching and exceeding our targets is impressive, the truly exciting fact is that those “targets” are people who are directly benefiting from the services that CMMB is providing.     

Field Trip

Kid trying to figure out why I am pointing my phone at him

This week I was able to spend some MUCH needed time in the field.  Don’t get me wrong, it’s not that I don’t  loooooovvvveeeee compiling data and writing reports in the office, but I am always happy to have the opportunity to visit the communities where we work.  I think it gives me a much better perspective of how the TB project works.  Sure I can look at the numbers and see how many people are benefitting from our services each month, but going door-to-door lets you see who these people are and how much of an impact providing something as simple as an HIV test or TB screening can have.  

Fieldworker counseling a client in her home

This week I went to Sweetwaters, which is an area just outside of King Williams Town, mainly to observe our fieldworkers in action and help identify/correct any problems they are having with the project.  Let me just say, our fieldworkers work SO HARD.  They are so great at interacting with the clients and you can tell that they really have a passion for what they do. 

Mrs. Ntutu explaining how to followup with clients

One of the best parts about being in the field is that you get to see the people our programs reach.   For me, it’s nice to actually put faces to the numbers that I deal with all day especially when you can see the impact providing door-to-door services provides on an individual level.  Even more awesome is seeing Mrs. Ntutu in action.  She is the project supervisor and she is SO good at her job.  When she is in the field, you can just tell she is totally in her element.  She loves teaching the fieldworkers and interacting with the clients.  She is the person who definitely goes above and beyond the services of our project to make sure that our clients are being linked up with the services they need.  The world could definitely use more people like her.  

World AIDS Day

Bongiwe and Ntando posing with CMMB car

On Saturday, CMMB was invited to be an exhibitor at the Eastern Cape World AIDS Day event in Mdantsane.  There was a huge build-up for the whole month prior to the event to engage the community in health education surrounding HIV/AIDS as well as encouraging them to attend the event.  CMMB took part in this build up during the month of November by going to the taxi ranks in King Williams Town and offering testing services to people coming and going in and out of town as well as promoting the event in Mdantsane.  We also joined with the Department of Health’s door-to-door services (obviously our specialty) and visited homes in the areas surrounding Mdantsane.  During this outreach CMMB did their normal practice of offering counseling and testing for HIV as well as screening and testing for TB.

Ntando setting up his testing station

On World AIDS Day, the event was held in an outdoor stadium where the finals for the youth soccer, netball, and boxing tournaments that had taken place in East London during the previous week were played.  The events also included speeches from keynote speakers and focused on youth outreach to promote their goal of a generation with 0 new cases of HIV.  Unfortunately, the weather was not on our side.  It was cold, rainy, and windy which definitely put a damper on the festivities.  But still, all things considered, the event was pretty well attended.  CMMB had a tent set up and offered HIV counseling and testing as well as general health information pamphlets.  We had to get creative to create private areas for people to test.  Solutions included creating makeshift partitions in the corners as well as using the CMMB car as a testing “room”. 

Timbela counseling a client

Family poses while waiting in line for testing

For me, I rarely get to go to the field so it was fun to watch our fieldworkers interact with clients.  They are all so passionate about what they do and so good when it comes to interacting with clients.  Even though it was a busy day from start to finish, it seemed like everyone on the team really enjoyed themselves.

This might actually be working!!

I just wanted to share a really awesome story that was shared with me yesterday.  Im sure it won't give you all the "warm fuzzies" that it gave me but I am going to share it with you anyway....

I was at a meeting yesterday with the sub district office for SA Department of Health (they have partnered with CMMB for the TB project that just started a few months ago) and the clinic programs manager, Mrs. Nelani, shared a great story with us.  She was at a funeral (this is not the "great" part of the story)this past weekend in Ndevana, and area where CMMB provides testing services, for a man that had died from TB (also not the "great" part I am referring to).  At the funeral they spoke about how sad this death was because it could have been prevented.  Then as more people got up to speak they kept talking about how TB is a disease that needs to be taken seriously and pleading with people in the congregation who are on TB treatment to stick to their regimens.  They also talked about the importance of people being tested for TB and that, as a community, they can prevent this disease etc etc. 

After the funeral Mrs. Nelani was so impressed with the information that these speakers were sharing with the congregation.  She asked one of the speakers how he and everyone else knew so much about TB.  The man told her that he and his community had learned about TB from "some Catholics" that have been coming door-to-door offering HIV and TB testing.  As soon as he said that, Mrs. Nelani knew the "Catholics" he was referring to was actually CMMB.

From my own perspective, I think it is really encouraging to see that the education we are providing to clients is really helping people to understand more about TB as a disease.  Of course the testing services we provide are important, but in all honesty, the health education that accompanies testing is the sustainable piece of this program that is going to last when project is over, hopefully helping to prevent new cases of TB in the future.  And after all, that's why we do what we do.