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.  

Training Day(s)

Field Workers and Nurses learning about HIV Counseling

OK.  So just a little background on CMMB’s TB project before I get into the important part of this post.  CMMB started their TB project, which involves door-to-door screening for TB and HIV testing aiding in the South African Department of Health’s intensified TB case finding campaign, in late August and really had to hit the ground running.  Approval for the project was wrapped up in red tape for quite some time (shocking, I know) so as soon as it was approved there was a lot of ground to make up from the original plan.  Because of this, there was little time to prep our field workers and nurses leaving most of them to have the bulk of their training on the job. 

Mama Gwiji Demonstrating how to collect Sputum

In order to make sure all the teams were on the same page and adequately armed with the information about HIV and TB, a mass 3-day training was held last week for all of our field workers and nurses.  Topics included a review of HIV and TB symptoms and disease processes, counseling methods, HIV testing procedures, specimen collection, etc.   Questions were addressed and solutions for some of the issues being experienced in the field were implemented. 

Overall it was an extremely successful training.  Our Field workers are so motivated and were so enthusiastic about participating in the training sessions.  I think they all left with a much better picture of HIV and TB as well as the impact they can have on their communities through CMMB’s project.  I am really excited to see the progress we make over the next year! 

Happy Thanksgiving!!!!!

Yes, yes I know I am a few days late but since it was just another workday in South Africa, festivities with my host family had to wait until Friday night.  Can I just say, I found it somewhat difficult to properly describe Thanksgiving.  I feel like I must not be doing it justice because most of my coworkers said it sounded a whole lot like Christmas to them.  Even more challenging was describing Black Friday, and now I’m pretty sure they think Americans are crazy.  They might be right… 

Anyway, last night I cooked a small feast and my family and some friends came over to partake in my make-shift holiday.  I of course made everyone join in with the cliché Thanksgiving tradition of going around the table and say what you are thankful for this past year and it was pretty clear that we are one lucky group of people who have been blessed with love, family, and wonderful experiences. 

Turkey Day Spread

I think the success of my Thanksgiving was best summed up by my host mom, Bomza.  This morning she told me,  “Nikki, your Thanksgiving meal was so wonderful last night, but I ate so much I almost died!”

And now just a few things that I am thankful for this year:

I’m thankful for a host family that entertains my requests for celebrating American holidays.

I’m thankful for the friends that I have made in South Africa, I don’t think I would be surviving without them.  

I’m thankful that I have such wonderful friends at home who have made me feel like we are just in different cities not on different continents.

 I’m thankful for my wonderful host family that has made me feel right at home since Day 1.

 I’m thankful for my family back home who has been so supportive and encouraging of this adventure.

 I’m so thankful to have this opportunity and excited to see what will happen during the rest of my time here! 

TB or not TB?

Many of you who know me, especially my fellow MPHers, know that I have a ridiculous obsession with Tuberculosis.  It's truly a fascinating and quite complicated disease posing many issues in the way of both treatment and prevention.  South Africa has one of the highest rates of TB in the world mainly due to its massive population of individuals infected with HIV.  TB treatment and prevention is one of South Africa's Department of Health's top priorities, which is why CMMB has recently started their TB project which consists of going door to door to screen people for the disease.  Naturally I gravitated to this project and I have been trying to use what I learned in my Masters program and what I gained from my experiences working in TB in Kenya to contribute its development

TB Poster in Grey Hospital Clinic KWT

I know finding and treating someone with TB seems simple enough, but its really a quite complex process.  The first round of screening is a questionnaire about TB related symptoms.  If someone appears to have symptoms, then our field workers collect sputum and send it to be tested.  But, of course, that can't be the end of it.  Because TB is difficult to detect, the standard procedure is to collect 2 samples from each patient on 2 separate days, meaning two trips to each person's house for our field workers.  Once this step is complete, the samples are sent to the lab where they are observed under the microscope.  From this the lab gives you a positive result (they saw TB bacteria under the microscope) or a negative result (no TB seen here!).  Simple right? Wrong.  Now there is the issue of using microscopy to diagnose TB.  It really isn't that great of a test.  For one, TB is easy to miss under the microscope not to mention the many issue that can arise with sample quality and contamination issues.

So what do you do if a patient has a negative lab result but suffers from TB symptoms?  Some of the rural clinics in my area say "that's it, nothing more we can do" while others will refer the patient for an xray and doctors visit.  However this happens at another clinic, which adds cost and travel time for patients that have little time or money to spare.  At every turn TB control becomes more and more difficult.

Sign on Exam Room Door Zwelitsha Clinic

Now lets say your patient's test comes back positive.  Great! They have TB so let's start them on treatment, problem solved.  If only it were that simple... First off, to cure TB a person needs to be on treatment for at least 6-9 months.  That's taking a pill every single day for at least 180 days straight.  If you start missing doses then your problems get WAY worse.  Improper TB regimens lead to drug resistance, and let me tell you, drug resistant TB is not something you want to mess with.  You'll have to go back on treatment for much longer and you're going to have to take more drugs than you did before.  Drop the ball again, you are likely to cause further resistance leaving you with very few options for treatment.

Much more than making sure that drugs and doctors are available goes into successful TB treatment and prevention.  You have to think about the barriers patients face when it comes to accessing these services.  Do I have transport to get to the clinic? Can I afford the associated costs? Can I leave work? Am I worried about stigma if someone sees me in the TB section of the clinic? How will I make sure I I have a continuous supply of medication?

The list seems ENDLESS.  My hope is that through this program we can address and eliminate many of these barriers by bringing clinic services directly to the people in our communities and having a well-defined referral system for the services that are beyond the scope of what CMMB can provide.  Establishing this should make for a VERY busy year.

MTA: Beyond Just HIV Testing

This past week, I had the pleasure of meeting with the fieldworkers for CMMB’s Men Taking Action (MTA) Program.  As mentioned in my previous post, MTA aims to increase HIV testing by empowering men with health education to encourage their families to get tested and educate them on how to prevent HIV.  The field workers for this program go door-to-door in the rural areas throughout the Eastern Cape offering HIV testing and counseling along with other general health screenings for tuberculosis, STIs, and diabetes.

MTA Field Workers in fromt of CMMB's KWT Office

Can I just say, our field workers are AMAZING!  The program has been running for 4 years and they still approach each day with such enthusiasm and with a commitment to furthering the project.  They are so organized and methodical about making sure they offer services to all the homes in their respective areas. 

What I really love about this project is all the benefits that come with offering HIV testing services in the home.  For one, clinics in these areas are few and far between making it difficult for families to access care.  Furthermore, the stigma surrounding HIV is high and because of this, many choose to not get tested because they don’t want to be seen going into the clinic for any HIV related service.  By giving them the option to test in the privacy of their home it actually increases their likelihood of getting themselves and their families tested.  

Field Worker's Map of the Houses Covered in his Area

Not only does CMMB provide services directly to the client, but also through the course of the MTA program, our field workers have served as a link between our clients and the services they need.  In our meeting last week, one of the field workers Xoliswa, was telling us about a family the she encountered on her daily rounds in Ndevana.  The head of the household was a young woman who had been left to care for her 1 year-old son, 4 of her brothers and sisters, and her grandmother.  The woman was HIV positive but was unable to get her supply of ARVs, her child was ill, and the whole family was suffering from malnutrition.  Seeing the state of the house and family, Xoliswa made appointment for the woman and her son at the clinic for the following day.  There, she was able to get a supply or ARVs, her son was checked out and treated, and the woman met with a social worker to apply social grants to help take care of her family.  

About a month later Xoliswa stopped in to see how the family was doing and was pleased to find them in a much happier and healthier household.  To me, this is just another great example of how willing the field workers are to go above and beyond to make sure that their clients are linked to services beyond the scope of our programs.    

Bizarre Foods!

Ok so the foods I've had this past week are not really bizarre but they are definitely not what I would consider my "normal" or "everyday" types of food.  So I don't think I have told you much about my host mom but she has a side business as a caterer.  Needless to say, I have yet to have a bad meal.  She has been trying to cook things that she thinks are American or something I will recognize but last week I told her that I would love to try some traditional Xhosa dishes.  Man, I definitely got what I asked for!  So far this week dinner has included cow liver, sheep tripe, tongue, and chicken livers.  Like I said before, my host mom is an amazing cook but man, I don't think I am meant to eat liver, from any animal or in any form. The tripe and the tongue, on the other hand, were pretty good!  In addition to new and interesting meats we also had samp (kind of like corn meal) and peas, Umbhako (steam bread), and dumpling bread.  There are talks of a pickled fish dish for next week, I'll keep you posted...

The Work We Do

The view heading out of town

I realized that I totally forgot to talk about what I doing work wise, you know, the whole reason why I am here...

I am based in a CMMB office in King Williams Town that is running 2 really cool projects.  The first one is called Men Taking Action (MTA) which is in its 5th year!  Basically, CMMB targets men in the rural communities with education surrounding HIV and urges them to discuss HIV with their families and for all of them to know their status.  To accomplish this, field workers go door-to-door in the rural areas and offer free HIV testing and counseling.  This method of HIV screening gives people the privacy to test in their own home (ideally making it more likely for them to find out their status).  Clients receive their results in 15 mins and if they end up testing positive they are referred to treatment centers so that they can have confirmatory tests and if needed, start on meds and receive education on how to properly manage their disease.  As this project has progressed it has also encompassed additional health screenings.  Now, the field workers will screen people for diabetes, STIs, and hypertension all at home to help reduce the burden of getting to and from the local clinics which can be pretty far from where many of these people live.

Buffalo River running through Amatole

The new project that just started a little over a month ago is a Tuberculosis program modeled after MTA.  It follows the same premise, but it focuses on TB screening and sputum testing services.  There have been a few kinks to work out which has made for some hectic days at the office but all in all the program is off to an amazing start and I'm really excited to see how things progress over the next year!

In closing, I FINALLY got to go out to one of the rural areas today, albeit just to quickly drop something off, so the pictures above are of the scenery we passed while driving out to the clinic.  Oh and dont worry, I have been promised many more longer trips out to where all the action happens, so more amazing photos to come! 

Houses on the hills of Ndevana

I made it!

Ok so yes, I have actually been here for 2 weeks now but I kept putting off blogging because I didn't know what all to say.  Alright, lets start with the basics...

I arrived in Joburg on the evening of the Sept 25 and then took a train to Pretoria, and let me tell you, I looked SO ridiculous dragging my 2 giant bags and backpack on and off the train in my post flight zombie-like state.  The next morning I went to CMMB's head office for a quick orientation and overview of all their programs then was whisked back to the airport in Joburg (the second go at the train with all my stuff was much better than the first) were I caught a flight to East London.  When I arrived in East London I was met by my new host mom and my project manager who then drove me to King William's Town.

Let me tell you about my host family.  They are AMAZING. I have a host mom and two sisters and all of them are hilarious and so loving.  They had my room all made up and decorated for me and had a delicious dinner waiting for me when I got there.  So far things are going great at the homefront.  Every day when I come home from work, we start dinner and pretty much just hang out until its time to go to bed.  On the weekends we are always going somewhere or doing something so all in all, life is good!

Bring and Braai Fundraiser

Let me start off by saying I have AMAZING friends.  Seriously, they are absolutely, totally, one hundred and ten percent the best and Mercy, I could not have pulled this off without you!!!

So the fundraiser for CMMB which was supposed to double as a goodbye party for all of us leaving NOLA was originally scheduled for August 28th.  The plans had been made and the food had been prepped and then, along came Isaac.  As sad as I was to have the event canceled I truly cannot  think of a better way to end my time in New Orleans than by riding out a hurricane.




Long story short, the fundraiser was rescheduled to last night and even though I wasn't in New Orleans anymore, my friends held it for me.  All things considered it was a pretty great turn out.  It was held at Handsome Willy's Bar which is right across the street from Tulane School of Public Health and a favorite hang out spot after class.


It was a great night to sit out on the patio with delicious food (South African BBQ style), great drinks, and live music.  I heard that a Painter even showed up at one point!   It sounds like everyone had a great time.  Thanks so much to everyone that made this possible, I miss you all!!

It's Officially Official!

My ticket has been booked and I will be leaving for South Africa on September 24th.  Now I just need to figure out how to entertain myself for the 19 hour flight... suggestions welcomed!

And thus it begins...

The countdown begins!  I will be leaving for South Africa in late September and I have to admit I am a combination of excited, anxious, nervous, sad, worried, and elated.  More details to come!  I wish I knew what to pack...