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.