Solitude in South Africa

re·treat  /riˈtrēt/

Verb     (of an army) Withdraw from enemy forces as a result of their superior power or after a defeat

Noun     An act of moving back or withdrawing

After months of numerous life changes, cross-country/cross-continental moves, and excitement-filled adventures, I needed to step back from the whirlwind. I retreated to Ha phororo, a Sotho name meaning "the place of the waterfall" for the weekend, seeking renewal and refreshment in its waters through reflection and prayer.

This youth retreat community sits near the Magaliesberg mountains, overseeing the Hartbeespoort dam. It is an ecumenical center with a foundation rooted in the Catholic Church. What made this community so unique and beautiful was the obvious influences of various religions, cultures and philosophies. For example, take the Izolwana Garden of Tranquility- a Zen garden, traditionally intended to aid meditation about the true meaning of life.

"In the East, the raking of a sand garden is a way of life. Calming and soothing, a pattern between the rick islands emerges and stress and anxiety flee. So rake a while, and take home a little tranquility from this place."

 The garden set against the Magaliesberg Mountains, which are among the oldest mountains in the world. It's almost 100 times older than Everest.

A wooden chair with carved images of elephants and game animals. Beautiful interwoven elements of African and Japanese culture.

Labyrinths are an ancient form of body prayer and can be found on all continents and in all religions. There are three labyrinths here, a Native American, a cosmic walk, and another similar to the most famous labyrinth set into the stone floors in the nave of Chartres Cathedral in France.

It was my first time meditating in this form, and I found it surprisingly calming. There are three things I'm supposed to keep in mind while walking- release, receive and integrate. I found myself letting go of my preoccupations and really stopped thinking. Meditation has always been a challenge in that respect for me, as I have found it hard to just clear my mind of all thoughts. But the rhythm of walking around in circles and hearing the rocks crunch beneath my feet did the trick. As I continued walking, I tried to be aware of the present moment and enjoy the beauty of my surroundings. 

 I finally reached the center, where I reflected on a text. 

Friday evening began with a Jewish ceremony of prayer and blessing over wine to celebrate the opening of Sabbath. Taking part in Kiddush for the first time was very special and helped me better understand what Jesus was probably doing on a Friday evening. We closed the Sabbath on Saturday evening and proceeded on a light meditation through the darkness to the bush chapel. On Sunday, it was amazing to take part in Taize prayer-African style. Taize is a religious community founded in France during the WWII, borne out of the desire to show that members of various churches, nations, and races can live together harmoniously. Taize has spread all over the world through its meditative music, in which shorts songs of a few verses are repeated again and again in prayer. 

We closed the weekend with a truly awesome Mass, where all God's creatures were welcomed (the dogs were very well behaved), and chants and song were in English, French, Zulu, Sotho, Hebrew, and Latin. It was a beautiful way to end the weekend. Ha phororo is definitely one of my favorite places so far in SA.

Part II: Umama noSana Uthukela Community Project

 

The second aim of this project as mentioned in the previous post is to revive clinic committee (CC) programs to ensure community participation and service provider accountability. You might be wondering, what are clinic committees?

CCs are a part of SA's governance structure intended to give expression to community participation at a local and district level. They are composed of various community members and can include elders, traditional healers, community care givers (CCGs), and Sisters (the local term for nurses, who are most often female...I've asked about how to respectfully address a male nurse to which I have not gotten a definitive answer, but it has been confirmed that we don't call them Brothers :). The CCs are intended to act as a link between communities and health services, relaying the health needs and aspirations of the community to to different levels of government. They are crucial entities to improving health status of a community, and especially as related to Umama noSana, crucial to improving demand for maternal and child health services through community mobilization. 

There are four CCs we're targeting at four different sites around the Uthukela district. Our first task was to meet with the CCs and assess how functional they are, learn about their work, and find out what challenges we could help them with. The first CC meeting at Driefontain was very productive, and we met an engaged group of people. (Every clinic is identified with medical symbol and the first letters of the area.)

Working with the community is easy-peasy I thought. How naive of me to take ease of communication for granted. My perception was rather premature as things quickly went downhill after that. We arrived to a scheduled meeting with the second CC at which there were zero people in attendance. Apparently the Sister with whom we had talked to and planned the meeting with decided not to tell any CC members about it. I was flabbergasted to hear and see her blatantly deny that we had come to speak to her the week before to set it up. The story turns out that this particular Sister has been having some issues with the Sister in charge at the clinic, and she seemed to be sabotaging clinic work from the inside. Next, we had the third CC meeting to which only two members came because the remaining six to eight of them recently were employed and would not be available during the weekdays to meet. There are telephones at these clinics, but it apparently didn't occur to the CC to let us know and reschedule another time. Then there was the fourth CC that we unsuccessfully scheduled a meeting with, the failure related to the local politics of the community. There was infighting for control of the CC between the former CC chairperson and the tribal chief. We trekked all the way to the tribal court in an attempt to make some headway, but was only met with the chief's mother who told us to come back in 6 weeks to request a meeting with the chief himself when he's back in the area. We could merely only make a request in 6 weeks, not even have a meeting with the CC itself! 

These incidences of breakdown in communication were frustrating, especially since there was quite a bit of preparation for each meeting. Traveling is not a walk in the park either. These clinics are located in remote rural areas, anywhere from 30 minutes to one hour away from Ladysmith. Many of the roads to the destination are paved, but many others are still dirt. These are some of the scenes I saw out of the car window.

So what we found out was that only one of the four CCs is really functional. This may not be surprising as it reflects a national trend. In 2008, there was study assessing the status of the CCs in all of SA. It found that while 57% of facilities reported having a CC, there was a wide range of factors that impacted how functional they are. Yes, national legislation had created a political climate receptive to community participation, but the lack of provincial guidelines, inadequate resource allocation, and the limited capacity of committees constrain their abilities to actively fulfill their intended roles and responsibilities. 

We have a lot of work to do on this part of the Umama noSana, and it's been a humbling exercise of patience so far.  

Part I: Umama noSana Uthukela Community Project

Although I'm based in Johannesburg, I have been spending most of my time in the town of Ladysmith in the KwaZulu-Natal province and working closely with the Mpilonhle Santuary Organisation. Mpilonhle, which means holistic health in Zulu, is one of the original community-based NGOs that was sponsored by BMSF-STF program in the early days. 

Umama noSana Uthukela Community Project, meaning Mother and Child Community Project is one program I'm working on with Mpilonhle and the Nelson Mandela School of Medicine at the Univeristy of KwaZulu-Natal in Durban. The project aims to 1) mobilize the community to improve demand for maternal and child health services and 2) revive clinic committee programs to ensure community participation and service provider accountability.

Many women in parts of the world, including South Africa (SA), have a high risk of dying while giving life. According to figures released by in 2010, there were 625 maternal deaths per 100,000 live births in SA. Compare that to U.S. figure in 2007, the latest year for which data is available, the maternal mortality rate was 12.7 deaths per 100,000 live births. The SA Millennium Development Goal has set a target of 38 deaths per 100,000 live births for 2015. That means there's a lot of work still to be done!

Two-thirds of these largely preventable deaths are a result of non-pregnancy related infections, obstetric hemorrhage, and complications of hypertension during pregnancy. A myriad of factors have been identified as contributing to maternal mortality, including minimal antenatal care attendance, delay in accessing medical assistance, poor diagnosis, and sub-standard care by health workers. As for disease burden for children, the most common causes of death for kids under five are: AIDS-related death including TB (40%), deaths during neonatal period (18%), low birth weight (12%), diarrheal disease (11%), pneumonia (6%), severe malnutrition (5%), infections (3%) and birth asphyxia (3%). A healthy child starts with a healthy mom.

So in order to mobilize the community, we are developing and conducting household surveys to assess the challenges and gaps that exist as related to maternal and child health issues. This will serve as the basis of the IEC (Information, Education, and Communication) materials that we will subsequently develop to improve demand of these health services in the community. We drove out to clinics in four rural areas in the Uthukela District to introduce the project and hopefully get some buy-in from the community.

Mama Zwane, the director of Mpilonhle, is showcasing the project to community stakeholders at Watersmeet Clinic.

 

There were nearly 40 people in the audience at Watersmeet crammed into a rather small room, including community care givers (CCGs), nurses, traditional healers, and community leaders. 

Here we're relating the UN Millennium Development Goals to why we need health mothers in our community at the Driefontain Clinic. 

After a lively discussion with the group, they expressed significant interest and value in Umama noSana. I'm excited that the project is starting to roll out.

Some of us are mothers already, and many of us will be mothers one day. But all of us have mothers. Mothers risk their lives bringing us into this world, and that risk is often greater or less depending on her postal code, if she even has one. There's a disparity here, and we're going to help close it.

Cảm ơn mẹ...thank you mom.

Raison d'etre...ici

"Why are you in Africa again?" a friend asks me. Good question. Here's a bit of context to what I'm doing here. I'm currently the resident in a post-PharmD training Public Health Residency sponsored by Rutgers, The State University of New Jersey and Bristol-Myers Squibb Foundation (BMSF). This program is designed to focus on two different public-private partnerships during each half of the year:

Secure the Future (STF), a program that develops and replicates innovative and sustainable solutions for vulnerable populations, including women and children, infected and affected by HIV/AIDS in sub-Saharan Africa

Together on Diabetes, a program that improves health outcomes of people living with type 2 diabetes in the United States, especially adult populations disproportionately affected by the disease

STF entered its third phase as a Technical Assistance and skills transfer program (TAP) in 2008, and there's an expert pool of TAP faculty members who shares their experience, knowledge and expertise to the organizations receiving grants from STF. While I'm here, I'm providing technical assistance to non-governmental organizations and community-based organizations.

The residency is based on projects rather than rotations, and there has been a diversity of projects I'm engaged in (more to come in future posts). There has also been a fair amount of freedom to pursue projects that I have identified as needs in the community (e.g. diabetes health education in township clinics).

That's why I'm currently in Africa.