Women of South Africa

Everywhere I go in the community and every community I go to in this country, I notice a lot of women. In the professional realm, they run the Department of Health clinics in the townships, they reach out to clients as community health workers, and they manage the NGOs. It may be that the healthcare sector is dominated by women here, but there are very few men to be found. It's also common to see women running households, perhaps the men are off working in the mines, and it's even more common to see older women, grandmothers running it.

As I mentioned in the previous post, many children were orphaned when the HIV/AIDS epidemic stole the lives of parents. Many of them sought refuge with their gogos, or grandmothers, who would now take care of their grandchildren since their own children had passed. 

In 2001, Bristol-Myers Squibb Foundation funded a project now known as GAPA, Grandmothers Against Poverty and AIDS. This project was designed to meet the needs articulated by gogos living in Khayelitsha, a low socioeconomic area outside Cape Town, who were now taking care of their grandchildren. GAPA runs workshops for gogo's with the aim to empower them to take charge of their lives and circumstances through education and transfer of practical skills, like parenting, vegetable gardening, and business/income generating skills.  

There is a strong kind of woman in South Africa. Women, especially gogos, hold together the fabric of this society.

Orphans and Vulnerable Children

With the HIV/AIDS epidemic raging at full force during the '90s and 2000s, entire families were destroyed when it took the lives of mothers and fathers alike. Hearing stories from that time, it was commonplace to have dozens of funerals take place each weekend in one community alone. The result was a flood of children left behind as orphans. At some point, extended families cared for orphans, but the vast number of deaths have left children alone, to be cared for by a grandmother or by an older sibling in orphan-headed households. This is one manifestation of how HIV/AIDS has drastically changed the social fabric of South African society.

One response to this crisis and the needs of orphans and vulnerable children (OVC) was the establishment of halfway houses, child care centers where children could drop in during the day. Mpilonhle founded 18 halfway houses in the rural uThukela district surrounding Ladysmith. It is estimated that the HIV/AIDS prevalence rate in this area is about 40%, and there have been over 3,000 OVC identified. Each halfway house cares for more than 50 children.

Vezimpil Project is one of the halfway house I visited with Mpilonhle.

The halfway house programs take place in donated buildings that are hosted by a family or located in community centers. OVC go to the halfway house in the morning before school for a hot breakfast and return again after school for lunch, assistance with homework, grooming, laundry, life skills, art, and recreational activities. As one can imagine, given the circumstances OVC face at very young ages, many of them have great psycho-social needs. There are workshops to help children deal with the trauma and the pervasive death surrounding them. Positive changes, in regards to school attendance and performance and health and wellness, have been observed in OVC who attend these halfway houses.

Vezimpil Project is housed in a long, narrow room. Here, the volunteers, who only receive a small stipend, cook and serve the meals and the children gather.

In the past year, the kids have helped paint and decorate it so as to create a warm and inviting atmosphere. The next project involves getting books for the children and shelving to store them.

Important messages are painted on the walls reminding the children about how to maintain their health and wellness. 

As you can see from this message about the importance of knowing your HIV status, these young kids are aware of very mature concepts.

The volunteers also maintain a garden that provides food for the house. This is one way to make the house more self-sustaining and less dependent on donor funds. Means to diversify income sources are continually explored to ensure that the houses can continue after grants end. 

Impilo Yonke: Mental Health and HIV/AIDS

Mental health correlates of HIV and AIDS remains a rather unacknowledged and unexplored domain in Sub-Saharan Africa. What we do know from limited research is that people with mental illness are more likely to become infected with HIV as they may be vulnerable to abuse and may engage in risky sexual behavior. Conversely, people living with HIV/AIDS are more likely to develop some form of mental illness. The rates of mental disorder are as much as two to three times higher than the general population. Bottom line: mental health problems are both a precursor to and a consequence of HIV/AIDS. 

The implications for mental health status can be far-reaching and the consequences can significantly impact HIV/AIDS treatment outcomes. For example, a person with poor mental health status is more likely to have poor adherence to medications and antiretrovirals (ARVs). Health services directed towards this vulnerable population is lacking in South Africa, further magnifying the considerable health burdens of this group.

Impilo Yonke, a collaboration between Mpilonhle and Ladysmith Provincial Hospital, is one of the STF projects I've been working on in Ladysmith that aims to provide a coordinated and comprehensive care model by integrating health services for mental health disorders, substance abuse, and HIV/AIDS. The project has 4 components:

1. Promoting and providing HIV counseling and testing (HCT) in persons suffering from a mental health disorder

2. Screening for substance abuse in youth who are being treated for HIV

3. Providing psychosocial support and budgeting skills training to patients who are receiving government disability grants 

4. Training and educating health care workers to tailor care and HCT specifically to patients with mental health disorder  

There are currently no services that specifically address HIV testing in the mentally ill. Substance use run rampant in the community, especially with young people, and patients accessing ARV treatment are not formally screened for drug abuse, thereby jeopardizing their treatment. All patients who have been diagnosed with a serious mental illness or who have a CD4 count <350 are eligible for a governmental disability grant. Often this is the primary source of income for patients and their dependents. Providers have observed that many patients often have difficulty budgeting this money, and they frequently default on their treatment due to not being able to afford food and transport. The government issues disability grants without equipping patients with the necessary knowledge or skill to budget that money. 

My role in this project has really pushed me outside my comfort zone and let me dabble in areas that I previously had limited (really no) experience in. I came on board in the initial stage of the project when it was still trying to set up and gain momentum. I've been working with the Mpilonhle director in managing the project and mentoring her through various processes (e.g. improving communication with all parties involved in project, streamlining implementation procedures, increasing financial transparency of grant money). I had my first exposure to the realm of Monitoring and Evaluation (M&E) and helped the team develop an M&E structure and plan to capture data and outcomes. Putting on a more academic hat, I taught the physicians and nurses about the model for planning and evaluating continuing medical education and helped them develop assessments to capture the impact of the HIV/Mental Health training workshops they were giving. All this said however, I think I've made the greatest impact on the data capturer. I've worked with him very closely and mentored him on things like development of these assessments, analysis of the data, and writing of reports summarizing that data. 

There are many little things that seem quite simple to me and for which I take for granted (e.g. creating agendas to increase efficiency in meetings). But this mentoring and management experience has reminded me that someone at some point had to teach me about these "simple things," and now it's my turn to teach another.