Not Your Average Business Trip

So last week I concluded my first African business trip to the KwaZulu-Natal province, the second-biggest in South Africa. I was joining some people from UNICEF and a production company they’d hired to document a program that they’ve been working on for the past 2 years, called MomConnect, which enrolls pregnant women and new moms in an SMS (text) program that sends them reminders about proper pre-natal care and nutrition, when to come to their local clinic for check-ups and immunizations/pill refills (if they’re HIV+) or routine testing (if they aren’t). During this shoot, the production company was also planning to capture some footage that will help document the success of the country-wide PMTCT (Prevention of Mother-to-Child Transmission) program that the National Department of Health had been leading. The video is meant to be shown at an African Union conference on newborn health in early August. This is why I was sent along, to add guidance where I could (from a communications point of view), and also to just absorb what really goes on in these hospitals and local clinics.

Flying over Eastern South Africa

On Wednesday, I caught a 7AM (one-hour) flight out of Johannesburg into the small town of Pietermartizburg, meeting my new colleagues from UNICEF on the way. It was funny to be able to keep my shoes on going through security and not have to worry about liquids in my bag. I was also served a mango juicebox and a ratatouille “pastry” on the plane. So that was different. 

Once we landed bumpily at the tiny one-runway airport in foggy Pietermaritzburg, we rented a car and made the drive to Edendale hospital. Even just the short drive to the hospital was eye-opening. The hills were filled with shantytowns (if that’s what you call them?), interspersed with actual mud homes. On the side of the road there was a lean-two type structure with a chair inside and a sheet over the front, with a sign outside that said “hair salon” and showed a few choice styles (and I saw plenty more of these over the next 2 days). Whole families walked along the street hitchhiking, with cardboard signs indicating their desired destinations.

The lovely decorated meeting room in the hospital

We quickly arrived at Edendale, where filming was to begin and a steering committee meeting for MomConnect was taking place, which basically put all of the key stakeholders of the program in one room to discuss how the program was going. It was a 5-hour meeting on very little sleep (for me), but still pretty interesting. MomConnect was, as you can imagine, very hard to get started and is still only just starting to gain traction, especially in the more rural clinics with 3G connection issues, but the intent is pretty amazing and smart. I hope they’re able to roll it out to more clinics in the future and that these women and healthcare professionals continue to value it. The meeting began with us all standing and bowing our heads, and 30 or so nurses and staff members singing a beautiful morning prayer, in harmony.  

My first sight of Edendale Hospital, from the back parking lot

The hospital itself was nothing like the major hospitals in the US, as you can imagine, even though it’s considered one of the major teaching hospitals in the province. Mattress on stretchers were stained, metal doors were rusted, tiles were chipping on the floor, etc. But the staff was very friendly and engaged, and interestingly, the nurses all wear felt epaulettes (like soldiers) on their uniforms, with different colored stripes and pins indicating their stations and rank. 

There were about 45 people in this meeting, which was pretty crazy to begin with. I also eventually realized that they hadn’t all met about this program since early December, and this was the first follow-up to see how the program was going! That was shocking to me, since I’m used to things moving so quickly at work (too quickly, sometimes). And it was emphasized by one of the women leading the meeting saying at one point, “I know we’re not a first world country, but let’s try to start acting like one.” Pretty strange for her to actively recognize something that we (or at least I) take so for granted in the US. And once again I was struck by how different it felt to be the youngest person in the room, by almost 20+ years. I sure wasn’t at W+K anymore.

Someone told me last week that 5 out of every 7 employed people in South Africa are working for the government. So that should give you some idea of how many people seem to be involved in every decision that gets made here! Not to mention the growing list of “partner” organizations that I’m keeping track of (so far: NDOH, CHAI, UNICEF, UNAIDS, USAIDS, WHO, hospitals, feeder clinics). So this all probably also explains the large amount of “consultants” that I’ve run into so far, all trying to help these organizations work more efficiently and effectively.

However, going back to that 5 out of 7 statistic, it seems like the other 2 South Africans in that total that aren’t working for the government are still working to help the country in some way – like writing software to track orphans’ health or HIV immunizations, or improving hospital infrastructure. I know some of this goes on in our country too, even though I’m rarely exposed to it, but it’s pretty humbling to know how passionate all South Africans seem to be about making their country a better, more developed place. And those who are employed here seem to work SO hard. I foolishly thought that we really worked hard in NYC, and were even stereotyped as such, but I’m pretty sure these people work just as hard, if not harder – I’m talking 13-14 hours a day at the office, and then again once they’re home at night, and often on weekends. The amount of work there is to do, especially for the people who I’ve met working on HIV/AIDS and maternal health initiatives, seems overwhelming and unending.

So, back to the trip. That evening, after the hospital, we all went to our respective bed & breakfasts (it seems that a lot of people who own large, old homes here have turned them in B&Bs, and many people travelling to these smaller towns choose to stay in them, rather than the large hotels which can often be a bit seedy). I’ve also noticed that every different room that I’ve stayed in here thusfar – 4 in total – has had a full or queen bed, plus a twin bed in the same room. Not sure of the reasoning behind this. Families traveling together, perhaps? 

My room at The Homestead B&B in Pietermaritzburg
Not pictured: the twin bunk bed right behind me

Sidenote: I burned through my first R212 (that’s 212 South African Rand, or about $20USD right now) worth of minutes and data in less than 2 and a half days and was stranded, technology-less and disconnected, until I found a “recharging” station. I miss my unlimited plan with Verizon. So American of me, I know. Also, Vodacom SA’s hold music on the phone is “Africa” by Toto. Pretty amazing.

Cute little kids at Caluza Clinic
Emma from UNICEF taking a picture of them as well

The next morning, after my breakfast at the B&B where the lady of the house gave me a piece of her mind on just how (in)effective she thinks the SA National Department of Health is, we went to Caluza Clinic near Edendale Hospital to continue filming. It was filled with mainly women and small children, most of whom will likely wait (patiently and quietly) all day to be seen by a nurse. The kids were absolutely adorable, running all over the place and very curious about what these strange-looking white people were doing standing around with camera equipment. It was clear that even though most of the people there didn’t have much

Just outside the BP station by the clinic - I think the sheep are for sale too

(we learned that the one mom-to-be who was our “actress” for the day lived in a mud house when we gave her a lift home), they took pride in their appearance. Again, I was mostly a quiet observer, noting what was going on around me, except for one point when a mentally ill patient came up behind me, sobbing, and threw her arms around my neck. A few moments later she gave me three quick pecks on the cheek, stopped crying, and wandered away. Just another reminder of just how far away from my “regular” life I am right now. 

Filming in the Labor Ward at Prince Mshiyeni

That evening, in the pouring rain, we got on the road for our next destination – Umhlanga (pronounced “oomshLAHNga”). Another night, another B&B, with some incredible beachfront “holiday homes” that we passed along the way. Again, another reminder of how close the line is here between intense poverty and wealth – sometimes less than a mile apart in the same town. The following morning, we headed to Prince Mshiyeni Memorial Hospital, about 45 minutes away. This was a quick stop, just to film a soundbite from the (female) CEO about MomConnect and some footage from the labor ward (2 babies were born while we were in there! I only heard the crying, wasn’t too keen on getting much closer). Prince Mshiyeni and Edendale and the more rural clinics that feed into them were the pilot sites for the MomConnect program. This hospital was probably even more run down than Edendale. 

And finally we arrived at our last site, the uMlazi-U Clinic, to film our second mom-to-be getting STI and family planning counseling from the nurse or “sister” there. We also needed to show someone getting the new FDC (Fixed Dose Combination…again with the acronyms) antiretroviral drug – that’s the new single pill that combines the drugs of the 3 pills they used to take. However, as with most places, there is still a very serious stigma regarding HIV status, especially in pregnant women, who fear their partners may leave them if they reveal their status. So we made sure to only show a hand reaching for the pills when the sister handed them over, rather than the woman’s face (not that she revealed her status to us anyway, as far as I know). 

Filming our mom-to-be receiving counseling from the sister at Umlazi Clinic

One of the many FDC ARV posters from the NDOH that I've seen in these clinics

It was great getting to meet more South Africans on this little trip, especially two lovely girls from UNICEF closer to my age, who made me feel a bit less alone in this large group where I’m still very much keeping silent and trying to learn as quickly as I can. I also learned (and maybe I shouldn’t reveal that I honestly didn’t know this) that Afrikaans is the language that most white people speak here, that sounds like a mixture of Dutch and German, and Zulu is the language that a lot of black people in the area speak – the one with the clicking noises. It was also amazing to see how these hospitals and clinics really operate. All of the patients (or “clients”) are so quiet and observant and patient, but I can’t even imagine some of the struggles that they’re dealing with on the inside. Or maybe they’re not – maybe they’re just grateful to be there; to be alive and healthy (or at least appear so) and to have a place to go and receive care. I haven’t quite gotten up the courage to ask these very personal questions of these people who I don’t know at all, but maybe I will, after awhile. I’ll report back.

These stickers are everywhere in the clinics & hospitals

So often this week I was reminded of how lucky we are to live in the US. To live in a developed country with seemingly endless resources is something I really don’t think I’ll be able to take for granted when I get home. It’s amazing the barriers that I seem to run into constantly here, that no one really thinks twice about. I also definitely am not going to take for granted the (relative) safety that I feel, living in Manhattan. The fact that I can’t really walk around outside here once the sun even begins to set (which is at around 4:30PM) because it’s “just not safe”, especially as a younger white female, was one of the most frustrating things about this past week. This might also sound ridiculous after just a week here, but it honestly feels like it’s been much longer.

Anyway. From there I headed to Durban, where I spent the weekend hanging out with some fellow CHAI volunteers. More to come on that adventure in the next post!