Sorry – I couldn’t find something work-related that rhymed
with “way” and “day.”
Today
is Nelson Mandela’s 95th birthday, which is celebrated every
year (since it was declared an international holiday by the UN in 2009) as “Mandela
Day” or “Madiba Day” (which is sort of like an endearing nickname for him that
people use here). People recognize this day by doing 67 minutes of community
service – representing the 67 years of his public service, starting with his
campaign for human rights for every South African that began in 1942. As far as
I know, there’s unfortunately no organized service project for the Dept. of
Health today, but I will sort of be giving back (belatedly) this weekend by going
without electricity for 2 whole days! More on that later.
Mandela is still in the hospital in Pretoria, which we actually
drive past on the way to work every day. I’ve only caught a quick glimpse of
the side street where well-wishers leave candles, flowers, notes, etc. but
it looked very impressive. Choirs often gather there to sing up to his room, as
well. President Zuma and the Mandela family released a statement today to say that
his health is improving and they hope to have him back home soon, which everyone
is very excited to hear. I get the feeling that there’s a bit of unease
surrounding his death (whenever that may be, hopefully not soon), since he’s
really still seen as the cornerstone of the change that has been brought to
South Africa, so people seem to be somewhat nervous and questioning what
post-Apartheid life will be like post-Mandela.
In other milestone news, yesterday was technically the halfway point through my time here, so I am officially more than halfway through my TIE experience. I can already tell that it’s going to fly by much more quickly than
the first half did – the work days are going by more quickly and I already have my
next/final 2 weekends planned out. I can’t believe that I’m going to be back in the
States two weeks from tomorrow! I will admit that a good portion of me is
genuinely excited for that, as I do still miss my family & friends quite a
bit, but I’m sure as soon as I get to the airport I’m going to want to say –
wait! There’s so much I didn’t get to do! I’m not ready to leave just yet! So I’m
really trying to focus on making the most of every day left here, both at work
and outside of it.
Living and working in another culture so different from my
own, away from all of the people who I love, has not been easy, but it
certainly has been refreshing and so educational. Like I’ve said before, at the
very least it has made me incredibly grateful (and feeling almost guilty) for
what I get to return to – the people, the work, and the city. I also really feel lucky
that my situation here ended up working out the way it did. I think I’d be
feeling quite differently today if I hadn’t had the opportunity to move into
the guest house and make some friends (with a car!) to hang and travel with on
the weekends.
And now, I finally have an update on work that's worth sharing. The past 2-ish weeks have been at times slow, and at times very frustrating,
but it seems like I’ve finally figured out exactly what I’m going to work on
for the rest of my time here. Better late than never, I guess!
I had been told that TIE objectives often shift (sometimes slightly,
sometimes greatly) when you actually arrive on-site and get a lay of the land
and the workplace – understanding just how quickly (or slowly) things move, how many
stakeholders are really involved, and what they actually want you to be doing.
Keeping this in mind has definitely helped me to keep myself motivated and
optimistic (most days!), because as I said, there have definitely been some
tough ones in there. So once I got here, I realized that my
original objective was really too lofty and broad to tackle effectively in
4 weeks. I had no idea how nuanced the department is, with so many people working
on so many different initiatives, all part of larger groups with other people
overseeing them. And it doesn’t help that it’s a very siloed organization as
well – very few people actually communicate with each other, which doesn’t make
things easy, either. And to top it off, people are rarely physically in the office. They
work from home, or they’re traveling around the country (for weeks at a time)
performing quality checks in clinics or having meetings with hospital
personnel. And I’d say the last major hurdle is that people are so busy and
involved in their own work, they aren’t particularly keen to take an hour to
talk to me and really invest in what I’m doing here. And some are just plain
skeptical that I can accomplish anything at all in this short time, but I’m
hoping to prove them wrong!
Taking all of this into account, it was agreed that I would
focus mainly on maternal health, pregnant women, and the PMTCT (Prevention of Mother-to-Child Transmission) program, so I spent the past few
weeks mostly listening and gathering information about these women and their experience
within the healthcare system. After speaking to many different people at the
DOH, their partner organizations (mostly CHAI and UNICEF), and actually interviewing
a few nurses at these clinics, I realized that while there is a wealth of information
available to the healthcare workers and community home workers (“laypeople” who
are trained at a basic level and visit pregnant women in their homes, often in
very poor/rural areas), there is really nothing that’s actually given to the
patients themselves.
These women come into the antenatal clinics for their
first pregnancy check-up, and are just bombarded with information about healthy
eating, birthing options, the number of times they need to come back to the
clinic, the tests they need to take – and double that information if they’re
HIV positive (or become infected while they’re pregnant, which sadly happens
often). So I decided to create a week-by-week “pregnancy guide” for
these women; something that they would be given on their first visit and that they can
keep by their side throughout their pregnancy. It would also cover the
first 6 months of life for their child. This way, they can see when they need
to schedule their visits, what will happen at those visits (so they can ask for
certain vaccinations/tests if they aren’t being offered it, for example), tips
for a healthy pregnancy, danger signs, and then the schedule of postnatal
visits once their child has been born (HIV and TB testing for the child,
breastfeeding tips, etc.).
I’ve gotten a pretty positive response from everyone that I’ve
run this by, which is reassuring. It seems like there was just a major gap here (with
the actual patients themselves), in terms of the information that is being
delivered routinely by the NDOH, so I’m hoping to fill that gap with this information. I
think it will take the shape of a simple little booklet, mainly with
illustrations, since literacy levels vary greatly in this country (and there
are 11 national languages).
I’ve spent the past few days putting together the copy for
the booklet, which is currently in the format of a week-by-week timeline, and
meeting with all of the “experts” in the departments who can tell me if I’ve
missed key information for anything like antiretroviral treatment, family planning
counseling, etc., all of which needs to be included on this timeline. I then
wrote a creative brief yesterday, which has been sent out to a few different
design agencies, one of whom will hopefully be affordable and quick enough to
help me design the actual booklet. For those of you who donated – it looks like
this is where the funds will be going!
Now I’m just hoping that if I can’t actually finish this before I leave
(I’m a bit nervous about the number of stakeholders who will need to review it),
I’ll at least be able to make enough progress so that someone can pick it up in my
absence and finish it out. We will likely pilot the booklet in the district that
the DOH is in, called Tshwane, and if it’s well-received here, they’ll roll it out
to clinics, hospitals and private practices across the country, since the goal is to start to standardize healthcare information across the board in South
Africa.
So that’s the update! Oh, and getting back to this weekend –
tomorrow I’m going on a little safari weekend, staying in a traditional “bush
camp”/eco lodge in the Madikwe Game Reserve, in the Northwest province of South
Africa, right near the Botswana border. This means we’ll be staying in raised
platform tents with no running water or electricity, and having all of our meals
cooked over an open fire. And did I mention that it’s an unfenced camp, so you
can’t walk around by yourself at night? Hopefully I don’t wake up with a
cheetah in my bed. Or, more realistically, a monkey destroying my things. We’ll
be going on 4 game drives in total (in those very safari-esque 4x4s) before
heading back to Pretoria on Sunday afternoon. The goal (for me, at least) is to
see the “big 5” of Africa – lion, elephant, buffalo, leopard and rhino!
More to come…