Human Rights Day in SA

Sanibonani,

Another South African Holiday is coming to a close. March 21st is called Human Rights Day but it is the anniversary of the Sharpeville Massacre in 1960. One of the ways the government under Apartheid rule maintained power was the use of passbooks which contained identification specific the racial classification.  If someone was in the wrong place at the wrong time, the police would look at the passbook and depending on the race of the person the office could slap additional charges or worse.

Understandably the people of Sharpeville (in Southern Gauteng Province), became fed up with this arrangement today 56 years ago, between 5,000 and 10,000 people marched to the Sharpeville police station to turn themselves in for mass arrest for not carrying their passbook. The police were not prepared to handle this demonstration and ordered the crowd to disperse. The crowd did not comply and the police fired on the crowd. 69 people were killed and 180 were injured in the Sharpeville Massacre.

Like most days of observance South Africans are encouraged to reflect on their lives today and how it was a vastly different reality from just 20 years ago. For human rights day, they are specifically asked to contemplate their rights. Today there are thankfully no passbooks that are mandated to be on the person constantly, because numerous people fought against the law. Many paid for their beliefs with their lives. The Sharpeville massacre was the final straw for many anti-Apartheid activists and the resistance towards the government ramped up. Sharpevillle is never forgotten and Nelson Mandela made it a point to sign the South African constitution on December 10, 1993 which is the day the Deceleration of Human Rights was signed in the United Nations. The date is observed as human rights day in the world.

 

Today I finished “Cry the Beloved Country” by Alan Paton (highly recommended if you are looking for a thoughtful book recommendation). Paton creatively developed his own characters that shadowed real events in Apartheid South Africa. He was also articulate about the shared internal battles humans face that transcend cross cultures and justice. In the midst of resent events with terrorist attacks and the continued healing process in South Africa, I wanted to share a bit of Paton’s wisdom. Some people may interpret as a disheartening meaning but for me it is inspiring. I was reminded to not let fear get the best of me and engage with people who are different. Also we cannot let prejudice dictate how a country functions, in the end the entire nation will suffer (even those with privilege.)

“Cry, the beloved country, for the unborn child that’s the inheritor of our fear. Let him not love the earth too deeply. Let him not laugh too gladly when the water runs through his fingers, nor stand too silent when the setting sun makes red the veld with fire. Let him not be too moved when the birds of his land are singing. Nor give too much of his heart to a mountain or a valley. For fear will rob him if he gives too much.”
Alan Paton, Cry, the Beloved Country   

All the best,

Katey

The Policeman and the Provocative Question

Blog-Challenge-2016

This Entry’s Theme of the Blogging Abroad Boot Camp Challenge: crazy moments (aka 90% of this blog’s content). Just for clarification, the amaZulu and Republic of South Africa are not the crazy parties. I am the crazy one, bumbling around rural KZN to the lighthearted amusement of my communities. South Africa is never boring and it always keeps me on my toes. Every day there is at least one cultural curveball from the Rainbow Nation. These moments come in many forms including conversations where English is a second language for one of the participants, which was the case last Monday…

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Washing day for the cars of Schnitzeland’s SAPS (South African Police Force) office. You can see the distinctive trapezoidal shape of SAPS cars.

Here in Amajuba, a policeman visits my house once a week. It is actually a spontaneous arrangement I am happy with, as at site 1.0 the police did not know I was in the area until our Safety and Security Manager visited due to a sudden escalation of violence in the area. If another PCV supports this organization, I will certainly have a discussion about boundaries and how they with differ with each person. For now, Sargent is very respectful and never enters the house. He always stops by in the early evening on his way home so I can anticipate the brief visit which usually consists of exchanging greetings and I confirming there are no concerns.

Last Monday, our conversation was a bit longer than usual as he indicated there were problems at the schools with feminine hygiene products being stuffed down the toilet. I offered to join him on visit to the schools and see what was going on (because if a policeman lectured me about my menstrual behaviors at age 13 it would have intensified my existing embarrassment). Puberty was not that long ago for me and sensitivity to the mater could move towards a solution with minimal hurt feelings. Anyways he was open to the idea and while plans were made to stay in contact(will keep y’all posted if anything comes out this…I am still trying to understand why the police monitors the female toilets) we joined my host family’s spirited conversation under the rondavel’s shade. 5 minutes goes by and the isiZulu translation part of my brain reached daily capacity. So I zoned out, until Sargent asks me a question that I did not anticipate.

“Simphiwe, do you have AIDS?”

Now there were 3 thoughts that flashed through my mind..

1.) That was a very forward question in a valley where stigma is so prevalent that patients will not openly declare they ae picking up ARV (antiretrovirals) prescriptions, at the local clinic. They will say “pansi/down” gesturing to the HIV ward but never describe the amaphilisi/pills with “HIV” or “ARVs.” Also, World AIDS Day 2015 in Schnitzeland did not feature a single speaker who talked about being HIV positive.

Then the more irrational 2.) Crap. They know about autism (which I keep private at site…post explaining why is coming within the month) and have extrapolated my life experience to the prominent life-threating condition that also starts with the letter “A.” Great.

Finally 3.) Eish, South Africa. How do I respond to this without adding to stigma? I have every reason to believe that I remain HIV negative, but taking the literal interpretation of the question and firmly responding “No” could indicate that HIV is something I consider shameful. Not the accurate let alone productive message I want to portray in the community.

Once I remember that no one could find out about my identity as an autistic as the internet capabilities are limited in my area (let alone I have not divulged any hints), I use my 1-year-in-country knowledge to determine that no one would openly diagnose a community member in South Africa outside of a clinical setting (and Sargent is not a sister/nurse at the clinic). He meant to ask something else and I calmly ask him to please clarify.

“Do you have American Money for HIV/AIDS?”

Turns out a creshe serving orphans and vulnerable children just lost funding and Sargent wanted to know if there were American based options. Still not a fun conversation to have  but a dramatically different request. I tried to explain the confusing situation through a 1 minute summary with basic English. In a sentence, there is limited HIV related funding available in South Africa and organizations in Amajuba do not currently qualify for assistance because we have one of the lowest HIV prevalence rates in the province. Sargent apparently understood, as he responded by saying we should write a letter to Obama. Eish, if only international aid was that simple.

Another day in South Africa with another Eish inducing moment. Life is never boring in the Rainbow Nation.

An Unfiltered Glance of Carers for Orphans and Vulnerable Children

Blog-Challenge-2016

This entry’s topic for the blogging boot camp challenge: community member profile (aka interviewing someone that resides in my current home).

Interviews are a significant but unwritten part of my current job description. As a health extension volunteer, I frequently interview community members for informal needs assessments as I try to get a grasp on the current situation. Since my service I have coordinated focus groups of teen mothers, people living with HIV, and the largest source of pediatric health knowledge in rural South Africa: Child and Youth Care workers. (CYCWs)

I have the public health context behind South Africa’s response to the HIV epidemic at the end, but for now I will yield to the real expert in my area of Amajuba: a woman who serves as a CYCW for my organization. We did this interview in broken English, so her words are not verbatim (we are working towards an isiZulu tutor, it still may take a while) but I tried to maintain her thoughts with as much of her sentence structure as possible. Take it away inkosazana (fair maiden in isiZulu).

What do you do as a Child and Youth Care Worker (CYCW)?

As a child and youth care worker, I work with children. We do home visits and a lot of primary school visits. We especially support orphans, as many of them are HIV positive.

Who is an orphan in South Africa?

Orphans have both parents’ dead. Usually they live with a gogo/granny. If one parent is alive but they are not present in the child’s life, they are considered OVC (Orphans and Vulnerable Children).

How did you become a CYCW?

Amajuba District started the program last year. Other districts in KZN province have had CYCWs for a while, but my guess is our schools started to overwhelm the government social workers with cases. So they started to train workers at Drop-in-Centres (DICs) who were already working with OVCs directly affected by HIV.

How did you first encounter HIV in the community?

I would say the schools, because HIV is taught in the local schools. Also the local clinic.

What was it like when HIV first came to Amajuba?

It was awful. Many people died before resources were available. However after about 2007 when ARVs (antiretrovirals) and VCT (voluntary counseling and testing) things got better. People are still scared to get testing but peer pressure from the schools, where children talk about their HIV positive family members.

What was our community like before Child and Youth Care Workers?

Not good, because referrals were slow, if there was a concern. The Social Workers did not have the time to investigate the school’s concerns. Now CYCWs can visit the schools and refer if needed. It is much better.

What do you like about being a CYCW?

I love working with children and being a support. The children are too scared to talk to their granny so I play with them. Then they talk to me about their problems.

If you could change one thing about the CYCW program, what would you do?

I would get the government department to try and provide emergency money. Sometimes a child needs food now, and I use my own money for an emergency food parcels.

What do you want Americans to know about South Africa?

We became free but we still suffer.

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Checklist the CYCWs use during home visits

 

 

In the South African context, Home Based Cares (HBC which provides care for people living with HIV/AIDS at their homes) and Drop-in-Centres (DICs places that provide psychosocial, homework, and nutrition support for OVCs directly impacted by the AIDS pandemic or OCVs) were established as the model for the governments delayed response. The history of South Africa’s, the response to AIDS is a tragic story. The first documented deaths in the country connected to AIDS occurred in the early 1980’s, when South Africa was still in the grips of apartheid. In 1994 when apartheid rule dissipated, the government had the tedious task of restructuring the country. Until 2008 government officials denied that AIDS was caused by HIV, and through policy treatments like ARVs were not widely available in the country. The result was that HIV and deaths were rampant in communities. After 2002 the government prioritized the care of HIV positive individuals, increasing lifespan for people living with HIV. Today, South Africa is the nation with the highest population of people living with HIV in the world.

Currently, South Africa is in the midst of an international conversation over the effectiveness of Home Based Care, and funding towards HBC and DICs reflects the changes. The majority of organizations CHOP (Community HIV Outreach Project) PCVS are partnered with are a mixture of HBC and DIC(both of my organizations implement both models). Regardless of their future, these organizations have shaped the communities of rural South Africa for the past decade, helping families heal, grieve, and thrive in the midst of the HIV epidemic.

The Izikhanyezi Theory

Setting: Afternoon of Christmas Eve, on the taxi back to site from Duke City. I have stumbled into conversation with a few men in the back. After exchanging pleasantries, a gist of the following exchange took place.

Man: It is too hot!

Me: Yebo, Kuyashisa (the sun is hot…what I say to commiserate with people when the temperature is uncomfortable in terms of heat).

Man: Yebo Kuyashisa. Did you hear about the stars exploding?

Me: No (wondering where the sudden supernova reference is directing the conversation). What about the izikanyezi (stars)?

Man: It is usually not this hot, but (gestures towards one of Amajuba’s steel/coal plants) the factories put chemicals in the sky. The chemicals make the stars grow and then they blow up. The pieces of the stars hit the earth and heat the ground up. That is why we are in a drought.

Me: (Speechless for a few seconds) Interesting. No, I have not heard of the exploding stars.

As someone who believes that global warming is a reality that must be addressed, I like this perspective better than the abstract version of the phenomena (no offense to the Engineer and Bill Nye).  It is not exactly accurate but more creative, if only the conference officials tapped into South Africa’s storytelling genius before Paris. I think bits of stars falling from the sky (or fireballs of gas) is visual enough to help those who are in denial understand.  

In the end, people realize it is a problem (and they got 60% of the story right) and KwaZulu-Natal is hotter than usual. I struggle to explain the ozone layer’s dynamics in English, so I did not push the conversation forward. Instead the men asked me why some women do not respond when a man approaches them. That conversation took the rest of the 45 minute ride.

Privilege: Are you restricted from Certain Countries?

A huge portion of public health is advocacy. Until HIV /AIDS concerns became my full time job, I did not think about HIV/AIDS in a life span context. Once you have HIV/AIDS, there is no medical cure and you live with this diagnosis for the rest of your life. With advancements in treatment and access to healthcare, people are able to live for the most part fulfilling lives. Unfortunately, there is an aspect to life with HIV that hinders the living process: stigma and its cousin discrimination. Stigma means that HIV negative people automatically gain this concept of privilege. Since you do not face the daily hurdles HIV positive people face, your life is easier in one respect (other forms of discrimination and  apply here as well but that would add at least 5 more pages in Word to venture into those complexities, for the sake of brevity I am just covering HIV tonight).

For an example, you have the freedom to travel. Travel is not something one would think as a privilege but there are countries who deport visitors with an HIV positive diagnosis. Entry into countries depends on a clean personal record and following the labyrinth of visa laws verbatim, but usually health history is completely irrelevant to a customs check.
However this is not the case for HIV,

According to UNAIDS, over 30 countries still have restrictions on entry. Progress has been made, and the USA’s abolition of restrictions is fairly recent.

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Credit to UNAIDS 2015

While these efforts are great, there are miles to go before we sleep. Here is another map explaining the categories of restrictions.

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Credit to UNAIDS, 2015

As a public health student, I see why governments would want to restrict entry to PLWHIV. The threat of an infectious disease that is known to be fatal and expensive, would motivate people to prevent that concern from entering the country. I agree that quarantine should be implemented in highly infectious conditions like ebola and tuberculosis that are transmitted by air or casual contact.

With that said, baring restrictions actually creates more problems (or stigma). Besides how attempting to track detailed medical histories with blood test in a customs takes resources (and customs are bureaucratic enough), HIV is not infectious through casual contact. HIV is transmitted through contact with blood, breast milk, semen, and vaginal secretions. HIV is not an immediate threat to unaffected citizens, unless sexual intercourse or copious bleeding occurs in the customs line (and there are bigger issues beyond HIV if that is the case). Also if you dig into the rationale behind the countries that have the highest restrictions, public health has less weight than cultural perspectives of the LGBTQ+ community and racism (the countries with highest HIV prevalence rates are all in Sub Saharan Africa. Regardless of the reasons, it does not change the fact that this is health discrimination which fuels stigma.

In case anyone is doubtful this is discrimination or why is this still a problem when most of the world is against restrictions, substitute HIV for the other health experience mentioned frequently on Eish: autism. If heaven forbid mental health restrictions start to form entry requirements, I would really have to reevaluate this global health career path since in international fields, employers need you have flexible mobility (you do not get to pick where the next outbreak takes place). Also if you think about all the reasons why people go abroad beyond work (tourism, love, school, and oh yeah volunteering), living becomes a restricting process.

People with HIV did not ask to live with a life threatening condition but from what I have seen many are thriving. We need more HIV positive individuals to work in global health. They would do a better job in my role as they actually understand what HIV is like and can connect with communities. It is hard enough to live with HIV but people with HIV should have the right to benefit from cultural exchange just like everyone else. Let’s continue to work towards an accepting world with no restrictions.

Finally to end this on a pleasant note, here is an awesome project showing how dogs are supporting HIV positive people and their efforts to live.

When Dogs Heal

References:

http://www.hivtravel.org/Default.aspx?pageId=152
http://www.bodypositive.org.nz/Pages/Travel_and_Immigration/

All the best,
Katey-Red

I can see Lesotho from my house…

Literally Tina Fey, I can also make geographic snarky remarks.

The white stuff is basically Lesotho taken from the hillside behind my homestead.

The white stuff is basically Lesotho taken from the hillside behind my homestead.

I am the closest PCV to Lesotho (in South Africa… according to the PC website there are roughly 78 PCVs that reside in the Mountain Kingdom…if anyone is reading this from my direct West we should meet)

Anyways Lesotho calls the shots, it is winter here…even though there is no snow on my side. Which is concerning as the entire area is in a drought. Do not tell my religious org, but I am blaming global warming.

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This is a picture of a speeding car at dusk, but the cloud of smoke demonstrates how dusty it is.

Here is another one of a minibus trail.

.IMG_1399Manje (now) it looks like this outside.

Not today but a day like today.

Not today but a day like today.

I am still hoping for precipitation.

We need rain.

Seriously.

Ubuntu and a Funeral

The isiZulu word of the post is going on a brief hiatus as my isiZulu dictionary is packed away for needed construction! Ngiyabonga for understanding!

I hesitated to write this post. When you work in a HIV/AIDS context in a high poverty area there are a lot of painful things to witness. However in the midst of extreme suffering there can be incredible displays of humanity. I decided to share the following story to show an example of South African resilience and ubuntu.

This month one of my host mom’s learners died suddenly. She was in her 7th year of school, moved to the valley last school year, and around my American brothers’ age. The week before, the War Room (post coming on what that is) initiated a debate for Freedom Day (the 25th of April) and that day she suddenly started to complain about a “runny tummy”. Teachers visited the house over the weekend where her grandmother and father said she was hospitalized. The same teachers stopped by the hospital on Monday the 4th and received the gut wrenching news.

It is one thing to see public health statistics on diarrhea but another to see your host mother blinking back tears as she shows a grainy cellphone video of the learner reciting a poem about Nelson Mandela and says her name describing her as “very clever,” I know that children die of flu complications every time there is an outbreak and once had a classmate who lost a 4 year old brother to pneumonia in the States. I do not know her medical story (nor is it my business) but I will never be okay with children dying. She had many younger half siblings, and they should not have to deal with the death of a child. I am crushed to think how she could have used her clever mind to help South Africa progress. I am also not okay with people dying from anything related to diarrhea in 2015.

In other words, there is nothing right about the situation. It is tragic full stop. Since the mother and the father were not married, tradition states that the funeral is at the mother’s home. In this case the Mother was Xhosa and the funeral would be in the Eastern Cape Province. This was pretty devastating to the school because South Africa is big (it is twice the size of Texas) and so the community would not be able to attend the funeral. The school quickly created a memorial service for the girl and made a conscious effort to make it honorable. My host mom stayed for two hours after school let out Monday to try and coordinate a choir to sing a beautiful isiZulu song about death (although she did not think the choir was ready for the 10 AM performance the next day).

After the memorial service, everyone pitched in to purchase two taxis to the Eastern Cape so people could attend the funeral. I cannot stress how moving this gesture was because most people in my valley are on government grants and minimum subsistence. The day before the memorial service my host mom did not know if it was an option to attend and I was heartbroken that this community would not have any closure (one week ago the child was in class and now they are dead). Yet, the school cared enough about their learner to go to their funeral. The taxis left at 2 AM to arrive at the funeral by 6 AM, full of teachers and a few learners. They got back late at night and yes everyone went to school the next day.

In America, families will bend over backwards if a loved one passes away. However we rarely think about what to do about the communities impacted by the loss. The tendency is to go to the memorial service if it is close enough and send flowers/monetary donations if it is too far. If someone means a lot to a community, they may have their own memorial service if the funeral is too far. In a group oriented culture like AmaZulu, everyone matters and the community grieves together.

On a slightly less depressing note, my host mom got to see the Eastern Cape for the first time. She wants to travel and eagerly awaits her retirement when she can explore South Africa. I gently teased her (we have a relationship that allows me to do so) that Eastern Cape is next door and it is about time she visited! We called my cousin (who works in Pretoria but is home in Mooi River for her Maternity Leave) who also experienced the Eastern Cape through a funeral for any tips but she was bit tired after having a child 8 days before. I have yet to experience the Eastern Cape so I told her to let me know how it is (but I really hope my time in the Eastern Cape is either work related or a holiday…not a funeral). Apparently there are mountains like our home in the Berg!