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.

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It’s beginning to Look a Lot Like…Summer

 

Sanibonani,

December 21st marks the  shift in seasons and while the United States braces for snow and colder temperatures, South Africans (and the rest of the Southern Hemisphere) are now in the throes of summer, even though I have been saying (in incorrect isiZulu) inhlobo lapha/summer (is) here since mid-November. It is also 2 days until the highlight of December Merriment. South Africa definitely observes Christmas as roughly 80% percent of the population identifies as Christian (as of the 2011 census). My organization has been closed since 15th of December.  Ironically my Christian host family does not make a huge deal out of Christmas. They are planning a large lunch but New Years Eve is their main celebration.  

I am actually okay with a low-key Christmas as I try to minimize the hype anyways. The crowds, social cues with gifts, and over the top decorations are sensory overload for this autistic. Which is why I am getting a kick out of South Africa’s upscale grocery store Checkers use of Ram Jam for their holiday adverts, as it mimics the season’s intensity fully! For the past decade, Christmas was off my radar until the end of finals and this is the first year where December was not completely dominated by exams or term papers. In the South African summer the intensity still exists, but from the bizarre juxtaposition of evergreens, Christmas lights, forest green, crimson red, and navy blue snow scenes that I am convinced will eventually absorb enough sunlight and self-combust in the 99 degrees F heat. I never knew how much the Northern Hemisphere dominates the image of Christmas until I became a PCV.

Christmas is observed without a major fuss in my family (minus the one year the Manager was born on Christmas Eve).  However December is one of the best times of the year to be back home when the crisp air wafts the sweet aroma of pinon pine burning in fireplaces, fresh bizcochios melt in your mouth, and the Sandias look like a magical pink velvet cake in the winter sunset especially when it is iced with snow. Most important my favorite part of being a New Mexican is a quintessential Christmas Eve site in Albuquerque: luminarias (or farolitos… the terminology depends on the cultural area). The flickering lights gently light pathways and inspires personal reflection over the past year: what I appreciate the most about the holiday season.  It is just hitting me that I will not see neighborhoods expression New Mexican solidarity and since it is fire season paper bags and candles are not worth the cultural exchange. No luminaras feels weirder then sweating at the site of (the South African) Duke City’s fake Fir.

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Duke City’s Christmas Tree, my theory why it is 1/4 decorated is that a poor city worker got heat stroke…it was almost 100 degrees F this day

Most PCVs in South Africa spend the holiday on vacation. While it would be nice to experience Christmas on the beach, due to the timing of the site change travel was not in the cards for this December. I am spending all 4 weeks at site, volunteering at the local clinic reception desk (before people claim that I am an altruistic person, this gives me something to do and I need sensitive statistics from the clinic for the needs assessment….this is a way for me not to completely rip them off). Families from the larger cities come back to the rural areas and when accidents happen (like the little boy from Johannesburg today who fell on his hand while playing) people need to access local clinics. My main tasks are registering clients into the computer system, signing or creating their clinic cards (and there are different cards for general illness, chronic illness, HIV testing, Post Natal Care, Antenatal Care, and Family Planning), and organizing patient files.

It is only day 3 but I am learning more about the health needs in this portion of Amajuba, obtaining much needed isiZulu practice, and gaining an appreciation for the clinic’s challenges. People are not open about their status so I did not see HIV as a prominent health concern in the area until I registered over 20 people into the digital register for ARV pickups (and that is a time span of 3 days). I am also seeing many young women who are very pregnant or who have just given birth to 6 day old babies. Today was a holiday luncheon and the Sisters graciously shared their potluck of wors (sausage), buttery pap, and oily vegetables (I ate every bite). The consensus is that the amaZulu are busy with cleaning their houses for visitors before Christmas and do not get sick, but around New Years Eve the clinic is in high demand.

When I am not at work, the other main project is typing the community needs assessment 2.0. I am fortunate to work for a supervisor who prioritized this report and we were able to scramble with information during an unideal time of the South African year. With World AIDS Day and closing the org, I have not had the chance to organize the notes from focus groups. We still need to have a few more focus groups of People Living with HIV (PLWHIV) when we come back from break, and hopefully we can hit the ground running with actual projects in February. I am exploring a prevention campaign in late March and a specific support group, and am also researching educational materials during the break. This plus bonding with my host family, blogging (anticipate, dance practice, reflecting on 2015 and reading my stockpile of books…I have no time to dwell on the weirdness of my first Christmas away from home.

But if you are in New Mexico, please enjoy the luminaras for me as I embrace South African Christmas with cold adaptations of Christmas treats, copious amounts of Cranberry Kiwi Juice, and the gingerbread scented handwash I brought from the States.

All the best and a happy and healthy iKhisimusi (next year I will master happy holidays),

Katey-Red

 

World AIDS Day Antics 2015: Utrecht Edition

World AIDS Day Antics 2015: Utrecht Edition

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The chief’s land where the event took place (I think this area looks like the Drakensburg).

 

Thursday was only the municipal events. Friday and Saturday were the District event with Friday intending to be focused on woman’s health issues.  The actual event was more celebrating amaZulu traditional heritage as it took place on a chief’s land outside of Utrecht. To this is day it is the one of two segregated meals I had in KwaZulu-Natal (the other was an umsebenzi at host family 1.0’s house…aka the time 30 intoxicated men were outside my porch). The one speech I heard geared towards women’s health was a well done and heartbreaking dialogue by a traditional gogo dance group on how HIV was not present in the old days.  There were Sisters/Nurses from the district hospitals providing cervical cancer, Blood Sugar, and Blood Pressure screenings as well as the mandatory HIV testing and counseling. However all the people present were government employees or caregivers who knew about HIV, and not the community at large.

The event started at 11 AM and ended at 4 PM. The local political dynamics caused drama with our transport to the event I was in an agitating mood. Since I was in the back row of a hot tent, trying to maintain a low profile, I did not realize when one of the district officials during the appreciation section acknowledged my presence (the one non-Black at the event). Mr. Swazi leans over and says, “they are talking about you.” I thought he meant our org’s the inattentive caregivers. No apparently the speaker pointed me out…oops. Hopefully I was not doing something notable.

 The other part that was worthwhile was the dialogues on social concerns. Granted they were after all the political speeches and at 3 PM when everyone was hungry (after going since 11 AM without food in a hot tent). The event organizers still pressed a 15 minute discussion.  They had us split up into four groups: men older than 35, men younger than 35, women older than 35, and women younger than 35. I joined my respective group where we were assigned to discuss the causes of teenage pregnancy and substance abuse. The women were candid in what they saw in their clients and loved ones. I was able to keep up without an isiZulu translator and actually shared a bit of what heard in a focus group of teenage mothers that I conducted that week. The only bummer was that the older men decided they were hungry and interrupted the womans’ groups (deep in conversation) with song to close the event.

In the end, I am glad that I went. First because I now realize how permeated stigma is in South Africa related to HIV. Stigma can be fueled by how we describe diseases. Second, I am aware of what makes the events interactive: safe place for discussions and songs. In Graduate School, my class analyzed a midwife education program in Malawi where participants in the training did not have access to education and used songs to learn concepts. Music is also an integral part of amaZulu culture that could be incorporated into a campaign to reach adults who experienced Bantu Education and children who speak isiZulu. Third, the rural communities need to be the target population as they are the ones who deal with the brunt of HIV/AIDS’ impact. Any event I coordinate needs to be accessible to them. Most of the people at the two events were Fourth, public health slogans need to have meaning to them. I lost count of the times I heard 90-90-90 and other slogans (in English) but the speakers did not talk about the context of these campaigns.

Finally (and probably the most important) I had to check myself. I am looking at this as a public health graduate student serving as a PCV in a country that is rapidly losing HIV Funding. Since the country still has the highest population of People Living With HIV (PLWHIV), every event needs to count at this point. The politicians were seeing this as an opportunity before the March 2016 local elections. The older participants (like the isiZulu dance group) have lost their culture in so many ways and may view HIV as just another method of pulling the younger generation away from tradition. Recently I was reading a book and a remark from a traditional leader in Modern-Day Nigeria brought some perspective to my lens.

 “We cannot leave the matter in his hands because he does not understand our customs…just as we do not understand his. We say he is foolish because he does not understand our ways and perhaps we are foolish because we do not know his…”

-Chinua Achebe, Things Fall Apart

Yes politicians were strutting themselves at the event and I abstained from attending the main event on Saturday since the two days gave me enough of a cultural fix. Yet perhaps to the amaZulu they reconnected with their traditions and maybe prevented illness though free condoms and beneficial health screenings at these events. I may be frustrated by local politics but government is a major stakeholder in public health. If the government cannot keep their people healthy, then they defeat their purpose of existence: to take care of people. It is high time for me to stop calling things foolish and instead figure out how to incorporate tradition in campaigns and try to work with a municipality as a team.

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Also ending with ukudla/food!

 

Shosholoza,

Katey

World AIDS Day Antics 2015: Schnizeland Edition

(I broke this World AIDS Day into two parts due to the length)

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Waiting for the speech (that never occurred). Taken with  the org camera (the grainy image reminds me of Retro Peace Corps)

 

Sanibonani,

As probably indicated by my previous post, I have a love/hate relationship with awareness events. Like most Americans, I appreciate free swag. I also acknowledge that raising awareness is a way people demonstrate their compassion towards others facing overwhelming health situations. Wearing a color or attending an annual event is a manageable commitment in this busy world. If executed well, awareness campaigns can include education and even start social change! The problem is that in a public health context, it does not work…in the long term. Unless the activity is interactive, people will not retain the information. Finally my other pet peeve with awareness campaigns, is that they tend to be an excuse for politicians to use for their own gain, without adequately supporting the people dealing with the health concern 24/7.

I plead ignorance when it comes to bizarre dynamics of South African politics. All you need to know is that KZN is VERY political, especially my corner of the province and the political drama often hinders the org’s work which agitates me. Especially the tendency to coordinating last minute meetings and expecting me to adapt to their needs, and disregard previous commitments to the community. World AIDS Day fell on a Monday this year, so Amajuba moved their events to the weekend. Thursday were the local municipality events, and ours occurred right outside the organization. Three days before we had a request for the supervisor to give a speech at the event adverting the organization’s services. Mr. Swazi thought this was a good opportunity for me to integrate. After reminding him that my isiZulu is lacking and 3 days is not enough notice to translate a speech, we decide that we will split the speech up. I will do my 30 seconds in English and he would share our organization’s services in isiZulu.

The day before the event, beloved funder decides to call a last minute provincial meeting in Pretty City (which is not even in our district) and the local office orders Mr. Swazi and his supervisor (the local AIDS coordinator) to attend, this is more important than the community event. I am still trying to comprehend the logic on scheduling a meeting for HIV programs the weekend following world AIDS day, for the province with the highest HIV prevalence rate in the country. Anyways, my supervisor delegates the speech to me and the supervisor of our caregivers. Between my extreme annoyance with yet again another last minute meeting and concern over how this will look during an election year (because unfortunately that is a factor), I was not in a good mood that afternoon.

The next morning I showed up to the organization, relieved to see Mr. Swazi is at the gate. The local office came around and he is not going to Pretty City, the local office still sent the local AIDS coordinator. We wait half an hour for the municipality to show up and start to walk to the march (a 15 minute walk to the tent). The entire municipality waits for the mayor (highest political office in the district) for another hour and then we finally start to walk. South Africa has a rich history with marches and even a health awareness event had songs and movements that clearly delivered the message. The nurses and community care workers sang about condom use, prevention of STIs, and self-care. They also simultaneously danced with condoms for both genders while singing. I hope the condoms are put to their intended use, but it was refreshing to see a lack of embarrassment with contraception.

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Have you marched with contraception yet? It is a thrilling experience!

 

After we arrived at the tent (right across the street from the Centre) the event began, and by that I mean speeches. The theme of the event was “Zero stigma, Zero discrimination”, and it should have been renamed into “Schnitzeland Political Show to Kill HIV/AIDS.” My isiZulu speaking ability is limited but I can understand health discussions fairly well and I can say (as Mr. Swazi backed me up on this) there was no mention of resources, speech from an HIV positive individual, and no mention of our organization. There were discussions by prominent members of the municipal government and cultural activities by the youth. I cringed the entire time a girl recited this poem, which to me adds stigma (and technically HIV would be the father of AIDS since it comes first?). I am all for giving children the opportunities for public speaking and dance performance, but it is also a good lesson for them to contemplate what message they are delivering. Meanwhile I was watching the agenda and made quick bullet points for an impromptu speech in case we had to discuss the organization.

In the end our organization did not give a speech, Mr. Swazi and I were more than a little annoyed. However the mayor finished off the parade with a speech that used a lot of humor but not a lot of pertinent health information. She also spent an entire 5 minutes getting the crowd to chant PANSI! PANSI! PANSI! Now, Pansi sounds a bit like Cansi (with the “c” click) which means sex. The mayor was screaming into the mike (my hands were in autistic position over my ears the entire time) and I could not hear the entire thing, but it sounds like she was yelling SEX! SEX! SEX! Since HIV is stigmatized enough, I was worried she was giving an abstinence only speech and potentially shaming sexual activity as a whole. That message would go over great in a community with teen pregnancy (also young girls 18-24 have the highest incidence/new cases rate of HIV in the country). I asked my host family about it, and what she was really saying was DOWN! DOWN! DOWN! Still did not make sense, but better than my initial concerns.

After the mayor finished, our local AIDS Counselor our special guests (see next post) we moved to the community hall for food and Schitzeland’s World AIDS Day 2015 Observance finished. That should have been the end of World AIDS Day 2015, but it was not. After the mayor finished, our local AIDS Counselor our special guests (see next post) we moved to the community hall for food and Schitzeland’s World AIDS Day 2015 Observance finished. That should have been the end of World AIDS Day 2015, but it was not. Enter a caption

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How all events in South Africa are supposed to end: ukudla/food

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

Keep Calm and Shosholoza

Keep Calm and Shosholoza

I am not going to lie, May has been a rough month personally. The first three months of Peace Corps Service (Integration Period) are challenging for most PCVs. In my South African life, it has been a Murphy’s Law celebration! There have been many moments where I have requested the universe to hold off on the personal growth opportunities as I am still processing the last challenge. Work has been crazy, I had to move rooms, and my electronics are quitting (as I type on my laptop with cracked glass…eish). Last weekend my Indian Store Blackberry’s battery literally imploded the night I got a nasty stomach bug (the one time I had to call the Peace Corps Medical Office).

No big deal. Shosholoza.

What is Shosholoza (besides my tattoo design if I felt the need for a permanent reminder of this experience…highly unlikely parents)? It is a national folksong with a mixture of Ndebele and isiZulu words. Here is the tune according to my sort-of neighbors: the world famous Drakensburg Boys’ Choir.

Shosholoza
Shosholoza
Kulezo ntaba
Stimela siphume South Africa
Kulezo ntaba
Stimela siphume South Africa
Wen’ uyabaleka
Kulezo ntaba
Stimela siphume South Africa

A rough translation:

Keep going
Keep going
from those mountains
on this train from South Africa
Keep going
Keep going
You are running away
You are running away
from those mountains
on this train from South Africa

In other word’s Shosholoza basically means, keep going. As with any national folktune, the origins are disputed but it probably derived from mineworkers working in the Witrandersand (Johannesburg). During the resistance to apartheid, it was a powerful freedom song sort of akin to Spirituals in the Civil Right’s movement.

Shosholoza is a term with special meaning to me and members of SA 31. Not just because my South African families are also Ndebele and isiZulu, but It is the name of a national folktune that we sang when morale was low during PST. Sometimes it was annoying to sing Shosholoza at the sporadic request of PC staff. Yet when we hit a mid-PST slump or a cohort member choose to ET when the permanent site did not work, we sang Shosholoza. When tears of joy streamed down my face after swearing in as a PCV, we sang Shosholoza. Now I sing Shosholoza when I am dragging my feet to or from work.

When I think about how “rough” I have it, I am quickly reminded by the AmaZulu about the accurate definition of resilience. Resilience is not “bouncing back” from adversity, it is learning to ride with the pain. This is a country that is too familiar with pain. As the media will show you, South Africa has had its fair share of bad periods and continues to struggle as all countries do. Yet, thousands of years after the people who thrived at the Cradle of Humankind UNESCO site, there are still people living in South Africa. They live with some nasty social problems, but they are still in my remote valley and siyaphilla: We are alive!

My walk home involves direct eye contact with the Drakensburg on clear days . As my personified witness, the Drakensberg loom over the valley and have watched the valley’s people for thousands of years. When I have a rough day and seriously wonder if I knew what I signed up for, the mountains are a harsh reality check, that they have seen worse. The Drakensburg and seeing the Southern Cross (my favorite constellation) at night keeps me grounded and reminds me that if my community can Shosholoza, then so can I.

I am going to try to take the slack off of my poor tablet/laptop and take a break from posting for a while (plus I need to finish the Community Needs Assessment). Hopefully I will not be gone longer than a week but just in case….Shosholoza!
All the best,
Katey-Red