Moretele

So the big question is what I am actually doing at work?  Well, last week I really got to find out!  It was my first "implementation week."  Basically South to South is working with the departments of health in the different provinces to help them improve their pediatric HIV care.  Since things in the Western Cape (the province that Cape Town is in) are already decent, most of our work is in other provinces (there are 9 in the country - sort of a similar concept to states in the US).  Right now we are working in the Northwest Province in a sub-district called Moretele (it is blue thumbtack below - you may have to zoom out a lot to get prospective, if it doesn't stay zoomed out)


View Moretele in a larger map

Moretele is about 1-2 hours from Pretoria depending on where in the area you are going and how much rain there has been (since many of the roads are dirt roads, when it rains a lot there is a bit of a problem getting around.  Luckily it is dry season right now ;) There are 26 clinics in the area and we are focusing on 10 (as requested by the department of health).  Only 4 of them currently supply ARVs to patients (and 2 just started this month) the rest of the patients who are HIV positive must travel to one of those clinics to get care, which is an improvement since they used to have to travel to the nearest hospital which is not even in their district.  The clinics are pretty far apart considering most people do not have cars, bikes, or donkey carts and public transportation is limited to minibuses....Many of the clinics do not have running water.  Most of the clinics have a severe chair shortage so meetings are held either standing up or on the beds in the labor room (when there are no patients in labor).  So what we are doing is helping the nurses, lay counselors, and the few doctors and pharmacists develop their skills and comfort in treating pediatric HIV.  We are also focusing heavily on PMTCT (Prevention of Mother to Child Transmission) since that is really the only way to stop pediatric HIV.  Some of the time is spent mentoring individual health care workers and the other part is helping the clinics put systems in place to improve care.

A typical sign listing the services at the clinic - though most are supplied by nurses only and many patients have to be referred to the hospital for further management which is hours away.  There is an ambulance in the area most of the time for emergencies though it can take a long time to arrive (and if it is not a life threatening emergency they have find their own transport, which many of them cannot afford)

On Tuesday, I got to attend the second meeting of the Teen Club in one of the clinics.  There were 11 teens (a stark contrast to the 200 who attend Teen Club in Botswana every last Sat of the month).  But this is the beginning. The teens got to know each other, elected members to do different tasks, and discussed the importance of confidentiality.  I am looking forward to working with the social worker at the clinic to help her develop the Teen Club even further, but it is off to a great start.  The kids were really engaged and clearly appreciated being able to attend.

The road to one of the clinics

South to South (S2S) has created registers (basically like patient logs, where healthcare workers enter information about the patients and columns like "mother on HAART y/n" prompt the healthcare worker to ask certain questions and send certain tests).  These have helped to improve the numbers of women who are receiving ARVs when they are pregnant and in labor.  But we realized that some of the health care workers do not really understand why they are doing certain things - they are just following protocols.  This is generally good except that without understanding the reasoning behind the protocols, they are often missing things.  So on Wednesday one of the S2S nurses and I sat with all the nurses in one of the clinics and explained the reasoning behind some of the protocols to them.  It was so nice seeing the lightbulbs go on in many of their heads.

I will be going to this district 1-2 weeks each month for the next 6 months and then we may expand to other districts depending on how things are going in Moretele.  In between traveling weeks, I will work on projects identified while there (this week, improving their adherence sheets, collecting resources for the teen club, and improving the registers).  And also conducting week long trainings at Tygerberg Hospital at the University of Stellenbosch (first one for me is Sept 5-9).

One of the clinics we visited is trying to make the outside look nice so all the workers at the clinic each brought a plant and they were planting and watering when we arrived.

On one of the days we visited a business of local women called the Heartfelt Project during the lunch break.  It was started by a woman named Martha after her son was wrongly accused, imprisoned and died in prison.  She lost all of her money to a corrupt lawyer who had promised to get him out.  She had worked for 20 years for a family in Pretoria and their daughter, Julie, helped her start the business.  Now they have 10 employees and create all sorts of hand sewn felt designs.  If anyone is getting married (or having another occasion to party) and needs nice party favors, consider ordering some from them they are great and the profits go to the women and also to support a local community health project.  .....www.theheartfeltproject.com is where you can read more about them and place orders.
They will even ship all over the world with enough time ;)

Here are some of the designs before being sewn and stuffed.

Hope everyone reading this on the East Coast is managing to stay dry and get back your power!  Stay Safe!