Long time, no update! Before getting here, we had both planned on blogging more regularly. Indeed, it is now September and we last updated in May. Whoops.
Just over a year ago, we received our invitations to serve in South Africa.
Exactly this time last year, we were somewhere along the US/Canada border, midway through an Eastern Canada road trip, scrambling to send the slew of additional legal documents to Peace Corps. After the invite, it’s almost like going through the application process all over again between the medical and legal tasks. When PST was rough, we thought about how brutal it was slogging through all of that in a short period of time.
We’ve been in South Africa for over 7 months. We moved to our permanent site in mid-April. We are in Msinga Municipality, right in the middle of KwaZulu-Natal. The name in isiZulu roughly translates to “the whirlpool”, referring to the wild crosswinds that blow through the Tugela River valley.
Over time, the culture shock finally started to wear off. Things like the extremely overwhelming crowded market area downtown now are merely a maze to navigate around, between the vegetable sellers, cows, taxis parked all over, drunk men, and vehicles driving in all directions, including onto the few stretches of sidewalk that exist.
The news and jokes people make start to make more sense and feel more familiar.
Something that admittedly hasn’t been as easy to get used to is the public transit situation. As PCVs, we are not allowed to drive during work hours. (Our site is also a bit unusual in that there are many international healthcare workers and volunteers here, all of whom are banned from taking public transit….and are horrified that we take it). Fortunately, we don’t have to take taxis often, as pretty much everything we need is right here at our site. This is unusual and far removed from the experience of most other PCVs in South Africa, as most PCVs are in deep rural sites, whereas our site is more of a township.
Really, it’s not too tough being here in terms of our physical comfort. We live in a much nicer house all to ourselves, no roommates or nosy neighbors (aside from a friendly stray dog and a baby goat) on the grounds of our org, a step down palliative care unit for adults that is an extension of the local district hospital. In the morning, we hear our next door neighbors, the Department of Health Mobile Clinic team, beginning their work day with singing and praying. Occasionally, we’ve found a TB patient sneaking a cigarette in our yard. The people who live behind the org’s campus seem to run some sort of taxi repair shop and tend to do this work at night. Aside from that, no one bothers us. Some might think this is a barrier to integration – quite the opposite, as we have space, time, and most luxurious of all, PRIVACY. Even better, no roosters!
In March, we visited our permanent site in Msinga for the first time. It was late afternoon by the time we made it from Pretoria to Pietermartizburg, the capital city of KZN. On the way to Msinga, we passed by rolling green hills of sugarcane. I thought to myself, “Hmm, not too bad.”
The landscape abruptly changes upon crossing into Msinga. It’s so stark. Lush fields recede to rocky, arid aloe and cactus strewn rugged hills. All the plants have spikes on them. It was familiar somehow, not unlike Twentynine Palms, California. Dry desert, big steep rocky canyons, strange desert plants, albeit with much scarier roads in questionable condition.
Rian Malan in My Traitor’s Heart (1989) summed up his first observations of the area succintly: “less grass, less hope, more goats”.
An NGO manager we met more recently said, “oh yeah, it looks like Mars out there”.
Then there’s the big mountain. It’s called KwaKopi and not going to lie, it is terrifying. Especially when you get to the cliff side stretch at the top of the mountain…eish. There is a massive roadworks improvement project trying to repair the long stretch of the road that snakes along the cliff. Giant potholes, patches of guardrail, taxis in questionable states of repair, overloaded bakkies packed with refrigerators and people, and tractor trailers vying to pass one another. The taxis tend to swerve as close and as quickly to the edge of the road as they can in vain attempts to avoid the potholes. Gogos clutch the backs of the seats, a man next to us once started praying. You know it’s bad when the men show they are scared.
Mid-April through mid-July:
The first three months at site are dedicated towards integrating into our community, getting to know different organizations, facilities, stakeholders, and also just meeting lots of people period. We were working on our Community Needs Assessments during this time, a big long report all about our area, local government, health facilities, other orgs, etc. It’s also known as the “no work” period. During this time we made our introductions and shadowed all over, mainly with the local Department of Health mobile clinic teams, the anti-retroviral (ARV) clinic, and other healthcare organizations. We met really interesting people from the community (grocers, butchers, young men, nurses, doctors, teachers, vegetable sellers, etc).
Being in South Africa has also allowed us to meet a lot of people not from South Africa – some Americans, some from the UK, Germany, and many from other countries. There are a number of healthcare professionals at the local hospital who are from elsewhere – the Netherlands, Cuba, and the Democratic Republic of the Congo. We have also met people in our wider community who are refugees or asylum seekers from other countries in Africa, such as the DRC, Burundi, Rwanda, Mozambique, and Zimbabwe. It’s been really amazing having the opportunity and time to get to know them.
The head nurse at the palliative care unit helped us make some initial introductions to the community, starting with our neighbors, the DoH Mobile Team. It went something like this:
“These are doctors from Yale. They want to learn about what you are doing here. Please let them observe your work.”
“Uh well. I guess you could say we are prospective nursing students. We are volunteers from Peace Corps. Igama lami ngingu…”. And we usually end with “Siyazama” – we are trying.
The audience is already bored, and they are also clearly busy and getting ready for the hundreds of patients they will be seeing that day. Noting the glazed over looks, people shifting in their seats, and the lack of interest people have dealing with these sweaty foreigners at 8am, we keep it short.
“Peace Corps?” People often pronounce the Corps more like “corpse”.
“Can you give a shot?” Well, technically we both know how to (from witnessing countless IMs administered), but that doesn’t mean we should. PCVs, even if they are trained medical professionals in the US, are not allowed to practice abroad. We settled on helping the nursing assistants with filling out the medical records (all paper here!).
We both took the settling in/integration period seriously, as it is a crucial time to get to know people and get a sense of the community’s current needs, past projects, what has worked and what hasn’t. And also establish what we can and cannot do.
Defining our roles here is perhaps the most important part of the settling in period. It was interesting navigating expectations.
Why are you doing the Community Needs Assessment again? It has already been done! Things may have changed, and each volunteer brings a different perspective, skillset, as well as interests.
Are we here to be office workers? No.
Can you give me money for school? No.
Are we here to donate our vast personal funds to poor people? No.
Can you give me a new Bible? No, and we are definitely not here to proselytize.
Then what use are you? Good question.
Hence, the integration part. In addition to laying down work boundaries and figuring out what we are capable of working on, this three month period is a crucial time to get to know what people’s issues are on the ground level, day to day. And to begin to grasp the myriad complexities of said issues. It’s also a time to identify compassionate, motivated people in the community who want to lead projects – we can come in and help support them.
Sometimes it is very busy – we shadowed a mobile clinic outreach campaign that reached over 500 patients in 4 hours. It sounds like madness, but it was extremely efficient. TB screening, women’s health, nutrition screening, childhood immunizations and wellness checks, HIV testing and counseling – and more! One of the nurses did over 25 Pap smears!
Occasionally, there are some days when, in spite of our best efforts, transportation falls through, appointments get rescheduled or forgotten, and the highlight of our day was watching a tumbleweed blow by. (We’d never seen a real tumbleweed before. It was just like in cartoons, except real life).
But it’s amazing how even with downtime, it’s not really downtime here. There is always something to do or someone to talk to. We’re constantly thinking and researching, learning about South African government and research initiatives to better healthcare services, learning about what’s happening at other hospitals and NGOs in KwaZulu-Natal and the rest of South Africa, and trying to connect with as many people as possible during our relatively short time here in South Africa.
As health volunteers under the umbrella of PEPFAR, we are primarily here to promote HIV/AIDS awareness in the community. Our community is doing a GREAT job in this area, in terms of HIV testing and basic awareness (there is literally a public service announcement EVERY TWENTY MINUTES on the local radio stations about HIV and other health issues), but there are other gaps that need to be addressed such as deep stigma and TB education amongst other health issues. Also the deeper issues and other problematic things such as gender-based violence, education gaps in terms of understanding of health issues, and identifying holistic ways in which we can help unite providers and other organizations to better address community issues. In order to best build capacity, the conclusion we came to for our community is that we want to help people here find ways to develop their ideas and advance their work and projects themselves.
In terms of our roles so far: we’re not going to build physical structures (they already have a really nice library here actually, with a computer lab and air conditioning), but maybe we can help identify at-risk young women and serodiscordant couples in a study to prevent HIV transmission; we’re not going to solve serious and systematic transportation issues, but maybe we can help anticipate transport costs and other barriers to healthcare access; we’re also not going to teach in schools, but we can help facilitate early childhood development research in a rural setting.
It’s been important to slow down and recognize our American attitudes towards work that we didn’t think would be as strong but are when you’re spending three months not working and hanging out with people who mostly are working. Especially as we were approaching month three and conversations were starting to go a bit more like this:
Nurse: “So… what are you guys going to work on?”
Us: “We don’t know quite yet, we’re trying to find that out”
Nurse: “So…why are you here?”
Us: “We are…still trying to figure that out.”
The integration period really never ends. We’re in a pretty big town, and while it works to our advantage in some ways that people from the community are generally used to the presence of foreigners, we still have to establish what we are and why we are here. People are used to two types of foreigners: doctors and missionaries. Being neither is a bit confusing.
It’s taken time, but we’ve started getting into a workflow of sorts. We are working on ongoing research and helping to bridge a gap and build continuity between researchers at the hospital. We’ve also used our time here as an opportunity to reach out to other researchers who are working on HIV and TB prevention and treatment studies in South Africa. Additionally, we are currently helping facilitate another research pilot with a different organization focused on early childhood development. It’s still in the very early stages – fingers crossed! We’ve also been helping another organization with a health education project on common diseases and conditions aside from HIV (hypertension, stroke, etc).
So far, so good.