On the 3rd of November a team of 6 community healthworkers, the Keiskamma health cordinator Unathi Meslane and ourselves- two volunteer doctors - bundled into the Trust’s backie and set off for Horton Clinic- an hour away via potholed roads and through heavy rain. A quick stop in the town of Peddie to pick up enough supplies for the trip (a lot of chicken!) and tie up a few loose ends and we were on our way.
Our aim was to deliver training to these community health workers along with others from Horton on key areas of women’s health that need improvement in the Ngushwa district. We then planned to pass on this knowledge to the catchment area of the clinic via a door-to-door campaign. This initiative was based on the government plan for Prevention of Mother To Child Transmission (PMTCT) of HIV. We hope that by targeting all women (not only those who already have diagnosed HIV) we will be able to pick up new cases of HIV early and initiate treatment as soon as possible.
We began with a day of teaching delivered by KT founder Dr Carol Baker, educating us on the reasoning behind early booking in pregnancy, exclusive breastfeeding and contraception. Presenting to a medical professional late in pregnancy is a major problem in the areas served by the Keiskamma project. Contributing factors include cultural practises of non-disclosure, fear of the consequences of extra-marital pregnancy and worries around the perceived “compulsory” HIV testing. Exclusive breastfeeding has been difficult to establish as previous advice was to bottlefeed if mothers were HIV positive and clinics were providing free formula (see WHO guidelines for more information). The use of contraception appears to be patchy as there are high numbers of teenage and unplanned pregnancies.
Over the next three days, we were ‘released’ out into the village knocking on people’s doors and passing on our knowledge with the help of some brand new Xhosa pamphlets that we recently developed. It was a privilege to be invited into the homes of people from a culture that we had not encountered before. The range was quite extreme, from corrugated iron shack, to clay rondavel to 4 bedroom modern constructs. And the people we met inside had different stories to tell as well as different health issues. Although our main focus was promoting contraception, healthy pregnancies and exclusive breastfeeding, we also wanted to obtain a profile of the village and its health needs. These ranged from a 2 year old child that was failing to thrive, to a mother that presented to the clinic 5 months into her pregnancy, to an elderly man who needed walking aids.
Our aim was to deliver training to these community health workers along with others from Horton on key areas of women’s health that need improvement in the Ngushwa district. We then planned to pass on this knowledge to the catchment area of the clinic via a door-to-door campaign. This initiative was based on the government plan for Prevention of Mother To Child Transmission (PMTCT) of HIV. We hope that by targeting all women (not only those who already have diagnosed HIV) we will be able to pick up new cases of HIV early and initiate treatment as soon as possible.
We began with a day of teaching delivered by KT founder Dr Carol Baker, educating us on the reasoning behind early booking in pregnancy, exclusive breastfeeding and contraception. Presenting to a medical professional late in pregnancy is a major problem in the areas served by the Keiskamma project. Contributing factors include cultural practises of non-disclosure, fear of the consequences of extra-marital pregnancy and worries around the perceived “compulsory” HIV testing. Exclusive breastfeeding has been difficult to establish as previous advice was to bottlefeed if mothers were HIV positive and clinics were providing free formula (see WHO guidelines for more information). The use of contraception appears to be patchy as there are high numbers of teenage and unplanned pregnancies.
Over the next three days, we were ‘released’ out into the village knocking on people’s doors and passing on our knowledge with the help of some brand new Xhosa pamphlets that we recently developed. It was a privilege to be invited into the homes of people from a culture that we had not encountered before. The range was quite extreme, from corrugated iron shack, to clay rondavel to 4 bedroom modern constructs. And the people we met inside had different stories to tell as well as different health issues. Although our main focus was promoting contraception, healthy pregnancies and exclusive breastfeeding, we also wanted to obtain a profile of the village and its health needs. These ranged from a 2 year old child that was failing to thrive, to a mother that presented to the clinic 5 months into her pregnancy, to an elderly man who needed walking aids.
It was heartening to see people hastening to Horton clinic the same day to get screened for HIV or have their blood pressure checked or be started on contraception. The immediate effects of our campaign were apparent. The experience gave us better understanding of the way the communities function and the cultural and social factors that affect people living with HIV and other stigmatised conditions.
Spending three days working and living with some of the Community Health Workers was an insightful and often entertaining experience. We cooked to the beautiful sounds of their naturally harmonising voices and had our first experience of Miely Meal- pap doused in soured milk and sprinkled with salt (not entirely sure about that one but we were grateful for it all the same!) They looked bemused at my slightly confused look when first handing me the basin which I was meant to fill with a mixture of rain and boiled water to go and wash in as there was no running water in the entire village. One lovely lady was even kind of enough to demonstrate exactly how we should do this. Some of the community health workers themselves who were HIV positive spoke loudly and without self-consciousness about their diagnosis. There was a lot to learn from them and their input helped shape and direct our work.
Dr Cavitha Vivek
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