You know you live in Africa when... VI

You know you live in Africa when....

... the groundskeepers use machetes to cut the lawn.

... your dress shop (in the middle) is a headstone shop in front and a hair dresser in the back.

... monkeys become the equivalent of squirrels in your eyes.

... ironing clothes (and I mean every piece of clothing, jeans, underwear, scarves, tshirts, linen pants, you name it) is a daily essential unless you want to be ridiculed by your co-workers.

... and last but not least...

... your car breaks down and the first guy that comes to help is wearing such short shorts that you can't actually talk to him. (Thanks Lorrie!! - true Afrikaaner stylings)

My pride and joy

My funders: Ipas (doesn't really stand for anything, might have at one time? website: http://www.ipas.org/Index.aspx) is an international NGO that promotes sexual and reproductive health and rights, with a large focus on abortion.  Their headquarters are in North Carolina, but they have outposts all over the world, from the Americas to Asia to Africa.  They have five outposts in Africa, including one in South Africa, based in Jo'burg.  Their work includes research, training, and advocacy, among other things.  They conduct research about the above mentioned issues, including rates of teenage pregnancy, contraception use, and unsafe abortions, making them a great resource.  They train health care professionals in providing safe abortions and supply equipment as well.  Their advocacy is very broad and far reaching and covers all the above issues, and any related issues, including gender norms and violence.  For example, they are heavily involved in the activism surrounding women's health issues in the US right now in partnership with Planned Parenthood.  My experience with them ranges from them helping fund a Global Reproductive Health Week annually at my medical school to funding and helping facilitate programs here for educators and learners.  Their work extends all over the country.  For example, I have a Peace Corps friend who works at a woman's center in Mpumalanga (in the corner between Swazi and Moz) which they also help support.  Basically, they do some really cool stuff.

My project: A small grant to develop a program to support pregnant teenagers, which includes identifying pregnant learners earlier and making all options available, including termination (available during the first trimester by the woman's choice), as well as continuing with a safe and healthy pregnancy by getting early antenatal care.  We are also promoting keeping pregnant girls in school (which is required by law, but often they are pressured to leave) so that they can hopefully support themselves and their baby, providing them with some autonomy.  We have extended this program to target all at risk teenagers because so many of these issues are so closely linked.  One such issue we are particularly focusing on is gender based violence, being as pregnancy, violence, and HIV create a major triad, all of them leading to one another.  To address these issues we are implementing a mentoring program, made up of both educators and learners, to provide support and resources to learners within the school.

Part of our inspiration was Tim's program actually, Grassroot Soccer.  Grassroot Soccer is an activity-based HIV curriculum that supplements our formal health curriculum we provide in the units.  GRS is implemented in the schools by "coaches".  The "coaches" are recently graduated matrics from the community ("matric" is the final year of secondary school or high school that culminates with a large exam of the same name that a lot of their future depends on - the "coaches" all passed their matric).  We hired coaches as permanent positions at each school to teach the curriculum, and soon enough the learners started approaching the coaches with their problems and asking for help.  The coaches made us realize the learners need, appreciate and utilize having a trusted resource associated with Mpilonhle at their fingertips. 

Mpilonhle's mobile units rotate through each school once every 5 weeks on average, leaving a gap of time when the learners don't have access to a nurse or social worker.  This becomes an issue, especially in relation to time sensitive and crisis situations, such as pregnancy or violence.  While the coaches are great at their job, they are not trained as counselors, so we decided to create a more formal program, which now goes by the name PALS (Partnership for Adolescent Learner Support - yes, I came up with that, thank you very much).  The idea of the program is to create a permanent presence in the schools by training these ambassadors, more or less, who are available at school full time and will provide a bridge between the schools and the organization by having contact with the Mpilonhle staff 24-7.  So if they identify a vulnerable learner who needs to see a nurse or social worker, they can call us, and we will send the appropriate personnel within 24 hours.

We opted to have two layers, with the educators, who serve as trusted adults that have access to resources, including contact to the Mpilonhle services, and the learners themselves serving as peer counselors, because there are some issues adolescents just feel more comfortable talking to a peer about, as well as that the learners often have the best sense of what is going down at school.  We wanted to involve the members of the school community, in part because when we talked to them, they all spoke about these problems they are facing, and while they are very aware of them, they didn't know what to do about them, how to help, educators and learners alike.  They were very discouraged.  And so by including them we hope to give them the tools and resources to become involved, giving them some ownership over the problems and their solutions within their communities.

We just finished our first training of the educators, a three day workshop where we covered mentoring and counseling skills, sexual and reproductive rights, including abortion (facilitated by IPAS), mental health, abuse, drugs, and other vulnerabilities of adolescents, including physical, emotional, and socioeconomic.  And in my opinion, it was quite a success.  A quote from one of the satisfaction surveys: "The workshop was good and it helps me to accept and not judge people who have made abortions because they have their reasons".  I know that it might not sounds like much to a lot of us, but that, THAT is success here.  Woo!  Go team!

We will start training the learners (peer counselors) soon, which will be a two day workshop that includes some mentoring skills, as well as talking about gender issues and sexual and reproductive health and rights (again, with the help of IPAS), among other issues mentioned above.  Eventually, we also want these teams to help run awareness campaigns in their schools on such issues as pregnancy, gender-based violence, substance abuse, etc.

Woo!  Okay, I think that's about it.  Again, please let me know if you have any questions and/or comments.  Would love to hear from you all!

Richard

Felt I should finally explain who Richard is...  Lorrie introduced this to us soon after she arrived and we drop direct quotes from it on pretty much a daily basis...  Here it is, in all its glory:

Richard...

The good life

Whoa, it's been awhile.  Things have been a little hectic, to say the least.  I've been back and forth to America and organized and run a workshop since I've last posted.  But, since getting back, and actually starting to see some of my efforts come to fruition, I've realized my days here are numbered, which has inspired me to start recording my adventures again, at least for memories sake.

To start:  What the hell is Mpilonhle?!  I realized in my last couple posts, especially the one about the initiation ceremony and circumcision, that I have never really explained my organization and what they do.  I have explained what I do for them a little bit in the beginning, but that doesn't really explain who we are or what we do.  Ok, here goes...

Mpilonhle (pronounced mm (like the sound) - pee- lon - shle (kinda lispy) ) means "good life" in Zulu.  The foundation of our organization is mobile health units that circulate between 12 rural high schools, so servicing upwards of 10,000 adolescents, providing health education, computer education, and HIV testing and counseling.  Our counseling entails a 45 minute one-on-one session between a learner (aka student) and a counselor, where the learner is screened for everything from malnutrition to TB to abuse, and then offered rapid HIV testing.  I am pretty proud of this being as many children in America don't get a 45 minute health screening annually.  Now if anything raises a red flag during the screening, the team includes a psychologist/social worker and nurse to further manage the concerns.  Due to confidentiality concerns (aka anyone who goes to see the psychologist/social worker and/or nurse has a problem), we have every learner go through the process of seeing the nurse and/or social worker so no one can be singled out.

All health education and IT education is grade appropriate and progressive.  Since we come back to the same schools year after year and see the same kids, we build on what we taught them the previous year.  So, it's not the same information over and over again, but we continuously build on their knowledge base.  We've also found that coming back year after year offering HIV tests has normalized the idea of getting tested, getting rid of stigma, so more and more kids test each year.

Now, the ideas behind it.  Adolescents, no matter where in the world you are talking about, are an incredibly vulnerable group.  This holds true even more here, in this rural, impoverished area.  There is also a transition we see here, from primary school, where no one is getting HIV, to 50% of women between 20-25 years old in this area being HIV+.  Yes, in a large part this is due to them beginning to be sexually active.  And a big part of our organization is acknowledging this fact, rather than denying it, like many people do here.  But, they are not just having sex, they are having unsafe sex.  So, our thought is to intervene at this transition point, and hopefully stop it before it starts (or help them know when it starts to help them stop passing it on and remain healthy).

A big asset to our program, in my mind, is that we acknowledge that HIV is a multi-faceted issue.  That it is not simply an issue of sex, as if by teaching safe sex practices and giving out condoms we will solve the problem.  We take a much more holistic approach, providing other services that we have found a need for in the community as well as being related to HIV prevalence.  For example, we provide food parcels, career counseling, shoes (TOMS!), home based health workers, sports fields, gardens for schools, water and sanitation, and as I've talked about in other posts, other health services, including eye care and circumcisions, among other things.  This is where IT training comes in.  Behind HIV, the biggest problem probably facing South Africa is unemployment.  By teaching basic computer skills (we're talking like turning on/off a computer, using the mouse, Microsoft Word, and some other basic office programs), we are hoping to make them stronger candidates for employment.  And unemployment is very closely related to HIV incidence.  If people don't have a job to go to, what is there to do?  Well, have sex.  And for women, a common way to make money when they can't find a better option is prostitution.  So, multiple partners, often unprotected, aka very high rates of HIV.  My project is also related to this holistic/multi-faceted approach to HIV, but we'll get to that another time.  I do have to say that this holistic approach means we are spread pretty thin sometimes, trying to address each and every issue.  But, coming back year after year to the same schools, and approaching the challenge from multiple angles, we hope to create a sustainable and affective intervention.

We also have a strong belief that all of this information and aid should be transmitted from one local to another.  Other than the top bosses (aka Mike and Christine), and us four mulungus at the guest house (and now Claire more and more :) ), the entire organization is African, mostly Zulu.  Who am I to come in as a 25 year old, blonde, American, female and tell these teenagers how to have sex?  Please!  The audience is much more receptive when they can relate to the people providing the services.  It also allows them to speak in Zulu, their native language, which often makes it easier for them to express themselves more freely.  This is especially important when talking to adolescents about sensitive topics because it allows them to use the slang they feel comfortable with and talk about the issues as they hear them, in their conversational language.

Ummm... what else is there to know?

Director: Dr. Bennish aka Mike -> American physician- pediatric ID (infectious disease), working in global health for over 30 years.   Him and his wife (Christine - an adorable Belgian woman) head-up the org, she on the administrative side, as a graduate of the Kennedy school and working in development for decades.

Funders: at least the major ones - PEPFAR, Charlize Theron, South African government through the lottery and IDT,  and of course Grassroot Soccer (aka Tim - should also explain his part at some point) and Ipas (ME! - tomorrow I will explain exactly what that means and what I am doing).

Questions?  Please.  Would be more than happy to answer any questions/expand/clarify.  I'm sure I left something out.  Doing this day in and day out has normalized a lot of this for me, so I don't even realize when I'm leaving stuff out anymore.  Can't wait to hear your responses!