the Emporium of Care

In a disused boiler house, Nils Groebler and his colleagues have built the Emporium of Care - what started out being an ARV treatment program now has ARV treatment plus income generating activities, skills development, VCT, spiritual care, a playroom for kids and the newest project is a community garden. The tables you can see in the foyer are part of the tea shop - a place for PLWHA (People Living with HIV / AIDS) to sit and chat with people who really understand what they are going through.

To me this is the ideal of where we should be aiming for HIV treatment programs - without an income and food, all the ARVs in the world won't help. The Emporium of Care really tries to be a holistic community and care centre.

Robben Island

I arrived home two weeks ago already, but didn't have the time / energy to return and add my photos. In a few weeks I'll return to Cape Town for 2 months - and I expect that my blogging will increase again since I will have more time to do that sort of thing. And interesting observations to make!

Cape Town from Robben Island; with famed Table Mountain in the background. (I climbed that once).

Robben Island: the notorious Western Cape island prison, for political prisoners during the struggle, including Nelson Mandela.

The visit to Robben Island was excellent. For me it was an emotional thing, to see the quarry where the leaders of the struggle spent their days, moving rocks from one place to another and yet still teaching each other to read, and leading the struggle. To see the cell, where Nelson Mandela spent so many years of his life. To see how truly shamefully we humans are capeable of treating one another on the basis of the colour of someone's skin.

A Canadian colleague recently mentioned that in the late '80s / early '90s he was hardly aware of what was happening in South Africa. From what I remember, it was hardly covered in the western media so you had to be interested to know what was going on. I remember it - seeing news footage of riots in Soweto, hearing of the school strike, seeing masses of youths doing the toyi-toyi.

But it didn't seem real, in a way. But when I now am spending time in South Africa, I am humbled by the strength and determination of those involved in the struggle.

The ex-political prisoner who was our guide talked about how the guards worked to 'divide and conquer', driving wedges between prisoners using access to 'luxuries' such as newspapers, extra meat. He showed enlarged mockups of the cards that ruled everything in their lives.

Even in prison, there were huge differences between how the apartheid-defined racial groups were treated. I just have so much trouble understanding how an entire country was run on those bases for 50 years - true democracy only started in 1994 in South Africa!

As I continue to work in South Africa I will surely learn more about it; but as a privileged, white foreigner will never be able to truly understand.

Anatomy of a collaborative study

I’m here in South Africa for two workshops on the development of a huge planned study. Its challenging to bring together such diverse groups to work on one study, to communicate and truly collaborate. And the politics can be such a minefield, often tough to negotiate – though for now its not me who will be doing that. Again the time “before independence” defines a lot of how people relate and its hard for the foreigners to sort it all out. We’re often making inadvertent blunders. Luckily we have two young South Africans on our team, to help us negotiate all that.

The site visit yesterday was just great. It was so helpful to see to a certain extent what the level of care is like here, and what is available. The Drakenstein valley is really beautiful, in a basin surrounded by mountains with wineries all around. The hospital & HIV clinic we visited was much better resourced and better developed than what we had last year. The “Emporium of Care” provides a variety of health care services, social support, spiritual support and income generating activities. Its just a really neat holistic facility. Our conference badge lanyards were made by the beadwork project from there – www.kidzpositive.org

Yet the health care workers all talked about being discouraged with the system and how draining it is. I wonder if part of that is the fact that there are such riches here.

I’ve been struggling a little with what my role really is; I’m not an expert in any area and I sure don’t have any experience in designing and implementing any large study much less one of this scale. So I find myself wondering what I can really contribute.

The anthropologist that has been working with us has been really good – although she’s just working on her Masters, she’s worked on a number of prior studies in the area, and in other parts of Africa.

One of the challenges has been to establish “community participation” and “community driven” … no one in the core group (especially of the Canadians) has actual experience in doing that in low and middle income country settings. Yet how you go about community engagement is different if you are selling / engaging them on a study that is essentially already designed is quite different from really finding out what the community wants and studying that. My public health hero, Dr. Bang has taught us about projects that ultimately fail when they didn’t take into account the community.

Anyhow, there are no easy answers, that’s for sure. We’re all learning incredible amounts along the way though.

Welcome to Cape Town

The last blog entry that I wrote related to a trip to Haiti. How I’m onto the next big project… a tri-university collaboration in the Western Cape, South Africa.

I’m writing this first update from South Africa, halfway through a 10 day visit. The weather has been just beautiful – this is a great time of year, not too hot (about 26-30 in the day) and sunny. (In Vancouver there is snow!)

We arrived last Thursday, and spent the next two days delving into a psychosocial pre-workshop.

Sunday I went with some colleagues to Robben Island – the prison where Nelson Mandela stayed for 18 of his 27 years in prison. It’s a national historic site now. I really enjoyed the trip although it was pretty exhausting – even as a foreigner its hard to understand Apartheid and how it affects everything here. But to hear the stories of political prisoners is really moving. How can a society heal from the wounds of such discrimination and of so many years of oppression of the majority of the people? People here refer to the end of apartheid as “independence” and the time since as “since democracy”.

Cape Town is a strikingly beautiful city and it’s a little hard to come to grips with the poverty that lies underneath the city that looks like any Western port city – Vancouver, San Francisco, etc (but with sun!). The waterfront is a quaint area of lovely restaurants and shops nestled in a working harbour. Table Mountain is the anchoring landmark for the whole city. There are malls with all sorts of fancy shops.

Yet… nearby are places where people live in shacks cobbled together with whatever they could find, no electricity or running water. There are towns that have some of the highest rates of fetal alcohol syndrome in the world. The culture of violence is incredible and effects everyone from the bottom to the top of the social ladder. The poverty is pervasive in this society, yet hidden from view. There are such riches, yet 6% of kids don’t get to go to school at all. There are some amazingly brave and resilient people and some that crumble under the pressure. It is a country of contrasts, of dichotomy and I think it will take my whole career to even scratch the surface of how it all works.
What a learning experience!