A recent visit to South Africa led occupational health educator Anne Harriss to use her healthcare and teaching skills in a remote rural community. Here, she describes her rewarding experience.
One of the ice-breaking activities I have used with new students registering on the degree programmes that I teach at London South Bank University is “guess who is coming to dinner”. It goes something like this: you are having a dinner party and you can invite a mix of guests from the past or the present. Who would you invite, why would you invite them and what would you like to discuss with them?
Year on year we have interesting discussions. A range of guests has been proposed. I recall Aileen, a Scottish student wanted to invite Margaret Thatcher. Her reason: she wanted to ask her why, back in 1989, while Prime Minister, she wanted to introduce the poll tax (community charge) in Scotland. A conversation guaranteed to be heated and lead to indigestion ensued.
I would invite Archbishop Desmond Tutu and Nelson Mandela. I was one of many who recall Mandela’s release from prison and am still in awe at his strength of character. In South Africa, Mandela established the Peace and Reconciliation Commission with the aim of investigating some of the inhumanities that occurred during the era of apartheid. Desmond Tutu chaired that commission. Both Mandela and Tutu are inspirational leaders and that would be one of my reasons for inviting them.
However, I have another reason: both are great humanitarians. The Archbishop has a smile that can light up a room, an infectious laugh and a great sense of humour. An interesting evening would be guaranteed.
With regard to Mandela, I would like to remind him of one of his most memorable quotes: “A good head and a good heart are always a formidable combination.”
I have had the privilege of meeting and working with people who have these attributes in abundance. I would like to share with Mandela my experiences of a health promotion project I established in 2003 and have gone on to deliver annually in a remote part of the Limpopo province of South Africa. I have met some inspirational people as a result of this project, some who have had limited education, but despite this have become leaders in their communities and are playing an important part in health interventions. I would like to tell this story to Mandela. It is highly unlikely that he reads Occupational Health magazine but, who knows, this article may get into his morning post.
The spirit of Africa has the potential to get in to your blood. I was born in Uganda, East Africa; however, other than a brief spell working in Oman, I have spent most of my life in the UK. Perhaps the spirit of Africa crossed the placental barrier, lying dormant until 1993, when I finally persuaded my husband to visit South Africa for a holiday. It was easy to fall in love with that beautiful country and we became frequent visitors. In 2001, we decided to incorporate a safari into our next holiday and booked into a lodge in Limpopo, a very remote part of northern South Africa. When I arranged that holiday I had no idea how much it would affect my life. The lodge was beautiful and comfortable but located in a rural and quite impoverished area of the country where HIV and associated health problems are rife.
It was obvious that the most pressing health crisis was the devastation that AIDS had brought to an already impoverished area.”
During our holiday, we visited a project, established by Dr Elbe Coetsee, that brought much needed employment opportunities for local women. Coetsee describes herself as a social entrepreneur, but I would describe her as an anthropologist with entrepreneurial skills and humanitarian values. The project she set up was quite small in scale but was evolving into a research centre that, among other things, has been recording the life of the local villagers over a number of years. Coetsee is committed to what she terms the “upliftment” of the local community so that its young people do not have to move away to more urban locations in order to gain employment. She is a prime mover in ensuring that the local community has access to at least a basic level of both healthcare and opportunities for education.
That visit was life-changing for me. My husband and I became friends with the Coetsee family and my life was different from that point on.
I volunteered to return the following year and deliver a variety of health promotion activities. I have done this on an annual basis ever since. I have also been able to persuade friends, colleagues and graduates of our OH degree programme to participate, giving their time, self-funding the costs associated with travel and providing training materials.
So what does the project involve and what may catch the attention of the South African Government? It may be interested in how it started as a result of the tourist industry – the first course was very small and delivered on the last day of our family holiday.
Areas to address
It was obvious that the most pressing health crisis was the devastation that AIDS had brought to an already impoverished area. In preparing material to take out to Africa, I asked Coetsee what she thought would make the most impact but could be delivered in a one-day training session. She revealed to me the number and nature of home- and village-based accidents.
Accidents and incidents were many and varied but those involving children were particularly disturbing. These included:
- falling into a crocodile infested river while collecting water;
- drinking noxious fluids erroneously assuming they are soft drinks, it being common practice to decant paraffin and kerosene into empty lemonade bottles;
- severe burns that resulted from children having fallen into the wood fires used for cooking and heating their homes in the cool winter months;
- suffocation accidents resulting from children putting plastic bags on their heads in play; and
- snake bites and scorpion stings.
A needs assessment revealed the limited knowledge of infection control and first-aid procedures, compounded by the sheer remoteness of the area. This led to difficulties in accessing emergency care following accidents, which influenced the content of that first training day.
A needs assessment revealed the limited knowledge of infection control and first-aid procedures, compounded by the sheer remoteness of the area.”
The theme that day was preventing accidents, dealing with those that did occur and very basic infection control. The approach to delivery had to be innovative and required quick thinking skills. This was, in part, a result of none of the delegates being able to speak English as their first language, and some not speaking English at all.
There was a reliance on delegates translating for each other and teaching strategies were heavily dependent on role-play and the use of training games. Feedback from the delegates indicated that the day was a great success and they asked if they could have more – which was difficult on one of the final days of our holiday.
That was the start of what became an annual initiative. We set up a learning resource centre and have delivered training on a range of health-related issues including:
- Health beliefs and healthy lifestyles, incorporating “safer sex” taught in a workshop setting with adults including nurses, healthcare assistants and a police inspector.
- Safer-sex presentations and facts and fallacies regarding HIV delivered to teenagers at a local school. Sadly, this was the first time they had had this type of health education session as their teachers did not have the skills to deliver such a session and revealed their embarrassment in teaching this topic.
- Basic “home-nursing” care for people with long-term health conditions, principally AIDS and TB.
- Simple first aid.
Each year there are further developments, sometimes they are planned before we leave for South Africa, sometimes, due to unforeseen circumstances, they have to be developed “on the hoof”.
A small number of attendees return year after year. We have now incorporated a “train the trainer” element into the programme that is delivered on the final day of the workshops.
Somewhere in the region of 150 to 200 people have attended the workshops, with some of them travelling many miles. Their learning ripples back to their communities: attendees must share what they have learned with their friends and neighbours in their villages.
Attending a formal workshop is not the end of the story. There have been a number of success stories resulting from the project.
Etumelang Machaba, a young school-leaver with no formal qualifications, was accepted to enroll for a paramedic assistant’s course on presenting his AIDS Awareness and Basic Health Care certificate of attendance. He is currently in training.
After attending two AIDS Awareness and Basic Health Care workshops and receiving her certificates of attendance, Edny Manzana continued her training and qualified as a community health worker delivering care in nearby villages.
A group of 10 female community healthcare workers are now healthcare trainers.
When word spread of the training available, members of the police force based in Alldays, the nearest large town, attended the workshops to develop their skills, particularly in relation to first aid.
This project is playing a positive role in establishing and promoting healthcare in rural Limpopo Province that contributed to the welfare and improvement of health of the community as a whole.”
Without a coordinated ambulance service in this remote area, members of the police service are often the first people to attend serious accidents. I have never before had to ask an attendee on a first-aid course to remove their gun and lock it in a “gun safe” position before allowing them to practice their first-aid skills, which included examining and caring for an unconscious casualty and practicing resuscitation skills on a mannequin.
Perhaps one of the most inspiring stories is that of Pietnett Sepela. Pietnett was originally a gardener at the lodge we visited. Pietnett attended every workshop between 2003 and 2010. She is no longer a gardener – she has now set up the Matome pre-school project, which cares for 75 children.
Pietnett has done this despite having limited resources and little education. Many of the children are orphans and are HIV-positive. All are welcomed and cared for. The only formal training she received in order to provide this facility was the training she received at these workshops.
She was very disappointed to be unable to attend the workshop delivered in Easter 2011 as she was required to go to Pretoria to register the crèche in order that it would be recognised by the Government for some degree of future funding that had not been available to her before.
Sending out the message
Nancy Richards, a presenter from the South African Broadcasting Corporation’s SAfm radio programme Otherwise, became aware of this project and incorporated it into a documentary broadcast in April 2010. This was followed up with a further interview in April 2011. This programme was broadcast across several countries in southern Africa including South Africa, Zimbabwe, Botswana and Namibia and resulted in a further donation to improve the facilities at the Matome pre-school project.
This project is playing a positive role in establishing and promoting healthcare in rural Limpopo Province that contributed to the welfare and improvement of health of the community as a whole – more importantly, the destitute women, who as mothers and grandmothers fulfil a pivotal function within their communities’ healthcare. The project is still small in scale but it is evolving year on year and the ripples are ever-expanding.
Since 2003, Coetsee and the Mogalakwena Development Foundation have funded the training facilities and accommodation for trainers. Trainers have self-funded travel and associated costs and raised money for materials. The following people from the UK have been involved in the delivery of these projects – their input and support has been essential to the success and to the achievements of the people mentioned in this article: Edith Smith (retired OH nurse); Nessie Brooks (previous senior lecturer in OH nursing, London South Bank University); Anne Garvey (deputy dean, Faculty of Health, London South Bank University; Kathy Grindey (previous OH nurse, Rolls-Royce); Major Melanie Barbour (QARANC); Joy Power (course director, health visiting courses, London South Bank University); and Dr Sue Smith (occupational health physician, Camden Provider Services).
Perhaps these people, along with Coetsee, should also be invited to my dinner party to share their experiences with Mandela and Tutu. Their input and support have been integral to the success of the programme and I hope they too have gained from the experience of working with inspirational people in a remote area of South Africa.
Anne Harriss is a reader in educational development and a director of OH nursing courses at London South Bank University. If you would like to find out more, visit Dr Elbe Coetsee’s website.