July 31, 2009
It is Friday afternoon, and I am in the Johannesburg Oliver Tambo Airport preparing for my journey back to New York where I will arrive Saturday morning. I left South Africa and Swaziland at the beginning of July, only to return two weeks later to put together the project that I am now involved in. I was not sure how it would be to return so quickly, after spending so little time in New York and several days in Puerto Rico with Haydee and my grandchildren. I found this trip to be wonderfully productive and exciting, which encourages me in my ability to adapt to the flexibility that this new work will require.
To catch you up, I am here continuing the project to build nurse capacity out of Columbia University’s Mailman School of Public Health ICAP. I flew straight to East London, got unpacked into my continually welcoming home in Gonubie, and took off to rural Eastern Cape province immediately, to begin a whirlwind ten days of developing a concrete proposal to present to the national department of health today. The initial attention towards nurses when the HIV/AIDS pandemic was finally recognized here was to capacitate nurses already in service — at the community clinics, at the district hospitals. Now there is growing recognition that focus also needs to be given to the nursing colleges and universities so that graduating nurses will be able to function in the complex and extremely demanding health environment created by this burden of illness. So, we were directed to design a program, to be modeled in Eastern Cape, that could mentor the nursing educators to have greater knowledge and clinical skills in HIV comprehensive care. A rigorous and learning process unfolded over these days: the two nursing leaders that I am working with and I visited the training centers and the provincial department of health and met with nursing educators, with each gathering providing more ideas and deepening our creation of what I think will be a program that can contribute. Our final presentation today was enthusiastically given the go-ahead by the representatives of the national department — and in this process our core team learned how to work together, how to complement and build on each other’s strengths. So as you can sense, I am very proud of our collective work, which we now need to implement on the ground level. I leave here (probably to return in about a month’s time) with the initiative in a place that I could only hope for a week ago.
I have returned to South Africa with its political climate continuing to provoke more questions than answers. My healthcare colleagues generally though cautiously point to a new breathing space — based on the decisive end of the Mbeki era’s policies that resulted in denial of or reluctance towards addressing this national crisis in health. Those are for the moment replaced by policies and steps taken to mobilize with more force, energy, and resources to reconfigure the health care system that was paralyzed and is still overwhelmed in its efforts to initiate adequate care and treatment programs. Even a moment of hope — just to imagine for a moment that there can be breakthroughs — is critical, much needed by those I have witnessed working selflessly for these past years.
I know this time will be short-lived. The national plan is to double those on antiretroviral treatment within the next two years. A report from the National Committee on Confidential Enquiries into Maternal Deaths revealed this month that there has been a 20% increase in maternal deaths in South Africa over the past two years, with 79% of the women who died being HIV positive, and 43.7% of the maternal deaths being attributable to AIDS-related illnesses. Horrific numbers — women die in childbirth where intervention could have prevented these tragedies.
HIV/AIDS barometer: AIDS-related deaths in South Africa: 2,897,118 at midday on Wednesday, July 29.
I am also witnessing a nation in protest. When I arrived in East London last week, there was a national strike by municipal employees, where thousands marched to demand a living wage and improved working conditions. It is predicted that more protests are on the horizon as the need for more service delivery and jobs escalates. So far there have been twenty-four major protests (including the doctors’ strike) since the beginning of this year. The Zuma government is being called upon to deliver the promises that it made during the elections in April.
There is health and vitality here, in that these protests have been done in an overall peaceful atmosphere — the ability to dissent is a right that is respected here, which is a radical departure from the days of apartheid.
Kami Brodie, “Three Working Women: Anna, Lizzie, Maggie,” 1994, Constitutional Court of South Africa, Art Collection
I had a most amazing evening yesterday. My nephew Chesa, who has been doing a law internship for Judge Edwin Cameron (a major hero in the struggle to get ARV treatment available and accessible), invited me and two of my colleagues to a guided tour given by Albie Sachs (another champion of the struggle here) of the new Constitutional Court. This building was constructed at the site of one of the main detention centers under the apartheid government. As Albie eloquently explained, bricks were taken from the old building (used to support a system of oppression) and transformed into the new foundation of equal protection under the law that the South African constitution seeks to build. Entering the building, one passes through the old checkpoints and into the new structure, which architecturally and artistically is constructed to represent the aspirations of the new South African society. The use of light, air, wood, collective space — and amazing art produced by the communities across South Africa — comes together to remind one of what this is all about here. It is a place of hope, with the sacrifices of all of those who birthed this society thoughtfully presented at every turn.
Touring this with Albie was like an unfolding living theater experience — at each point there was another aspect of the history of the struggle to remember while the vibrancy and resiliency of the present was also brought to the fore. I think everyone who comes here must visit here, as well as the Apartheid Museum. Those of us working in the midst of this HIV/AIDS struggle can get rooted and re-energized again. Thank you, Albie and Chesa — a remarkable experience.
So I am off to fly — and look forward to catching up with many of you over these next weeks. As always, thank you for your support and encouragement.
Jennifer Dohrn, CNM, is Director of Midwifery Services at the Childbearing Center of Morris Heights, the Bronx, New York, the first birthing center in the United States to serve inner-city women of diverse backgrounds. Jennifer also directs the midwifery education program at Columbia University School of Nursing. She has been working in South Africa to expand health care in pregnancy, birthing and postpartum in the context of an AIDS health care crisis of epidemic proportions.