It is amazing that I am now at last again on South African soil, since my previous trip here was in December. I am at home in my soul in a way that is unique for my travels. I am breathing in the salty air from the Indian Ocean, feeling the hot rays of the sun greet me from my porch every morning, admiring the lushness of the flowers and bushes, and most of all, reconnecting with the many amazing people with whom I have come to share lives over these past years. My heart is full.
I arrived in East London on Tuesday late morning after the New York-Johannesburg-East London journey of 18 hours. I am here with two colleagues from Columbia University Mailman School of Public Health who work with me on the nurse capacity initiative (INCI) that began April 2009. We are here to support a large workshop for nursing educators in Eastern Cape on HIV knowledge, clinical skills, and health systems strengthening. The workshop is entitled “A Hands-on Workshop in HIV Care and Health Systems Strengthening through Nurse Mentorship.” We are expecting eighty nursing tutors from 14 campuses. During the workshop we will officially launch the INCI’s Center of Excellence which is a center for communications and exchange amongst INCI countries. I have been running trips to the airport since yesterday, picking up the delegation from Swaziland (who somehow got separated and arrived on 3 different flights!). Everyone is taking the high road and in the best of spirits as it is such a great opportunity to have us all here together.
The timing of the workshop has increased in auspiciousness because on April 1 the new guidelines for HIV care and treatment will go into effect in South Africa. Nurses will now be authorized to initiate and manage antiretroviral treatment for adults and children; people who are HIV+ will be allowed to begin these lifesaving medications earlier in the progression of HIV disease and with safer regimens. Counseling for HIV testing has been changed from VCT (voluntary counseling and testing) to CT (counseling and testing), because it will now be policy that everyone who goes to a health care facility will be encouraged to test. These changes have been long fought for, and come at the price of nearly half a million avoidable deaths due to delays or unavailability of medications over the past eight years. Now comes the time for stepping up the skills of nurses, for stocking enough medications, for reorganizing the health care team to maximize community involvement with the hoped-for result of reduction of stigma. This is an historic time in South Africa in its struggle with HIV/AIDS and needs full recognition, particularly dramatic within the context of the years of the politics of denialism, the consequences of which now make their impact on every segment of life here.
I think we need to acknowledge the victories, especially those that were hard fought, those for which many sacrificed. That is even more so given the continuing disparities between the rich and poor, the increasing gaps between white and black South Africans — economically, educationally, socially — with the small exception of those in power who have amassed wealth. Headlines in the papers report the expanding business empire of the Zuma family. Townships are up in flames protesting the failure of service deliveries. Corruption at the highest levels does not seem to be abating. I arrived on the marking of the 50th anniversary of the Sharpeville Massacre. On March 21, 1960, 20,000 residents of this township marched on the police station to protest the apartheid pass laws. The police opened fire, killing 69 people and wounding 178. One half century later only 3 roads have been tarred since 1994; two schools were recently closed down. No sports facilities exist. The site where the Constitution of 1996 was signed, the George Thabe Stadium, is in disrepair. Unemployment continues to rise. Recently Sharpeville residents protested against the failure of service delivery and clashed with police. Though the anniversary of the Sharpeville Massacre is now a national holiday called Human Rights Day, a resident of Sharpeville stated: “We are still struggling, we are still protesting and we are still burning tires. . . . At some state, hell is going to break loose and we do not know when” (Mail and Guardian, March 19-25, 2010).
Yet a luta continua. The nurses I meet and work with band together, support each other, have hope. Now we can roll up our sleeves and really get to work, with the authority that we can make a difference.
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.