All over the world, the bureaucratic machine moves slowly. Organizations lumber towards results, interrupted by fiscal years and approval processes. Sometimes brilliant ideas wither and expire before before they’ve had a chance at the table.
In Africa, action sometimes masquerades as idleness. Initiative must take an indirect path. It’s anti-intuitive to the western visitor, and can test our patience. This is no place for frenzied activity, for make-work. Results come more easily to those who understand that the companionable conversation is part of negotiation, not a distraction.
So imagine my surprise to hear that in the meager five months since I left the Eastern Cape, Craig has succeeded where many have given up in frustration. This story picks up where my visit to the Duncan Village Day Hospital left off, way back in October ’09. Here’s what I remember most: Nomalizo’s confident, friendly, energetic face. She was the peer educator who handled the PMTCT workshop in the hospital’s crowded corridor, giving her presentation in both isiXhosa and English. Word was that project funding was set to expire in December ’09 so Craig was there to see if he could employ the peer presenters through his department.
I kept up with the status of the proposal by monitoring Craig’s uniformly exhausted-sounding status updates. Then, recently, this: “Craig Carty just got the email stating that the contract with the hospital network has been signed!!! Prevention education for South Africa’s most at-risk kids a go!!!” In this case (and only in this case), I can excuse the flagrant abuse of exclamation points. This is really big news.
In Craig’s own words (detailed, and very much worth the read):
Adolescent-centered health care is missing from provincial, government-run hospitals. Kids between 10-19 are lumped in with adults, thus many of them become “lost to follow-up” or return to clinics with “adult” problems. We know that the highest rate of HIV in this country is diagnosed in 20-25 year olds, therefore it is assumed that most contract the illness in their teens. Often they present at hospitals with advanced stages of AIDS as indicated by opportunistic infections which only arise in patients with seriously-damaged immune systems. If you couple the problems of overburdened ARV clinics with consistent issues of funding, kids presenting with AIDS are kids without a fighting chance at survival. That’s the reality. Plus, South Africa just stepped up their treatment standards to match those of the rest of the world in December of 2009.
We created an adolescent-centered education program based upon years of research and data collection from area amaXhosa communities. It is called “Let Us Protect Our Future!” and is co-authored by Drs. John and Loretta Jemmott and Ms. Lynette Gueits. Initially, it was designed for dissemination within the Department of Educaton as a tool to augment the existing life skills programs. For logistical reasons, this fell through. Working with the provincial government, particularly with certain departments, can be daunting (think meetings to discuss meetings to discuss meetings to discuss funding to discuss “how much we’ll get out of this,” etc.).
Shortly after my arrival in South Africa, I was approached by a very passionate physician working within the hospitals of the Eastern Cape. She proposed looking at the manner by which we could disseminate our prevention education program within hospitals, drawing from the patient populations in abortion clinics, maternity wards, HIV care clinics, casualty care (abused kids), pediatrics and chronic care (diabetics, etc.). So we did.
We sent the curriculum to the adolescent division of the CDC for analysis. The feedback was great. We met with the CEO of local hospitals (Frere and Cecilia Makiwane) as well as the Chief of Clinical Governance. We developed a 20-page Memorandum of Understanding (ugh) so that we could ultimately “gift” our work unto the health department over the course of about 12 months. They agreed to integrate the campaign into their 5-year fiscal program which, conveniently, started in April of this year. But the contract-signing part dragged on and on. It was a nail-biting experience since our training team was waiting in the wings with airline tickets reserved and I was working long nights perfecting the art of panic.
On March 31, 2010, they signed the contract. For all intents and purposes, it was a go and I was able to sleep through the night (only to wake up on April Fool’s Day wondering if it was a joke—it wasn’t).
This new program will provide a foundation that will demonstrate to the Provincial Dept of Health that the construction of new adolescent wings within our two major launch hospitals is an imperative. I was once told by a high-ranking government official that “first, you must prove that you can work in the conditions provided.” Then, she added, “ If you can make it work, they will build you space.” So we’re cramming ourselves into unused waiting areas adjacent to abortion clinics for the first round of pilots. And we’ll make it work.
One pediatric physician was concerned that her HIV + kids would be left out. Not so. Those already living with HIV will be educated in terms of prevention of transmission (commonly referred to as “prevention for positives”) alongside those without HIV. Since all the sessions are run in groups of 10-20, this will build a sense of fellowship and reduce stigma.
That same physician expressed worry about the work burden on her staff. No need to fret, I said. The “Let Us Protect Our Future!” campaign is designed to be self-sustaining through the employment of people like Nomalizo Nonkwelo who was recruited from a de-funded prevention education project in Duncan Village. For a minimal financial output, the hospitals will maximize the reduction of repeat cases of abortion, STI treatments, etc. through empowering their most vulnerable patients. In the long term, we’ll be reducing the burden. In addition, we have integrated the National Campaign for HIV Counseling and Testing into the curriculum. All participants will be referred for HIV-testing if they have not already been.
During my last conversation with the Chief of Clinical Governance (an amazingly calm and collected woman despite her incredibly-stressful post) stated, “I hope you are ready to be very busy. Every hospital in the Eastern Cape will want this campaign once we’ve completed the integration in our two hospitals.” Her assertion is great news, indeed! We’ll just have to muster up the energy (and funds!) to make it happen.
Once the pilots are completed and the campaign is successfully integrated, we anticipate drawing on even more of the de-funded agencies to hire more staff to hopefully enact this program in all hospitals throughout the province (but I’ve got my sights set on the entire country). It’s a lofty goal, but I have a capable, eager and determined team with a vested interest in stopping the epidemic in its tracks within this demographic. I’ve also been told that I’m too idealistic and that burn-out is right around the corner. Perhaps, but if South Africa foresees a future free of HIV, directing initiatives and funds toward the highest-risk populations in the highest-risk settings is key to making this happen and we’ll just have to buck up and deal.
– Craig Carty, “Let Us Protect Our Future!” campaign
Maybe this by-line should be “Craig Carty, Bureaucratic Machine-slayer”. Bravo to you for having the meetings about having meetings, and for getting your vision to the table. I could not be more impressed, my friend.