The needs for services to the poor in South Africa are both varied and numerous, and it takes both research and conversations with locals to identify a set of services we can provide with long gaps of time between visits. What does the tourist have to offer the underserved in Johannesburg? That is a truly humbling question; it frames everything I think and do here. If I can do anything, it must come from a dialogue between the culturally embedded needs, values, and beliefs of Sowetans and my culturally-embedded personal and professional horizons. This has been a slow process, which has included attempts by email, observations from last August, and conversations here these past seven days; it is not done, though I have a couple working objectives. Even these embryonic interventions are subject daily (hourly) to what is happening at Cotlands (an audit) and to the unique, unpredictable organizational mind of Meisie, the head of Home-based Care.
It is Meisie who I rely upon to sanction and empower me in the Home-based Care community of grannies, mothers, careworkers, and, now, families. Meisie is a community nurse who essentially runs the Home-based Care Center in Soweto, which provides counseling, medical, and development support for HIV+ children and their caregivers. Home-based care is a now widely used intervention in South Africa meant to deal with the escalating devastation of AIDS on its poorest citizens. It was intended to be a 'cheap solution' for the government because home-based care programs are run by NGOs (non-profits) and many rely on volunteers from the community to provide the support services. This reliance on the poor to treat the devastated has come under fire because it essentially is not practical and is exploitive of poor community members. Cotlands' Home-based Care employs its careworkers, who are from the community but are no longer volunteers. More on Home-based care another time. Below is a photo of Meisie (right) and Nomsa (a careworker) on a visit to Margaret, and HIV+ granny with 3 grandchildren (also 'positive') in her care.
As she drove us to the community center in Soweto, Meisie grilled me for what it was I intended to do while I was here and I struggled to communicate how my intensions were dependent upon what she thought might be some helpful ways to exploit my skills. When I suggested doing some work in families where "counseling" is seen as needed by her and her staff, or, perhaps, some training for the careworkers in basic counseling skills or family systems, she latched onto both. This resulted in her veering from her usual course to take me to a family that she knew needed therapy. I will describe the family and some events that appear interesting to me, but leave out the nature of the “problem” and other details in order to maintain confidentiality.
Without any advanced preparation, Meisie took me into a poverty-stricken home and introduced me as a "Psychologist" who would now help them with their problems. I seemed to miss the introductions, because I thought the careworker was a member of the family, which was an embarrassing gaff (among many that afternoon).
The poverty of the family was viscerally apparent in the meagre and tattered furnishings, the four small rooms (one a barren kitchen) to house six children and four adults, the black & white TV’s permanently distorted, flickering image, the diaper made of a terrycloth rag. There are two adult women in their early thirties who are HIV+ and their children. At least three children are “positive” and suffer from AIDS related disabilities. One mother had waited too long to be tested; instead, she got very ill, was hospitalized and diagnosed with TB and HIV in the hospital. Her “denial” extended to her children, one of whom had just returned from the clinic the day we were there, where she had finally been tested for the virus and found to be positive.
As is typically the case when a white professional tries to work with Africans, I needed someone to act as translator; the family members were Zulu and most spoke no or only rudimentary English. There are eleven official languages in South Africa, all of which are represented in Soweto, the countries largest black township. This need for translation creates a very interesting, unconventional process for “therapy;” much of the time I was being a “Psychologist” for the family, I sat listening to extensive exchanges between Meisie and the others, usually brought on by one of my exploratory questions. At one point, I turned to the sick mother and asked what Meisie was saying to her aunt; the mother informed me that Meisie was lecturing the aunt about her unreasonable behaviour! Amazingly, a small shift in the family process emerged as a result of our visit, which was identified by the clients themselves.
The above family visit may be the first and last of my family visits in Soweto! The past three days, an audit at Cotlands has meant that Meisie’s time at the Center in Soweto has been limited. Monday and Tuesday, we represented Cotlands at the Center while a volunteer group ("One World") faciltated groups of grannies and mothers in the creation of Memory Books (I hope to describe these in a later posting). Today, Meisie has been caught up in audit meetings all day, so I’ve been reading an article (Rochat, Tamsen & Hough, Angela (July 2007). Enhancing resilience in children affected by HIV and AIDS. Human Sciences Research Council) and creating this blog.