Home Visits in Soweto

This has been a week of no visits to the Outreach Center; Meisie was in a car accident yesterday morning and, though she's okay, is weakened by aches in her muscles from the impact. She is staying home to recover the rest of this week. I have been doing research on systems of care for vulnerable children in South Africa.

However, I did want to report on events before Meisie's accident. A week ago today, after our usual late start, turned into a full afternoon of home visits to Nomsa’s granny clients around Soweto. Our task was to distribute donated school uniforms to seven grannies for the HIV+ children they care for, entering their homes and chatting with them for a bit. Meisie encouraged me to take photos of each granny and they seemed happy to have photos taken of them and their grandchild/grandchildren. The poverty and cleanliness of each grandmother varied quite a bit. The first granny we visited lives in a one-room tin shack; neat piles of children’s laundry covered a single bed, but the “kitchen” wall was cluttered and the space was dark and rather dismal. Margaret, the grandmother was warm towards us, though she was clearly unwell and almost emaciated. Meisie told me after we left that Margaret was “positive” but has taken no steps to deal with her illness until, maybe, recently. She told Meisie that she’s been tested, but refuses to come to support group. It’s difficult to understand the degree of denial that can squelch concerns about the children’s welfare. Who will look after her grandchildren after she dies of AIDS?

Almost every granny was doing laundry or ironing when we arrived! Nomsa gave each of them a rather hideous knitted ski hat and scarf—all donations. About three grannies were not home, but we were able to leave the uniforms either with the children or a neighbor. The uniforms are for the children who are HIV+. Donations of uniforms may make the difference in whether a child can attend school or not. Some of the kids also got shoes with their uniforms.

One home we visited stood out dramatically from the others because it was bright, well-furnished, decorated with bright patterned curtains and chachkis, such as animal statues, a head of Mandela, pottery, and a beautiful enlarged photo of her eldest daughter in traditional Nbele clothing. The leather couches, while very worn, were shiny-clean, with linen squares of embroidered cloths along the backs. The granny showed me her beautiful, new tin bucket that she uses to get water for cooking or washing, as well as the two tin shacks in her back yard where her sons live. It was all very neat, and one shack had a rustic sculpture near the door made of metal and string. She was very proud of her home; as we left, I noticed and commented on her succulent garden at the front of the house. Her grandson, who seemed about ten years old, was quiet but polite and sweet. His head was covered with lesions, probably karposi’s sarcomas, and he was very thin. But, he was eating a sandwich he made for himself when we ended our visit.

Across the road and over the dusty red-dirt ‘yards’ was another client’s home, tucked behind a brick house. There were two shacks there, as well as an elder couple who seemed to live in one of the buildings. The client was not home, but someone went to fetch the two children, who would receive the uniforms, and the elder neighbor woman would sign for them. The children were delighted with their uniforms, which they took inside their shack (after posing for me). Meisie told me that Cotlands had built the shack for this granny & the children because it had been too crowded for them in the house fronting the road. It was a one-room shack constructed of corrugated tin. Cotlands also makes sure that each client has a small refrigerator (to make sure the ARV’s are kept cold), a stove, and a space heater. None of the homes we visited had running water and used outhouses for toilets. In one home, an entire room was filled with a queen-sized bed covered with stuffed animals for the children.

Home sizes varied from one room to four—I don’t know how many people actually lived in each, although none held fewer than three people. Men were few and far between. In the back of one home, the yard for two shacks and a house, several men were building coal stoves out of scraps of metal or old appliances. Another backyard that we entered held a shack and a shabeen. The client was not at home in her shack, so Nomsa had the shabeen owner accept and sign for the uniform. Four very drunk men sat outside the shabeen with their almost-quart-sized cups, filled with a yeasty brew that has high alcohol content. Alcoholics, the men will spend every cent they should to buy food on drink, much like alcoholics the world over. The little girl client appeared as we were leaving, running up to and embracing Nomsa with a huge grin on her face.

The last home I will describe was, as most of them, at the back of a house fronting the road; four children sat on a wall and got very excited by our appearance (and my camera). Meisie showed me the house garden next to the granny’s shack, which Cotlands had helped her start, and which she had added to. While it was impressive, I am skeptical that it would ever provide a significant amount of food for the family. Meisie’s goal is to have every granny in the program have a home garden to help decrease her poverty. This garden had a primitive wire fence, a box of used plastic bottles at the end, and a pile of trash or some stuff at the other end. There is much to be done with such chronically poor people, even these who are so committed to improving their lives and those of their grandchildren.

Service Proposal & Hospice

Yesterday, I was able to identify a service I (and perhaps 1-2 of our students) can provide Cotlands on an annual basis for a short period of time each visit! Busi, the Outreach Manager, let me know that she would love us to perform assessments for the Outreach (Home-based Care) children; there are about 100 of them, and they all have developmental delays. The schools in Soweto are the worst in the area, she informed me; she thinks it would be important to know where the kids stand, as she is beginning to focus on the educational needs of these children. She also recruited me to provide a "debriefing" session for the careworkers (9) here at Cotland sometime next week. On Monday, Meisie has asked me to do an inservice for the same careworkers, revisiting basic counseling skills as well as some psychological diagnositic concepts related to children with HIV.

This morning I had a chance to visit Hospice, where I 'stimulated' an emaciated little girl--holding her, touching and moving her arms, hands, legs and feet, and eventually feeding her some Rooibus tea with milk and sugar out of a bottle. There were a physical therapist there, who comes every Tuesday morning to assess and work with the Hospice babies. She talked to me about the little girl I was holding; Meisie brought the child, 18 months old, two weeks ago from the clinic because she was "failing to thrive." The child's legs and hands were emaciated, but her lower body had not developed at all from infancy. This is apparently common, because the children are often left sitting for long periods (her upper back has developed and is strong, but her lower back is curved and that of an infant), and so they cannot crawl or walk, as a typical 18-month-old would have already mastered. Her legs were floppy and would not straighten out on their own; the bottoms of her feet are rounded like infant's. The child is very passive and fairly unresponsive to touch; she did attend to the sounds of other children in the room, and would follow a toy with her eyes when I moved it in a circle before her. When it was time to feed her, she couldn't manage the sippy cup, letting the liquid spill out her mouth onto her clothing. When we brought her a bottle, that also seemed a challenge until the physical therapist took her tiny hands and put them on the bottle; then, the child grabbed the very end of the bottle and pushed it into her mouth, drinking gustily. The PT said that this was common for babies who are left alone to feed themselves, which suggests a fair amount of maternal neglect. Almost needless to say, she is HIV+, which means her mother is too.

I made the connection at some point between this child's situation and the story Meisie told me last week: Meisie had been trying to get a hold of the mother of a child she had admitted to Hospice the week before, because she had not yet visited her child there. She finally spoke to a family member while we were driving from Soweto back to Cotlands; the mother had left the area, telling her famly that her child was in the hospital and she could visit her. Meisie, somewhat despondently referred to the mother's disappearance as 'respite.' Child neglect is a serious problem here, primarily due to poverty and all its sequelae, and to AIDS. Cotlands will make sure the child is not returned to the mother until she can care for her appropriately. The physical therapist assured me that she would improve physically with time and Hospice care; she has seen other children come into Hospice in this condition (she's worked there 25 years!) and improve significantly.