ANSA International Program Blog

I've made the most of this meeting-free day, reviewing notes and sorting pictures and thinking about what needs to be done in my remaining two weeks here.  As a means of processing things I've encountered so far, I'd like to share a sampling of pictures and stories that, to me, reflect some of the remarkable aspects of life in this fascinating corner of the world.  The people pictured are facing unbelievably difficult circumstances, and some of the stories refect the crude manner in which life and work goes on.  But it does go on.  Inside it all can be found a spirit that is strong and generous and vibrant.  And of course within and around these people and places there is nature's own luxurious landscape, complete with crashing ocean waves, sweeping mountain backdrops and roaming exotic animals.  The contrast can be shocking.  Everywhere one goes is a magnificent mix of beauty and burden.

Let's start with shopping.  I visited the Crossroads Community Health Services center where I met a highly motivated clinic director who showed me around a bussling full-service clinic where HIV education was underway in a wide open room filled with benches and the large chronic disease and pediatric waiting rooms were packed with people waiting to be seen.  On the street beside the clinic, the Crossroads open-air market was in full swing on a tiny one block stretch of sidewalks.  Residents who had just received their monthly pensions were out buying shoes, cabbage, and various meat products for eating now or cooking later.  This woman is selling that meat for later, though I wouldn't wait too long.  This picture was taken at around 3pm on a blistering hot day.  My stomach sounded out something like, "Wow, I am such a wimpy American."

That meat will need some seasoning and afterwards your tummy might need some soothing.  So, next to the meat table is the place to buy traditional herbs and various potions.  Herbs and potions are sometimes marketed as a product for relief of this ailment or for cure of that disease, which has created difficulties at times for nutrition-related messages that promote good health through the intake of natural, indiginous foods and products. 

At a large TB clinic I visited I met this beautiful community health worker whose job it is to go to visit people living with TB (and usually HIV, since the overwhelming majority of the TB patients are HIV+).  She struggles with her own health issues quietly, focusing instead on the welfare of others day in and day out.  She and a colleague do TB education and outreach, going out into the communities, literally into homes of the residents, and standing with a laminated flipchart that explains how tuberculosis eats away at your lungs and how vigilence in completing your minimum of 18 months of treatment is critical.  Currently Africa is facing an alarming number of cases of XDR (extremely drug resistant) and MDR (multi-drug resistant) TB. 

In the same cramped room where this woman is on the phone, my host for the tour, a very nice clinic manager, wanted me to take her picture with her patient while she obtained his labwork.  Um... uh... I really don't think... okay.  I was about to offend her by saying no, so I took the picture.  I won't show it here, but there are two remarkable thing about that moment: she was not wearing gloves as she drew her patient's blood, and she was saying to this complete stranger behind the lens, "he has TB and HIV and we want to check to see if he is taking his drugs properly." 

In the townships, it is easy to see how disease spreads rapidly.  Residents are in close proximity to their neighbors and the ventilation in most of the houses is limited to a window or a door.  Here people know each other's business; stigma and fear of being "found out" is a big problem so many keep their status to themselves and don't seek medical care.  Many HIV+ new mothers refuse to accept the government-issued infant formula because someone made the unfortunate decision to package it in bright orange tins that just scream "for HIV+ women only".  Trash and refuse is not collected sufficiently and in some places not at all, so animals and bugs linger freely for long periods of time.  Women and children do risky things for food or food money.  And capable men, suffering from lack of structured and productive activity that can increase discipline and self esteem, seek relief in alcohol, drugs, abandonment, sexual promiscuity and violence.  

In these communities unemployment is incredibly high, as much as 80% in some areas.  There are no big employers in these outlying townships, no Wal-Marts to offer part-time work, no temp agencies to hire even single day administrative help.  And forget about the availability of longterm employement that provides training and skills building and retirement security.  Transportation into Cape Town, where jobs might be found for those with education, experience or a vehicle, takes a great deal of time (up to two hours each way) and a great deal of money because everyone has to ride at least 10 miles or more by bus or taxi -- each way. 

While all of this sounds despairing, all is not lost by a long shot.  You'll find healthcare workers, administrators, teachers, outreach workers, craftswomen and craftsmen, beauty shops and many other signs of individual business, education and artistic achievement throughout these communities.  You'll find a lot of laughter, love, neighborly concern for another's well being, extended hands to shake, and of course plenty of God bless you's.  People take time to tell the stories that brought them through their lives, and many create images of these stories through weaving, beading, painting, embroidering, carving, singing, dancing and much more.  This picture is one of my favorites.  This woman is a part of an income-generating program for vulnerable women at the Philani Community Clinic (Philani means be well in Xhosa).  Look how beautiful the piece is she is working on! 

Below is the youngest member of one of the two girls' dance teams at the Okahandje Soup Kitchen.  She and her friend are dancing to a traditional African song being sung by the other girls.  Out of sight just to the left is a nine year old girl sitting on the cement drumming out the African beat.  All of these kids are OVCs cared for by Hope Initiative Namibia.

It's dinner time so this concludes the brief "other highlights" story.  

Next week I will talk more specifically about AIDS in South Africa and how various NGO and governmental programs here address the issue.  My upcoming meetings include visiting the Director of Health for the Western Cape, the director of the organization that coordinates AIDS service organizations in the Western Cape, and the guy from Treatment Action Campaign who always seems to be targeted by the anti-drug zealots who swear AIDS drugs are poison and are meant to kill, not cure.  So these meetings will be excellent opportunities to view AIDS from the larger, broader picture, which isn't easy to do from the township vantage points.

Peace to all...Mary

Yesterday Namibians celebrated their 17th year of independence from South Africa. Just under two million people live here; 90% are Christian, 60% live in remote areas with unpaved roads (like the vast Kalahari, the oldest desert in the world), and 50% speak Oshiwambo or similar Owambo tribe languages -- even though English is the official language of Namibia. German influence is still quite evident in the capital city of Windhoek, a leftover from the German colonization that took a firm hold in the late 19th century. The latest influence to start taking hold is the Chinese, who are becoming increasingly good friends with the government and have staked their claims on several key building projects in the capital city of Windhoek (pop 250,000).

Throughout this vast desert country there are expanding areas of squatter settlements and refugee camps where people have congregated together on their way to what they hoped would be a better life. Because many view their situation as temporary, there has been little progress made in establishing any infrastructure to support these growing communities. In Katutura, at the northern edge of Windhoek, thousands of people live in settlements like Okahandje Park and Kilimanjaro, with no running water or electricity. They have very little options for transportation and jobs, and even fewer options for school for the children and adults alike. Having few choices by which they can improve their situation and nowhere else to go, most end up staying put.

Enter Hope Initiative Namibia.

Patrica and John are two Zimbabwians who saw the tremendous needs in the Namibian settlements and decided to start an NGO (non-government organization) to try to bring some relief and stability to the lives of those who were most at risk. Hope Initiative Namibia started four years ago with a small soup kitchen in Okahandje Park, feeding 70 OVCs (orphans and vulnerable children) lunch a few times a week. Today they feed 338 OVCs throughout the week in a new building complete with a playground, full kitchen, offices and a classroom where the 45 members of the adult HIV support group meet twice each week. The young girls have two dance groups whose outfits are sewn by local women, and the boys have a soccer team that is coached by local men. They run a second nearby soup kitchen in Kilimanjaro that feeds another 120 OVCs four days a week from a 10 x 12 corrugated metal shack. And to help bring the most disadvantaged kids up to speed so that they can enter public schools, Patricia and John started the Bridging School, where kids learn basic reading, math and the like.

Here as in South Africa, orphaned and/or sick children can qualify for government assistance, but in both countries there is a significant problem with the lack of birth certificates for the kids and death certificates for their deceased parents. Hope Initiative Namibia staff and volunteers assist in obtaining these documents, and they have begun to connect the most traumatized children to counseling resources. Caregivers, who are provided training and a monthly food parcel, provide for kids who are sick in their home (unfortunately sometimes the caregivers themselves are also not well).

Hope Initiative Namibia was helped on its feet first by a generous German benefactor named Jutha who is still involved with them today. They are also supported significantly by, and work closely with, Hand in Hand, a German NGO, Terres des Hommes, an Italian NGO, and our own ANSA member organization from California, Food for Thought.  Food for Thought volunteer Paula Seitz-Netherda has been working at the soup kitchens and is currently getting a beading project underway for the women in the HIV support group. Paula and her husband Mark, an HIV physician/clinical mentor with the International Training and Education Centre for HIV (I-TECH) and interim CDC-Namibia director, have been living in Windhoek since last year with their three kids, Erin, Spencer and Alex, and their hyper dog, Shiwa. They were all great fun and I am eternally grateful to them for their warm hospitality, and to Paula especially for generously chauffering me around.

A longtime friend of ANSA member Food & Friends, former staff dietician Michelle Mehta, is one of three community dieticians in all of Namibia. She works with Dr. Netherda at I-TECH, writing nutrition standards and policies for the Ministry of Health. Michelle visited the soup kitchens with me and was very helpful in filling me in on the broader nutrition issues of Namibia. Helpful too was her fellow community dietician Linda Larsdotter, the nutrition advisor for the Namibian Network for AIDS Service Organization(NANASO). Linda travels the country addressing community (civil society) nutrition issues, so her perspectives on local nutrition matters was extremely helpful.

In addition to her nutrition expertise and assistance, Michelle and her handsome boyfriend Martyn provided the one touristy evening I was able to get in: a night of camping and stargazing under a pristine sky in the middle of absolutely nowhere. We drove for two hours on gravel roads to reach a remote guest farm where there was a small observatory. We got to see star clusters, nebuli, dust clouds and Saturn up close, then sleep to the sounds of the wind that came from across the rolling hills behind us (pictured, at sunset). On the early morning drive back (alas, I had to leave way before everyone else), the shuttle driver and I watched herds of zebra, oryx, kudu, and springbok romp near the roadside, and baboons, guinea fowl, a jackal, and a warthog all trot (or in the case of the guinea fowl, dawdle) in front of the truck. It was the most enjoyable shuttle ride I've ever had!

I am certain you will be hearing more about Hope Initiative Namibia in the near future, and I am confident there is more we will do with the nutritionists, volunteers and community leadeers who are all affecting positive change for the people of Namibia. My thanks to all who spent time with me and let me into a different world for a rewarding and highly informative five days.

Peace to all...Mary

Today ends my first week of work in Cape Town.  I leave in a few minutes to catch my flight to Windhoek, Namibia and honestly, I'm relieved to have a few minutes to rest my mind on the plane. 

It is impossible to capture within the boundaries of this text box the scope of things I have seen and learned thus far.  My goal has been to gain an understanding of what kinds of programs are in place now, who is providing what and to whom, how services are coordinated or integrated, and how ANSA may fit into the whole picture.  Across the board, everyone has been incredibly gracious, first in agreeing to meet with me, and second in spending as long as necessary to give me all they feel is important for me to know.  They have also asked good questions about ANSA and have been generous in providing connections to other organizations or individuals that may be helpful for us to meet.

I have visited health clinics, community centers, schools, non-profit organizations and individuals throughout the city of Cape Town, the wineland city of Paarl, and nine area townships (massive mostly shack-riddled areas where blacks and "coloreds" (mixed race) had to live under apartheid's residential segregration laws and where many millions still live).  My first legal pad is already full and I have collected at least five pounds of reports, brochures and papers.  I will recount some of the more remarkable facts and figures in a later blog, but as my time is limited now I will briefly share just a bit of some of the cultural observations...and frankly, I wish Americans would adopt some of these...

Singing is a very common and important way of communicating in the townships.  Meetings often start with a song and prayer, and songs are often used to transition between issues and to recognize or honor special mentions.  While attending a community meeting about an early childhood development program with 80 women and two men, it was wonderful hearing the traditional songs of welcome, unity and blessings rise in rich, deep Xhosa voice, bringing about a powerful sense of togetherness.  Just this morning while visiting a large community clinic, the people in the waiting rooms sang greetings to me, and a room full of home health care workers sang and danced yet another song.  The director of the clinic had, of course, said that I was visiting to learn about the program and she encouraged the patients and staff to "make me feel welcome."  Each time we entered a room, one person would just stand right up and begin a song, then everyone else joined in.  A warm welcome indeed.

Agendas for community meetings are not set until everyone is together, and the group determines what they will talk about.  I was told that if someone comes in with an agenda, they are not trusted, as then it is not a community-focused meeting but a management-focused meeting.  The woman who ran the early childhood development meeting was one of several women "foot soldiers" who founded Ikamva Labantu with Helen Lieberman, and boy did she know how to knock out a productive and collaborative meeting! 

I get a lot of "God bless you" here, and everywhere I go in the townships I hear, "God has been so good, we are truly blessed to have....".  The pervasiveness of spiritual "good health" is extensive, and this important cultural aspect is taken into consideration in the structure and conduct of most social programs.  I have been told many times that the health of the person includes all parts of their lives, and in these communities they truly respect this fact.

I must catch my taxi now.  My next blog will have reflections and observations from Namibia...once again, I can't wait to see how things unfold!

Peace to all...Mary

My first work in Cape Town was a lengthy and wildly productive day with Helen Lieberman, the founder of one of the oldest and largest service-oriented non-profits  in South Africa, Ikamva Labantu.  For 45 years Ikamva Labantu has been assisting with social programs run by the community and today there are over 1000 of these programs operating throughout the country.  For the first 30 years they operated in spite of the apartheid government's regulations against such organizing activities.  I asked Helen how many times she had been arrested and she said, "that's like asking me how many times I ate."  To say that we have come upon a valuable partnership is an understatement of tremendous proportions. 

I spent the morning with Helen and Jo-Anne Prins, Ikamva's grant writer and the woman who originally responded to my introductoy email.  After a few hours of discussion and time to get acquainted with our intentions (which were scrutinized), Helen made the firm decision that we were worth Ikamva's time and attention, and she wasted no time getting me jump started in our work here.  Starting Monday morning i will be set up with an desk space and telephone at Ikamva to call various key local contacts - all the names and phone numbers already provided to me - and I have permission to use Helen's name to ensure I get a meeting set up. 

Over the next weeks I will be meeting with: the Director of Health for the Western Cape; the head of all local health clinics in the Western Cape; the lone nutritionist who does all of the nutrition education and trainings for Ikamva's local progams (on a part-time contractual basis); the Red Cross Children's Hospital; Feedbank, the main distributor of food products for the Cape; the Peninsula School Feeding Program; TB Care; and five health clinics in the townships of Crossroads, Philani, Phumlani, Weltevreeden Valley, Nzamezabantu.  All of these are in addition to the meetings with Treatment Action Campaign, Medicens sans Frontier and other large organizations.  Ikamva is setting me up with a driver to take me to the clinics and to the community programs they had originally recommended we visit to asses potential partnership opportunities.

Today Helen took me to three feeding centers in Pillipi and Khayalitsha, and to visit a woman with 27 orphans living in her home in Khayalitsha.  There are many, many of these women living in townships throughout South Africa.  She is taking me to several schools and other programs all day on March 23.  She will be bringing along a woman from Art for AIDS who she thinks we might have an interest in possibly collaborating with in some creative way.

Ikamva is active and well known in the SANCOs (South African Neighborhood Councils), the local governing groups within all of the townships.  These SANCOs work directly with, and are funded by, the regional and national governing parliamentary offices.  Helen will connect me with representatives from both the SANCOs and, as appropriate, Cape Town partliamentary officials "once we are ready."  

The meetings and activities this morning were incredibly valuable not only for the connections, but also because all of us spent a great deal of time discussing our respective approaches to non-profit work and our philosophies on community involvement.  We only scratched the surface on issues of community linkages, funding and other pertinent topics.  There will be much ground to cover together, and we are unbelievably blessed to have this sort of guidance and assistance to get us started.

I spent the evening enjoying some of the wonderful local culture and letting the day settle in.  As you can imagine, my mind and heart are still reeling from so much stimulation.

Peace to all...Mary

It is hard to believe, but I am finally packing my bags and business cards and heading out on the first official trip of the ANSA International Program.  I will be in Cape Town, South Africa for just over three weeks and Windhoek, Namibia for five days.  I am incredibly excited and admittedly a little nervous - as they say, we only get one chance to make a good first impression.

The preparations for this trip have been extensive and at times quite complicated (read: frustrating).  ANSA can now offer technical assistance on maneuvering through the tedious wonderland of international cell phone service and travel insurance.  After countless irritating conversations with phone services representatives, it was an odd relief to hear the plethora of scary accident and kidnapping scenarios recapped by chipper insurance brokers. 

The preparations for the international site visits have been exciting and so very different than how I would have prepared for a visit to somewhere in the states.  In establishing criteria for our potential partner sites, there are many factors that affect the design and success of a program overseas that we don't usually have to think about in developed countries.  For example, 66% percent of Namibians and 34% of South Africans have no electricity.  Literacy rates, child-led households, how safely women and children can be cared for, technological capabilities, potable water (and simply access to water), storage capacity...all factors affecting how and where we will work.  Some of these challenges actually make good opportunities for us, as certain obstacles create the perfect opportunity to link with a business or organization who can help us, thereby increasing the partnership network and increasing potential for sustainability. 

I am looking forward to talking for the first time about our program to people who are doing HIV/AIDS work in Southern Africa.  Between the profound poverty that creates an equally profound need for food and the anti-drug messages touting the right food as a cure for AIDS, "nutrition" is a hot and often very charged topic.  I have a tough challenge in messaging our intentions and capabilities just right.  In addition, I am eager to learn what other local and international organizations are doing and assessing where our programs can be integrated with other services.  It will be a fascinating puzzle to put together.

This morning I received word that another ANSA agency has signed on to become a Global Member Agency, bringing our total number of participating agencies to eight.  This is tremendous news on the day of my departure!!  It is hard to believe, but we are now nearly at estimated capacity for the number of agencies we can bring on board in our first year.  Unbelievable!

As I have gotten all the pieces together for this first trip, I have taken copious notes in order to put together a meaningful information packet for GMA representatives who will be traveling to the international sites.  They will hopefully be set with all the information they need on things like currency, weather, prophylactic medications, flights, local culture, and of course cell phones and insurance and much more.  My goal is to make this as easy as possible for all the people who will help ANSA be a success.

I am off to take my puppy to doggie daycare now.  My out of office messages are on, my laptop and cell phones are fully charged, and the taxi is due at 6:15.  I can't wait to see how the next few weeks unfold!!  Peace to all...Mary