http://mrzine.monthlyreview.org/2010/dohrn290310.html
29.03.10
by Jennifer Dohrn
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.
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