Arriving in Pholela

I’ve come to realize that in this digital age, when one is 9,000 miles from home, taking advantage of a little technology to keep in touch may actually be a good idea. As a result, despite my past feelings on the matter, I have decided to join the twenty-first century and keep a blog of my fieldwork experience here in South Africa. I can’t promise how regularly I’ll write updates, but I’ll do my best to share some of the experiences I’ll be having over the next 18 months. So here goes…

After three weeks in and around Durban, staying with friends, meeting with academics, and chasing down various leads on places to volunteer and ways to begin my fieldwork in the southern Drakensberg I arrived in Bulwer, KwaZulu-Natal. Bulwer is a village of 36 houses between Pietermaritzburg and Underberg, famous for hang gliding, and nestled in the mountains.

After settling into a small cottage I began volunteering at the historic Pholela Community Health Centre, just 15 km down the road in a piece of the former KwaZulu homeland. The PCHC is the reason why I have come to this area – the clinic’s history of holistic and community health care in the 1940s and 1950s provided a model for many parts of the world. Therefore, as you might imagine, the opportunity to begin my fieldwork by volunteering through the clinic is exceptional.

I have been allocated to the health promotions office, which is basically the outreach branch of the clinic. For these two weeks health promotions is sending out teams throughout the “catchment area” (a huge rural expanse) to give children vitamin A boosters. These boosters also come with a brief presentation in an effort to educate the children’s caretakers (generally their grandmothers) about nutritious foods and the importance of vitamin A.

Our team is a senior professional nurse, a nurse’s assistant, a community health worker, and me. Each day we load into the double cab pickup and take off into the mountains over dirt and rock roads. As we approach our destination, we pull out a loudspeaker and announce that we have arrived for the vitamin A campaign. I have trouble understanding exactly what is being said, as it’s all in fast Zulu, but I can tell where we’re headed by the streams of grandmothers walking with children in tow and others strapped to their backs. We then arrive at either a primary school or a mobile clinic stop (which often looks like a simple turn off). We hop out and set up shop, either in a classroom or out of the back of the truck.

The senior, professional nurse gives the short presentation then we begin to give the children boosters (a small capsule squeezed into their mouths). The community health worker along with local community health workers organize all of the grandmothers and children into a line and collect the medical cards. The senior nurse checks and fills out all the cards and the nurse’s assistant gives the kids the boosters. Finally, I, by far the least skilled and only non-native Zulu speaker, keep track of the number of children we manage to give the booster to. (This is by far the easiest job.) These numbers will be compiled and sent to the district office as part of some sort of assessment.

Many different aspects of this, my first experience as a part of a medical operation have fascinated, intrigued, and confused me. One important early realization is how truly remote these people are and how their location and their poverty largely dictate the relationship they can have to biomedical care. In many of the places the mobile clinic arrives once a month, if the roads are passable. These mobile clinics offer basic care, antenatal services (but of course no maternity services), voluntary testing and counseling (but not chance of ARVs), and TB advice. For anything more serious people would have to walk as many as a hundred kilometers to the health centre or would have to get some sort of transportation, which is infrequent, inconsistent, and expensive.

While these mobile clinics go out with two nurses and meet community health workers in the locations they visit, it is these community health workers that then provide the most consistent and direct face of biomedicine. These community health care workers are recruited throughout the Pholela’s catchment and are almost exclusively women. They receive training at the health center and provide an exceptional network through with to pass and receive information from even the most remote corners of the district.

As we travel through vast open pastures and small holdings with tiny garden plots, turning from unsigned dirt road to unsigned dirt road and constantly stopping and starting as we wind our way past the goats and the cows, I find it amazing that the health centre is able to come into contact with any of these people. And I am even more eager to get to know the area, the people, their health, and their nature.