Sunday evening I checked into yet another B&B, though this time it was much more like a hotel and less like just taking up a room in someone’s house. Nzwaki drove from East London and met me in PE. We got up pretty early on Monday to get started, once again working on data abstraction at the 5 sites funded by Johnson & Johnson in PE. There are certainly more than 5 m2m sites in PE and surrounds, but J&J only funds 5 of them, and we needed the logbook data from these sites in order to finish up the J&J report. Only one of the sites was close to where we were staying; the rest were scattered around the outskirts of the city. Fortunately (well, perhaps both fortunately and unfortunately, but I’ll get to that later...), Nzwaki brought her Garmin GPS. This was essential, as neither of us had any idea how to get from Point A to Point B otherwise.
Anyway, I looked up the first site on our list and found it pretty amazing that this small township clinic in was actually in the GPS database. Expecting nothing less than for everything to go smoothly, off we went, dutifully following the instructions of that nice little GPS woman. Lo and behold, 30 minutes later we arrived at our destination. I previously was impressed by our GPS being able to tell direct us through the remote lands of Eastern Montana, but having one able to tell us where to turn amidst makeshift township streets on the outskirts of a South African city seemed all the more amazing. Data abstraction at that particular site took about half the day and went well, at which point we hopped back in the car ready to tackle the next clinic.
Well, let me just say that GPS works really well when you can fully rely on it...but it can backfire amazingly when you are suddenly stuck in the middle of a township without it! As we started following the directions to get to the next clinic, all of a sudden the GPS just shut off. I tried to turn it back on, only to watch the screen go black again right away. Quickly realizing the battery had run out, I started to fiddle with the cigarette lighter. Try as I might, that little red light would not go on. Having a faulty cigarette lighter perhaps isn’t something you think to check when you get your rental car, but in the future, I think I will. So here Nzwaki and I were, driving around what essentially amounted to alley ways in the middle of a bustling township, looking very, very out of place and not having any idea whatsoever how to get to a main road or highway. At that point, we just started rolling down the window and asking passer-bys how to get...well, how to get anywhere, really, as long as it involved a highway. I will say that this situation would have been made much more difficult had a native Xhosa speaker not been present, but hopefully I won’t ever have to tackle such a scenario without Nzwaki.
Anyway, with the help of kind strangers, we eventually did make our way back to the highway, where upon we decided our next stop would necessarily be the PE airport where we could visit the rental car company and get the cigarette lighter fixed. To be honest, I really didn’t think too much about our little adventure, just that it made for a funny story, but Nzwaki later told me that she had been really worried that I was going to panic and be really upset and scared. I guess there’s a good side to not recognizing any township names! (Apparently we had been in the middle of one of the busiest township intersections, one that even Nzwaki, who doesn’t live in PE, knew by name.) I guess it’s a good lesson not to panic and to just trust that people are not evil and 99% of the time will likely try to help you if you need it. Of course it’s smart to remain on your guard, and of course I would never go anywhere by myself, but at the same time, there were women and children walking along the sidewalks and people laughing and being good natured, and I don’t want to fall in the mindset that I have to be terrified of everyone who is poor.
We weren’t able to get anything else accomplished on Monday once we had to backtrack all the way to the airport and get the car sorted out, but Tuesday with new found confidence in our GPS, we once again headed off to find the next site. This is when I discovered pitfall number two of relying so heavily on the GPS. After driving down the main national highway for a few kilometres, Ms. GPS told us to exit and turn onto a much smaller road that started heading through the township areas. This all seemed quite normal, until I heard her say “go straight for 17.8 km” as opposed to the 1-2 km I was expecting. Apparently she was trying to be helpful in finding us the most direct route to our destination, but obviously it would have been a lot more pleasant to be on a fast, easy highway for an extra 10 miles as opposed to the local township road. Oh well, lesson learned, haha!
Tuesday also happened to be Nzwaki’s 40th birthday, and I felt terrible about her having to spend with me instead of with her kids at home. Luckily, however, her youngest sister (who was my age) was going to school in PE, so she at least had some family in the area. We actually went out with her sister and her sister’s boyfriend for dinner both on Monday and Tuesday. It was nice of them to be so inclusive of me, and I definitely had a good time with them. Prior to dinner on Tuesday, Nzwaki and I took a little break to go for a nice walk on the main beach of PE before sunset. The weather wasn’t great (a little cold and incredibly windy), but it was still quite scenic. I can’t believe some people are insane enough to surf in such weather, but I guess I’m not a die-hard water person to begin with. The PE beachfront is nice enough, but it’s a little on the neon mall side for my taste. At least I’m glad I didn’t spend the whole week in PE without ever seeing the beach!
Wednesday we actually managed to finish up our data abstraction work, 2 days ahead of schedule. Fortunately, it turned out that none of the PE sites were that big, so even though it took us a lot of extra time to navigate between clinics, once we found the sites, things went pretty smoothly. I’ve really had a great time these last couple of weeks getting to work on the site level and having the opportunity to meet a lot of the Mentor Mothers and Site Coordinators. I’m not sure if I’ve explained this before, but Site Coordinators are in charge of usually 1-3 sites depending on the site size. They are basically responsible for monitoring the site, organizing group meetings, making sure all the supplies are up to date, and most importantly keeping track of the client information for all of the women the Mentor Mothers counsel. In essence, MMs spend their days meeting with people and recording basic stats, and then SCs go through the MM data and keep track of all the people they saw, making sure infomration gets properly recorded in the antenatal and postnatal notebooks and then transferred to the logbooks. SCs were once themselves Mentor Mothers (MMs actually only have a one-year contract with m2m; the organization purposefully wants lots of turnover to offer more women the chance to be employed and learn how to be role models) so they relate well to the MMs and know how to keep track of everything.
For the most part everything was recorded fairly well, but there was one particular site we visited in PE where it was obvious that the SC was not properly transferring information from the AN/PN notebooks (where each day’s visits are recorded chronologically) to the logbook (the “bible” where clients are tracked by name over time), with a lot of clients left out of the logbook. Nzwaki and I had a really long conversation about how to proceed, and it was very eye opening for me to hear her perspective.
My gut reaction was bafflement at how, when a SC’s entire job was essentially just to spend the majority of her day making sure data for a relatively small number of people is transferred from one book to another, the task still wasn’t getting done. The SC was home sick that day and Nzwaki told me she didn’t want to bring up the issue to the MM’s because it wasn’t their fault and she doesn’t like being negative and discouraging towards them regarding data logistics when their main focus is to be a good mentor. Beyond that, Nzwaki felt it wasn’t her place to speak up since she wasn’t a manager (after SCs there are Provincial Managers, and above that Regional Managers, who together create a ladder of management for each area). She also reminded me a lot of these women are under incredible emotional stress for various reasons and for many of them this is the first formal job they’ve ever held and they may not be used to such stringent standards or accountability.
We had an interesting conversation about how truly hard it is to develop a good system for Monitoring and Evaluation. Sure, I’ve caught on to the system m2m uses to track clients, but it’s definitely not simple, and I can see how it could be overwhelming to some people. Nzwaki said she also feels like a lot of women just aren’t interested in doing it well – they see their job as helping other mothers, not monotonously recording data. Unfortunately, at the organizational level, having real numbers and being able to talk quantitatively about the program effects, makes all the difference when it comes to funding – and thus being able to do the real mentoring work in the first place. Additionally, large scale data management is incredibly complex when you take away the use of computers for entering and tracking information! Such a foreign concept to us these days. It will be interesting to see how M&E evolves with m2m...on the one hand I can’t imagine them continuing to grow at such a large rate without implementing some sort of electronic data entry mechanism at the site level. On the other hand, I can’t imagine most of these MMs and SCs feeling any more comfortable working on a computer than their current set up. For some of these clinics, I don’t know if there’s a single computer in the whole building, so I really don’t know how strange it would be for m2m to have their own computers set up at each site...not to mention how expensive it would be to implement and maintain. Whew! When it got down to it and I was able to take a step back from my research-oriented mentality, thinking about all the MMs who are such invaluable women in their communities and admiring the strength they have for doing what they do...well, I felt pretty bad about being so quick to judge them about why they couldn’t just fill out a form correctly. Nothing is that simple, I suppose.
Wednesday night Nzwaki and I had dinner with Nomonde, who is a Regional Manager for the Eastern Cape. She is normally based in the Cape Town office but visits PE and other places in the Eastern Cape regularly. We were all staying at the same B&B, which was nice. I had a really great time getting to know Nzwaki so well over the past few weeks, and it was also really fun to spend time with Nomonde too. I ended up flying home early since Nzwaki and I finished up our project in PE ahead of time. It’s nice to be back in Cape Town, but I must say, I will definitely miss spending my days with Nzwaki! It’s too bad because she is only working with m2m temporarily on a few specific Innovation Center studies and the J&J report, and of course she’s based in East London. I don’t know if I’ll ever see her again, but I feel very fortunate to have become friends with her. Over the past weeks, she introduced me to a little bit of Xhosa culture, and I think I actually miss being called Sissy, haha! (The Xhosa all seem to greet each other using “Sissy” or “Mama,” and then they also refer to one another as Sissy, etc. in conversation. I think you generally call your peers and younger women Sissy and older women Mama?) And something else I think I’ll miss is always being greeted with hugs. I wish I was better at picking up the language, but it’s so different from anything I’ve ever studied and the clicks make a number of things nearly impossible for me to pronounce. Luckily enkosi, which means “thank you,” and molo or molweni, which mean “hello” don’t have clicks! Anyway, I really learned a lot these past couple of weeks and I hope I get out to more sites in the not-too-distant future. For now though, it’s back to Cape Town and back to the office!
Some views of the PE beach:
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