Work has been really busy lately (hence why I’m having a hard time finding time to write in the blog), so don’t think I’ve been doing nothing but having fun! Don’t feel too sorry for me though – work has actually been quite “fun” in its own right, as I’m really enjoying the projects I’m working on at the moment.
Immediately after returning from Christmas break, Nzwaki, Monica, and I set to work on preparing to submit abstracts to various conferences regarding our Early Infant Diagnosis Study which has now wrapped up at the Innovation Center in East London. We are submitting abstracts to an annual conference on Perinatal Priorities in South Africa, to be held in March, and also to the International AIDS Conference, to be held in Vienna in July. It’s nice not to be completely removed from the research world while working at m2m. Actually, despite not being in a lab, it has been a very valuable experience for me to take part in such different research based on public health, community, and social issues. The study has been really interesting, and right now I’m managing our database of client information and translating it into trends and findings about the success of Active Client Follow Up in helping encourage mothers to return to clinics to have their babies tested at 6 weeks post birth. I won’t go into too much detail about the study background at the moment, since I’ve described it before.
Beyond the quantitative data analysis I’m doing, I’m also gaining a new appreciation for qualitative data. I helped Monica and Nzwaki design Focus Group Discussion guides, and then Nzwaki conducted focus group discussions with the various m2m study participants (Mentor Mothers, Site Coordinators, and Provincial Managers) to try and better discern things like testing barriers, client attitudes towards being called and visited at home, staff acceptability of ACFU practices, etc.
The barriers to having a child tested are much more complicated than simply not understanding the importance of early diagnosis (FYI the reason it’s so important is that if a child is HIV+, starting medications early on greatly influences their health outcomes), and not at all related to what most people are used to dealing with in the U.S. Some barriers occur on the mothers’ end, ranging from mothers who are too scared to test their babies and not ready to deal with the results, to mothers who have not disclosed to anyone in their family and are afraid to admit to taking their child for testing, to mothers who simply cannot get to the clinic on testing day because of transportation costs or work schedules, etc. There are also a number of clinical barriers, including clinics that only do infant PCR tests on certain days of the week, clinics that have to cancel testing services when the nurse who usually runs the test service is sick or takes extended leave, etc., to clinics that run out of PCR test kits. Additional issues arise over receiving results (I myself was very surprised to see how many records we have indicating people had their babies tested but do not yet have the results). Often clinics are not equipped to run the tests in-house and therefore must ship off blood samples to other labs, and it’s understandably challenging for some mothers to keep checking back at the clinic for their results for weeks on end.
Yes, as you can see, accessing services like infant PCR testing is a complex matter. There are so many things we don’t even think about (“we” referring to a Western-oriented mind, in this case). m2m developed a lot of new measures during this study to try and get women to test their babies, including adding an extra employee at each site responsible for calling clients (and doing home visits at certain sites); having all site staff go through extra training to learn more about the importance of PCR testing and how to emphasize it to clients; creating a new wheel calendar tool that staff can use to easily determine the 6 week post delivery date (when babies are supposed to be tested), since it can be difficult for clients to calculate 6 weeks time on their own; and finally, giving clients an information sheet filled in telling them what day and which clinic they need to go to for testing, based on their address and available services in the area. After all of these additional measures were taken, the focus group discussions indicate that the favorite new tool of the site staff and clients is the simple 8.5x11 card with a picture on one side showing a baby being pricked in the heel for a blood sample and a couple of important talking points on the back for mentor mothers to cover when discussing PCR testing with their clients. The mentor mothers said having a printed card with a picture not only made them seem more professional to mothers, but also mothers were very grateful to see how the PCR testing worked. Simply seeing a picture of a baby pricked on the heel and thus knowing what to expect turned out to be very helpful to mothers – apparently a lot of mothers who take their babies for regular immunizations at six weeks don’t take them for PCR testing despite being at the clinic already because they don’t like the idea of their babies being poked, prodded, and made to cry and do not know anything about what is going to occur during collection of the test sample. So in the end, sometimes it’s the simplest of things that matter the most! It’s the perfect example of how easy it is for those of us who grew up in the Western world can have a very hard time predicting how to effectively reach a population coming from a completely different culture. It’s obviously not that any one group is stupid or wrong, we all just have such different perspectives, learned behaviors, and expectations.
(I see constant reminders of this kind of thing all of the time. Walking into our office building every morning, it’s not uncommon to see someone waiting for the elevator who has not yet pressed the button. Of course when you think about it, it might not be intuitive for everyone in the world to press a button to make an elevator come get you. Once I was at the gym and the woman on the elliptical next to me said hers was broken, and since I had just finished a 20 min. period on mine (we’re only allowed 20 min at a time on machines at our overcrowded gym – don’t get me started!), she asked if she could use mine. I obliged and decided to try hers, since it didn’t look broken and I didn’t want to stop working out yet. Hers worked fine, but when I looked over at the machine I had been using, once again, she was completely struggling and unable to move the legs or arms on her machine at all. This didn’t surprise me because she had the resistance set to 100%, as made clear by the lit up dots on the screen that went all the way to the max highest point. Of course she didn’t realize this (and unfortunately I didn’t have the time to tell her before she got off in frustration and walked away), and once again, if you think about it, if you have never been to a gym before, you might not know much about how exercise machines work. It certainly is interesting to be reminded of how much your culture influences you – and how long those influences have been shaping your mind. And this is also one of the reasons why I’m gaining so much being here in Cape Town and working for an NGO, learning to think outside the laboratory box I was trained in and the culture that shaped me.)
Another interesting aspect that came out of the focus groups was how important it was and how grateful clients were for m2m’s discreetness during all contacts outside of the clinic. For example, mentor mothers don’t disclose who is calling unless the client themselves answers the phone – a lot of families may share phones and it would be disastrous to tell a partner whom a client has not yet disclosed to that an HIV-related organization was calling. That is partly why the home visit testing aspect of this study does not seem to be successful – clients aren’t keen to have mentor mothers show up at their houses, and in turn mentor mothers really don’t feel comfortable going out and doing home visits in neighborhoods they aren’t familiar with. On the positive side, the phone call interventions seemed to be a really effective way to reach clients. Over 90% of clients enrolled had access to a cell phone, and site staff talked about how clients often didn’t want a sheet of paper telling them when and where to get their babies tested (sometimes related to the fact they didn’t want evidence around the house showing they were HIV+) – they much preferred to just type the date into their cell phones and set a reminder. So you see how technological Africa is getting in its own respects – cell phones certainly have changed things around here!
Another really encouraging note coming out of the focus groups was how clinics in which the study was conducted began changing their services. As m2m emphasized PCR testing to their clients and women subsequently began to request the test more and be less fearful about the process, then some clinic sisters (sister = nurse here) began to notice m2m’s efforts and worked to not just accommodate the study in their facilities but make extra effort to provide more testing services and increase the testing rates facility-wide (beyond m2m clients). It’s really inspiring to hear about m2m not only changing the attitudes of clients, but the nurses and facility staff as well.
Unfortunately, the Focus Group Discussions were conducted in Xhosa, so I couldn’t actually take part in that side of things, but it’s been really enlightening to see the data coming out of that type of research. It has certainly served as a good reminder that it’s all too easy to overlook important points from the planning/policy perspective – getting on the ground and figuring out the realities of the situation is crucial. I think that theme applies to NGOs and aid work on a much larger scale, in terms of looking at how foreign-run institutions effectively deliver services to a local population with such different perspectives and needs.
Anyway, we’re still in the process of analyzing all the data and putting together a report on the baby study, but there are certainly a lot of interesting observations that have been made and I’m very grateful for the opportunity to participate in the project.
Aside from working hard to write up this Early Infant Diagnosis Study report, one of the other exciting work project we have going on in DSITS is an evaluation of our Malawi country program. This is going to involve Monica, Ilan, and me traveling to Malawi for 12 days starting this weekend. We will be working with the in-country team, traveling around to sites to collect logbook data and have focus group discussions with m2m staff there. I’m really excited to learn more about Malawian culture (of which I know very, very little, I’m afraid) and take part in a country evaluation, and I’m sure I’ll have more to report on that soon enough!
Tuesday, January 19, 2010
Monday, January 18, 2010
Cape Agulhas
Realizing the 4 us were actually becoming quite booked over the next few months with various work trips, friends and family visits, knee surgeries, etc., we decided to take advantage of this one last weekend where everyone was free and hit the road. Thus, Saturday morning we took off for the town of Struisbaai, located near the Southern most tip of the continent (called Cape Agulhas) and about a 2.5-3 hour drive from Cape Town. It was a beautiful drive, and interesting to see the stark difference in the landscape this time compared to our last experience on the same highway when we traveled to Knysna on the Garden Route back in the middle of the South African winter (the rolling hills were previously bright green and yellow filled with crops, but now the land is all brown and dry, as summer is the dry time here).
We arrived in Struisbaai with enough time to check in at the backpackers’ hostel and grab a little lunch. The town is relatively empty to begin with – mostly just small houses dotting the beach, a few smalls stores (which do not really have weekend hours, as we can attest to), and about 3 restaurants – but we were surprised at just how deserted the town felt despite it being high season (summer). Struisbaai was quite beautiful, situated right on a beach filled with fine, bright white sand and the turquoise blue of the beautiful Indian Ocean. The postcard I bought even said it was the longest stretch of white beach in the Southern Hemisphere!
After lunch, we headed over to a farm where we had signed up to go horse-back riding. It had probably been about 10 years since the last time I’d been on a horse, but we all managed ok (and I should add that Julia is in fact quite the horse expert). I must say though, I like Western saddles much better than English ones (which we had to use)! We were led by two teenagers who didn’t actually seem that excited about working on a Saturday afternoon (go figure!) but were still treated to a very pleasant 2 hr round trip trail ride that took us from the farm through the fynbos (= unique Western Cape bush/shrub vegetation), and then out onto an absolutely gorgeous, remote, pristinely white beach where the bright blue ocean was particularly dramatic coupled with small sand dunes. It was really fun to ride along having the beach all to ourselves, and all in all it was a highly enjoyable experience.
After the horse ride, we cleaned up a bit and headed out for dinner at one of 2 restaurants which we found open in Struisbaai, as determined by taking all of 5 minutes to drive around all each side of town. We picked a beautiful spot on the beach and were able to watch the last light fade away while enjoying our dinners, which were excellent. Following dinner, we went back to the backpackers’ and hung out at the on-site bar for a while, where we had a good time meeting both fellow travelers and local South Africans. For a town with not a single thing open beyond 8pm (believe me, I looked, upon discovering I had forgotten my toothbrush), the backpackers’ bar was amazingly hopping. Who knew?
Beautiful sunset colors seen while having dinner on the beach
The next morning we checked out and drove to the next town, L’Agulhas (located about 5km further down the road right on the Southern-most tip of the continent), and were once again foiled by the lack of activity in the area as we searched for a restaurant where we could have brunch. We eventually just had to settle for a grocery store. We then visited the park to see the Cape Agulhas lighthouse and stand at the Southern-most tip of Africa, where two oceans officially meet (in contrast to how people commonly refer to them meeting at the Cape of Good Hope, near Cape Town). We took the obligatory pictures next to the rock that confirmed our destination, enjoyed the scenery for a while, and then drove back to the better (less rocky) beaches of Struisbaai to enjoy relaxing on the beach bit more before packing up and setting out on the road home. Sadly, I got very sunburned (and I was even wearing sunscreen!), but I think I’ll survive. We had a lovely brunch (well ok, it was 3pm, but we all ordered breakfast food) at a cute little road-side farm stall on the way back to Cape Town, making for a nice ending to our very pleasant little weekend outing. Hopefully we can do more of that sort of thing in the future, though for the next few months we all seem to have jam-packed schedules…
The town of L'Agulhas
The L'Agulhas lighthouse, dating back to 1848
I’ll admit Cape Agulhas is aptly named after seeing all the rocks dotting the beach in the area. (Agulhas means “needles” in Portuguese. They were the primary explorers of the tip of Africa back in the day. Bartalamou Dias first rounded the Cape of Good Hope (the peninsula which Cape Town sits on, which is the South-Eastern most point of Africa) in 1488 in case you need a good trivia question.)
And finally, my obligatory picture at the tip of the continent
We arrived in Struisbaai with enough time to check in at the backpackers’ hostel and grab a little lunch. The town is relatively empty to begin with – mostly just small houses dotting the beach, a few smalls stores (which do not really have weekend hours, as we can attest to), and about 3 restaurants – but we were surprised at just how deserted the town felt despite it being high season (summer). Struisbaai was quite beautiful, situated right on a beach filled with fine, bright white sand and the turquoise blue of the beautiful Indian Ocean. The postcard I bought even said it was the longest stretch of white beach in the Southern Hemisphere!
After lunch, we headed over to a farm where we had signed up to go horse-back riding. It had probably been about 10 years since the last time I’d been on a horse, but we all managed ok (and I should add that Julia is in fact quite the horse expert). I must say though, I like Western saddles much better than English ones (which we had to use)! We were led by two teenagers who didn’t actually seem that excited about working on a Saturday afternoon (go figure!) but were still treated to a very pleasant 2 hr round trip trail ride that took us from the farm through the fynbos (= unique Western Cape bush/shrub vegetation), and then out onto an absolutely gorgeous, remote, pristinely white beach where the bright blue ocean was particularly dramatic coupled with small sand dunes. It was really fun to ride along having the beach all to ourselves, and all in all it was a highly enjoyable experience.
After the horse ride, we cleaned up a bit and headed out for dinner at one of 2 restaurants which we found open in Struisbaai, as determined by taking all of 5 minutes to drive around all each side of town. We picked a beautiful spot on the beach and were able to watch the last light fade away while enjoying our dinners, which were excellent. Following dinner, we went back to the backpackers’ and hung out at the on-site bar for a while, where we had a good time meeting both fellow travelers and local South Africans. For a town with not a single thing open beyond 8pm (believe me, I looked, upon discovering I had forgotten my toothbrush), the backpackers’ bar was amazingly hopping. Who knew?
Beautiful sunset colors seen while having dinner on the beach
The next morning we checked out and drove to the next town, L’Agulhas (located about 5km further down the road right on the Southern-most tip of the continent), and were once again foiled by the lack of activity in the area as we searched for a restaurant where we could have brunch. We eventually just had to settle for a grocery store. We then visited the park to see the Cape Agulhas lighthouse and stand at the Southern-most tip of Africa, where two oceans officially meet (in contrast to how people commonly refer to them meeting at the Cape of Good Hope, near Cape Town). We took the obligatory pictures next to the rock that confirmed our destination, enjoyed the scenery for a while, and then drove back to the better (less rocky) beaches of Struisbaai to enjoy relaxing on the beach bit more before packing up and setting out on the road home. Sadly, I got very sunburned (and I was even wearing sunscreen!), but I think I’ll survive. We had a lovely brunch (well ok, it was 3pm, but we all ordered breakfast food) at a cute little road-side farm stall on the way back to Cape Town, making for a nice ending to our very pleasant little weekend outing. Hopefully we can do more of that sort of thing in the future, though for the next few months we all seem to have jam-packed schedules…
The town of L'Agulhas
The L'Agulhas lighthouse, dating back to 1848
I’ll admit Cape Agulhas is aptly named after seeing all the rocks dotting the beach in the area. (Agulhas means “needles” in Portuguese. They were the primary explorers of the tip of Africa back in the day. Bartalamou Dias first rounded the Cape of Good Hope (the peninsula which Cape Town sits on, which is the South-Eastern most point of Africa) in 1488 in case you need a good trivia question.)
And finally, my obligatory picture at the tip of the continent
Freshly Ground at Kirstenbosch
Clearly I am a devoted Freshly Ground follower, this being my 3rd concert in about a one month period. And what better way to see them than enjoying a lovely summer evening and the beautiful views at Kirstenbosch Botanical Gardens? In the summer, Kirstenbosch has outdoor concerts every Sunday evening, which is a really fun thing to take advantage of. Having learned our lesson with The Killers concert, we arrived at Kirstenbosch 2 hours before the concert, at the time doors opened. We were a bit dismayed when we showed up clearly running behind thousands of other people already there, but we were beginning to think the concert gods were trying to make up for our previous experience when we found the last on-ground parking space. This was particularly exciting for us, having walked for 3.5 hours total along side the road for The Killers concert, if you recall. On top of that, we managed to find room for our blanket amongst the only small shaded section of the entire place set aside for sitting. And then, as if things could make us any happier, we discovered that the band was really good friends with the people sitting directly in front of us, as various members kept coming up to say hi and sit with them before the show. Sorry, no pictures of that though – since we seemed to be the only ones who noticed (there were people walking up and down and around all the time, so I think everyone else just tuned the crowd out and didn’t notice the fact that the band members were sitting down right next to them), it seemed particularly inappropriate to draw attention to the scene. Needless to say, it was still cool. And the concert itself did not disappoint either. I had never heard Freshly Ground be particularly political before, but they dedicated one song to Mr. Robert Mugabe (the dictator of Zimbabwe, for those of you who may not know) and then proceeded to sing about being “too chicken to change.” It was nice to hear them be vocal about that issue. Anyway, hopefully there will be time to fit in more Kirstenbosch concerts soon!
Constantia Winelands
Apologies for not having updated this in quite sometime…I’ll just go ahead and start where I left off, right before going home for Christmas.
With a middle of the week holiday and the day off from work, as a self send off before going our separate ways for the Holidays, we decided to spend the day wine tasting in Constantia. Constantia is about 15 min from us, pretty much just a suburb of Cape Town. Not every city has its very own vineyard-filled suburb! It was a beautiful summer day (though that feels strange to say in December), and overall very enjoyable. As always, the wines were lovely, and it was really relaxing to just sit back and take in the scenery. We visited Groot Constantia (the oldest vineyard in South Africa, founded in 1685) and Steenburg. We even dressed up for the occasion and tried to look grown-up, since wine tasting by definition sounds classy.
We were particularly looking forward to visiting Groot Constantia since it’s so famous, but our true nature caught up to us and we suffered a few minor mishaps while there. Embarrassing Incident #1: Byron walks up to the bar and makes small talk with the wine pourer/wine expert. He grabs a brochure off the counter and says everything looks great and he’s excited to read more. The wine pourer informs him the brochure he just took was in Chinese. Byron tells him with a straight face that of course it’s in Chinese, we have a roommate who speaks Chinese (pointing to Wenli). When Julia, Wenli, and I make our way up to the counter to have our glasses filled, the wine pourer gives us a brochure in English and asks us to please deliver it to our friend, who just took the one in Chinese and “tried to act really cool about it.” Needless to say, much laughter ensued and the beginning of our downfall at Groot Constantia began.
After the tasting room, we drove down to the cellars to sign up for a cellar tour, where Embarrassing Incident #2 took place. We were 5 min early, so I figured I might as well use the bathroom. That was all well and good…except for the fact that I subsequently could not leave the bathroom. Yup, the lock-turn-thing on the door and pad-lock part of the lock just sort of disconnected, leaving no way to turn the lock. Luckily Wenli was also in the bathroom, so I wasn’t stuck without anyone knowing about my fate. The door went all the way to the floor, so there was no going under, and it was also a very tall stall, making it difficult to hoist oneself up over the top. Wenli went for reinforcements, while I tried gaining height by using the toilet seat and a small window ledge. It was much harder than I had anticipated, though admittedly I don’t think about climbing out of bathroom stalls very often. Or at least I didn’t used to. Anyway, about 5 staff people, 1 step-ladder, a ton of dust (believe me, they DO NOT dust on top of the bathroom stalls), and 20 minutes later, I was finally free. We then joined the rest of the cellar tour midway (apparently I had made a bunch of Chinese tourists very upset because I was delaying the tour, so they didn’t wait for us) but I must admit I couldn’t concentrate much once I did join – I couldn’t stop laughing at the whole situation. Embarrassing, yes, but hilarious all the same. All in all, despite not coming across as the classiest of wine tasters, we still managed to have a good time, as always. Oh, and we got a refund on the cellar tour :)
The pretty part of Groot Constantia
The not so pretty part of Groot Constantia (of course Wenli thought to document the bathroom debacle – who wouldn’t?!)
Julia helping brainstorm about what to do
Me eventually climbing up on the window ledge
And somehow managing to get over the top - freedom at last!
The Groot Constantia cellars (post bathroom debacle)
Steenburg
With a middle of the week holiday and the day off from work, as a self send off before going our separate ways for the Holidays, we decided to spend the day wine tasting in Constantia. Constantia is about 15 min from us, pretty much just a suburb of Cape Town. Not every city has its very own vineyard-filled suburb! It was a beautiful summer day (though that feels strange to say in December), and overall very enjoyable. As always, the wines were lovely, and it was really relaxing to just sit back and take in the scenery. We visited Groot Constantia (the oldest vineyard in South Africa, founded in 1685) and Steenburg. We even dressed up for the occasion and tried to look grown-up, since wine tasting by definition sounds classy.
We were particularly looking forward to visiting Groot Constantia since it’s so famous, but our true nature caught up to us and we suffered a few minor mishaps while there. Embarrassing Incident #1: Byron walks up to the bar and makes small talk with the wine pourer/wine expert. He grabs a brochure off the counter and says everything looks great and he’s excited to read more. The wine pourer informs him the brochure he just took was in Chinese. Byron tells him with a straight face that of course it’s in Chinese, we have a roommate who speaks Chinese (pointing to Wenli). When Julia, Wenli, and I make our way up to the counter to have our glasses filled, the wine pourer gives us a brochure in English and asks us to please deliver it to our friend, who just took the one in Chinese and “tried to act really cool about it.” Needless to say, much laughter ensued and the beginning of our downfall at Groot Constantia began.
After the tasting room, we drove down to the cellars to sign up for a cellar tour, where Embarrassing Incident #2 took place. We were 5 min early, so I figured I might as well use the bathroom. That was all well and good…except for the fact that I subsequently could not leave the bathroom. Yup, the lock-turn-thing on the door and pad-lock part of the lock just sort of disconnected, leaving no way to turn the lock. Luckily Wenli was also in the bathroom, so I wasn’t stuck without anyone knowing about my fate. The door went all the way to the floor, so there was no going under, and it was also a very tall stall, making it difficult to hoist oneself up over the top. Wenli went for reinforcements, while I tried gaining height by using the toilet seat and a small window ledge. It was much harder than I had anticipated, though admittedly I don’t think about climbing out of bathroom stalls very often. Or at least I didn’t used to. Anyway, about 5 staff people, 1 step-ladder, a ton of dust (believe me, they DO NOT dust on top of the bathroom stalls), and 20 minutes later, I was finally free. We then joined the rest of the cellar tour midway (apparently I had made a bunch of Chinese tourists very upset because I was delaying the tour, so they didn’t wait for us) but I must admit I couldn’t concentrate much once I did join – I couldn’t stop laughing at the whole situation. Embarrassing, yes, but hilarious all the same. All in all, despite not coming across as the classiest of wine tasters, we still managed to have a good time, as always. Oh, and we got a refund on the cellar tour :)
The pretty part of Groot Constantia
The not so pretty part of Groot Constantia (of course Wenli thought to document the bathroom debacle – who wouldn’t?!)
Julia helping brainstorm about what to do
Me eventually climbing up on the window ledge
And somehow managing to get over the top - freedom at last!
The Groot Constantia cellars (post bathroom debacle)
Steenburg
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