Swaziland is another very small, landlocked country surrounded by South Africa and Mozambique. There is always so much to learn about the context of HIV in different countries. Swaziland has the depressing right to claim the highest HIV prevalence in the world, at 26% (and for some sectors of the adult population, the prevalence can be around 50%). The life expectancy is about 48 – which is a pretty unreal number to digest. It is an extremely male-dominated society, which is obvious in every-day life. Officially called the Kingdom of Swaziland, it is a monarchy run by a king who has 13 wives, if that gives you any idea of some of the male-female roles in its society. I don’t want to go into the rights/wrongs of polygamy and upholding important aspects of peoples’ culture, but I will say the Swazi culture certainly plays a huge role in the dynamics of HIV spread. Young women are most at risk for infection and the HIV prevalence amongst young women is much, much higher than amongst young men. This is because, given the cultural norms, younger women marry older men – who are often infected. And that means the HIV prevalence amongst pregnant women (since young women are generally the ones getting pregnant) is quite high.
To try and put some of the gender roles and HIV stigma issues in Swaziland in perspective, I’ll share a very interesting conversation I had with one particular woman while I was there. This woman was definitely from a much wealthier background than most people in Swaziland, she was very educated (having completed college), and she was an atypically outspoken and empowered Swazi woman (having worked on HIV issues for years and travelled to HIV conferences all over the world). Even so, she herself could not avoid a heartbreaking story, which she shared with me. Despite trying to stand up for herself, she said she had trouble negotiating condom use with her husband, with him being mentally abusive until she gave up. She was infected with HIV and became pregnant. This was about 5 years ago when PMTCT knowledge was not very common amongst the public and most people just assumed that if you were HIV+ and had a baby, it would die (in reality, if you do nothing at all, somewhere around 1/3 of children become infected). It was also a time when PMTCT drugs and counselling were mostly just accessible through private clinics (at least in Swazi). This woman was telling me about how she could afford the private clinics, but that her doctor was really negative about the whole experience and essentially blamed her for getting pregnant because of the risk it would pose to the baby. She followed all of the PMTCT protocols and gave birth to an HIV- baby. However, she had some complications during pregnancy and had to deliver via C-section, at which point her doctor apparently told her it was the perfect time to get her tubes tied and essentially did the procedure without fully consulting her about the implications or giving her time to think about it – he just took over, assuming the mentality HIV+ women shouldn’t be having babies no matter what. This experience was terrible for her, which is part of the reason she said she has since been heavily involved in HIV work and PMTCT in particular – as she said, HIV+ women still have a right to have children and not be belittled in the process. The issue of having children is a particularly tough one in Swazi. This woman now has 2 girls (one from a long time ago and then her pregnancy that occurred later when she was HIV+)...which is an issue in a country that primarily values sons. Apparently her husband’s family is now putting a lot of pressure on him to take a second wife since there is no way for her to have more children. She said she really, really doesn’t want her husband to take another wife, but she understands he has the right to have more children (which struck me as a somewhat culturally brainwashed perspective, but I won’t go there...). She alluded to the fact that her husband is thus having extra-marital relationships, and she seemed quite resolved about the situation, implying it was better than her husband formally taking another wife. This whole story just made me feel so sad. If a woman who is so outspoken and empowered in her public life – and who, on top of that, has the resources to access good healthcare, drive a nice car, have her children go to private school, and was also educated and has her own career (thus she is not struggling in the same way that many other people in Swazi are) – if she still has to deal with these incredible gender and stigma issues in her private life, then what is the average women dealing with and what can the average woman hope for? It just makes you realize how ingrained some of these issues are in the culture and how hard it is to break through that.
Anyway, back to the rest of the trip. Upon arrival at the airport in Manzini, Monica and I were met by Lungile, the Monitoring and Evaluation Coordinator for the country. Right away we drove to a lodge in Manzini and got to work with the team. It was fun to meet everyone (Petros, the Country Manager; Siboniso, the Country Trainer; and Nontobeko, the Regional Manager). Throughout the entire trip, they were great hosts!
After one day in Manzini, the next morning Monica, Lungile, Nontobeko, and I drove to the next region (there are 4 regions in Swazi) to work there for the day. We stayed at a place called Simunye, which is at the heart of the sugarcane plantations – apparently the country’s largest export.
Driving to Simunye
Sugar cane plantations
And the sugar cane factory, which created a nice smog over the region
Each place we went, we worked with local Site Coordinators to collect data (SCs are like Mentor Mothers except they usually have a little more experience and are in charge of managing the MMs and the data at their site, aside from regular mentoring duties). It can be both interesting and challenging to work with them – on the one hand they have the best insight into what is going on at the sites and why certain trends are occurring, and it is really fun to work with them to help improve their data capturing skills, but at the same time it is definitely a new experience for me to work with people who often not very educated – I learn a lot trying to put myself in their shoes and explain things logically. I realize I take so much for granted in terms of what is “obvious” or “just makes sense” when dealing with data. Unfortunately, the language barriers don’t help, but in the end it always works out.
After Simunye, we then drove all the way to the south of the country. As always, I love the opportunity to take in the sights as we drive around. Swaziland is a very beautiful country – extremely mountainous. And we drove past lots of game parks as well, though sadly no animals were hanging out by the fences along the road. There was, however, a sign I saw at one point that warned pedestrians to be careful of lions (and I must agree some of those fences didn’t look like much). Right by the sign, there were a bunch of workers cutting the grasses along the roadside – I don’t know how ease I would be doing that underneath a sign that says to be watch out for lions, haha!
More roadside scenery driving to Nhlangano
Typical rural housing seen from the road
Minibus stops, with people set up to sell stuff whatever they can, dotted all the highways
Oh, the ubiquitous minibus!
Small towns
Nhlangano
No matter how small/rural the town is, there is bound to be a KFC
I found this to be a telling ad - it's terribly sad to say, but in a country with such high HIV prevalence, funerals are quite common
After finishing our work in Nhlangano, on Saturday we drove back up north to the country office located in Mbabane. The drive from Nhlangano to Mbabane was gorgeous, especially as we went over a large mountain pass.
Mbabane is Swaziland’s capitol “city.” I’m not sure how many people live there, but it obviously didn’t feel that big, though it was still nice.
We worked from the m2m office (which, oddly enough, happens to be located right next door to the Swedish consulate, which shares office space with the Swaziland Citrus Board...so there were lot of pictures of Scandanavia and oranges covering the walls, haha!).
The view from the m2m office window - the city definitely has a rural feel!
Saturday mid-afternoon, we packed up for the day and Petros helped Monica and I check into our B&B, which was nestled in a gorgeous little valley just outside of Mbabane. After checking in, we drove further up the valley to a giant rock called Sibebe Rock, which apparently is the second largest exposed rock in the world (second to some rock in the middle of Australia). It was quite beautiful and very impressive. Unfortunately, we got to the visitor center at about 4pm, only to have the guide tell us that it was a 2hr walk to the top, so there was no way we could still fit it in on that day. However, he did offer to let us drive up the mountain to get some views (and, an ulterior motive, I believe, was to drive him home, since otherwise he walks all the way up the mountain at the end of the day). We had the m2m country car, a big Toyota Hilux pickup, so driving up sounded like a great idea. Well...the guide sort of neglected to mention exactly what kind of “roads” we would be on. Honestly, I have never experienced that level of 4-wheel driving in my life. The “road” was a narrow little trail that wound up the very steep hillside, with grass higher than the hood of the car and rocks sticking out at every angle which were impossible to see. It’s not easy doing a switchback trail in a pickup truck! I don’t know how we made some of those turns. Monica was an awesome and fearless driver (I really never could have done it) but there were still times when I felt as if I was just holding on for dear life. About half way up, Monica, Petros, and I decided we had come far enough to have a nice view (despite the protests of our guide who assured us it was possible to drive to the very top), so we parked and got out to walk around and enjoy the views from where we were. It was such a beautiful, peaceful place. It was interesting to see the little huts dotting the hillside high above us (some people really do live quite remote lives on top of the mountain!) and was so nice to feel like we were the only ones up there. The setting sun provided a beautiful, soft light as well. All in all, the drive was definitely worth it! Thank god Unicef bought us a 4X4, haha...and hopefully no one will notice the giant paint scratches...
Driving up the valley to get to the rock
The grand Sibebe rock
This was taken looking out the back of the truck, as we start to drive up the mountain. Notice how there's no road?
Nice views driving up, despite the terror
A view of the "road" we were traversing
But it was all worth it - such great views from the top!
Me hiking around
With Petros (right) and our guide
It was a beautiful place to hike around and enjoy the scenery as the sun began to set
More views of the "road" heading down
Our trusty truck, admittedly a bit beat up after the 4 wheel drive ordeal
After the drive/hike, Petros took us to a little eating establishment in the valley, once again with beautiful views.
Swazi’s are quite big on their meat, and this was a bbq place where you pick out your meat displayed behind the meat counter and then they grill it up for you. We had some delicious chicken, beef, and boerwoers, along with paap (my favorite). A very nice way to end the evening.
Sunday morning, Monica and I got up early and to put in a good half-day’s work before taking the afternoon off to explore. We had heard about a couple of interesting shopping areas, so off we went. (We can be quite dangerous together – you should have seen us carrying our giant wooden bowls back home on the plane from Malawi!) Turns out Swaziland has really, really well developed community initiatives that make really unique, more upscale crafts (as opposed to the same stuff you can buy off the street from South Africa to Kenya). The first stop was a specialty glass-making store where we each walked away with a new set of wine glasses. There were also lots of fun jewellery stores, weaving stores, scarf stores, etc. We spent the afternoon travelling all over the area shopping. One place we went to was called the Ezilweni Valley – a very beautiful place and also the site of a big outdoor music festival coming up.
"Beehive" huts, which apparently are what a lot of traditional Swazi huts look like (though I must disclose these ones were made for tourists to rent and sleep in)
At the end of the day, we found a lodge with a bar and TV so Monica could watch Chelsea win the English Premier League. Another reason we make good travel companions – we both love to watch soccer!
Monday morning we worked from the office in Mbabane again. We stopped to have a lunch at a local joint which actually was serving Nigerian food – very good! I love it when we get to go to lunch where the locals eat. So much better than them thinking all we want to eat is greasy American food! If I never see another French fry in my life, I think I will be quite happy. Seriously, it so, so hard to eat healthily on the road in Africa. Everything comes with a side of chips (French fries). I think one day we were served chips with breakfast, lunch, and dinner. I don’t know how people do it, eating greasy, fried food all day long. Haha the women we were with even refused to get vegetables on their pizza! Well, it’s kind of obvious why people have weight issues here (and all the other related health issues that involves). No matter where you are, there is a KFC on every corner, believe me (and yes, people in Africa much prefer their fried chicken to any kind of burger – so relatively few McDonalds, surprisingly).
Monday afternoon Lungile took Monica and me out on a site visit. We went to a small, rural clinic where we met with the head sister and she took us around the facility showing us what happens to pregnant women and new mothers as they navigate the health system. She also told us how tired she was because, it being harvest season, so had to be on duty out in the fields to serve the workers at 4am, before she comes to work at the clinic for the rest of the day. It was really fun to talk to the Site Coordinator and Mentor Mothers as well. One of them looked so young, and when we found out she was only 20, it really hit home how different our lives were, despite the fact that I’m roughly in the same age group. And it’s funny to say, but I finally realized that day as we were driving around how different my own life was a year ago – I don’t think I ever would have imagined back then that I would consider it just another normal day at work to be visiting a rural health clinic in Swaziland!
Tuesday was our last day in Swaziland, and with data abstraction complete, we were able to run some numbers to share with the team and talk about the progress of the Swazi program in general, as a way of wrapping up our trip. I should go into a little more depth: the trip wasn’t just about data collection for the report, but primarily learning and team building for the purposes of bettering m2m. Yes, we have to submit a big report to one of our big funders, but it’s part of a big process that m2m is going through to take advantage of the fact that our monitoring and evaluation tools have been in place at the site level for over a year now, providing us with an ability to really understand the effects of our services and the dynamics of our service provision. We don’t have any baseline data for the successes and challenges of our programs to date, so this is a really interesting first step. It’s very eye opening and can really help m2m build upon itself. Not only that, but working with the small in-country Swazi team and involving everyone in this project (from country manager to national trainer to regional site managers) was so important, as it meant that everyone got a feel for how to work with data. It was really fun to spend the last day of the trip essentially having a workshop with the team and helping them see the advantages and ways to use data and trying to help build their capacity to get site coordinators interested in the same way. For example, it doesn’t do any good to have people filling out the logbooks everyday mindlessly without noticing things like “wow, that’s weird – most of our first-time clients at this site have already given birth – I need to work with the facility staff to make sure that they are filtering antenatal clients to us as well” or “wow, glancing through this book, it seems as if only 10% of my clients are able to disclose to anyone – I really should emphasize that in my group talks and one-on-one sessions” etc. It feels silly to say it – of course flipping through a logbook you would notice these type of trends – but there really is a disconnect in people USING the books vs. just filling them out and never taking in the meaning of them. And it was fun to get everyone in the team involved and help them realize that it’s not just the Monitoring and Evaluation Coordinator’s job to deal with logbooks – regional site managers should also pay attention because the data speaks enormously to program success and service quality and trainers need to pay attention because if they see big gaps they can help improve the curriculum in those areas, etc. Everyone felt really rejuvenated about work by the end of the trip and they all seemed anxious to go off and work on improve their programs and take things in a new direction – so much fun to see and take part in!
Tuesday night we all went out to dinner together at a little pizza joint. It was really fun. I had such a good time working with the Swazi team – such great people!
From left, Petros, Monica, Nontobeko, Lungile, Siboniso, and me
I’m very thankful to them for taking such good care of us, and also I’m very thankful to Monica for once again giving me such a wonderful opportunity to visit and learn from a new place. I really hope good things for the women in Swaziland – they have such a hard road ahead of them.
No comments:
Post a Comment