Challenges and Prayer Requests

Hello Friends!

Things are getting very frustrating here as the public sector strike has been on for over 2 weeks now. This means that the schools, as well as clinics and hospitals and all other government offices have been closed for this time. It’s really impacting the HBC volunteers and their patients – many are suffering without being able to get medical assistance, and they can’t afford to pay to see a private doctor. People who are supposed to collect chronic medicines (for blood pressure, epilepsy, and ARVs for AIDS) are having great difficulty doing so. This could have dreadfully vast implications in the community if this strike doesn’t come to an end soon.

The Injesuthi Clinic, which normally has a queue at least 100 people long every morning, has been limited to seeing only emergency cases – and many are afraid to go in for even those cases. People are suffering greatly, and there seems to be no end in sight. AIDS-related opportunistic infections left untreated can quickly progress to fatal illnesses.

The frustration is that the public workers are being intimidated by the unions, who in term are jostling around for political power and influence. This is the biggest strike since the New South Africa came in after Apartheid in 1994. Below you’ll see links to articles on this, if you’re interested.
Public service strike disrupting HIV care in South Africa – AIDSMap News
Civil Servants' Strike Intensifies in S. Africa – Washington Post
Public worker strike disrupts South Africa – Chicago Tribune

*Please pray that both the unions and the government will come to their senses so that the country can get back to normal.

*Please pray for healing and protection for the sick suffering without any access to treatment.

Please also pray for assistance and hope for the many orphans in South Africa. I’ve heard the most disturbing stories about orphan situations throughout Amangwe in the last couple of weeks: staying alone without food or clothes to keep warm in this winter weather; staying 12 kids together with a sick granny; a 10 year old boy staying entirely alone, etc. Pray we’ll be able to find sustainable, empowering ways to support, encourage and love on these kids.

Thank God for the exciting developments within the Winterton church community to bring together and advance the work of multiple ministries, Thembalethu being just one of them. Simunye, the name of the interdenominational committee, well-represents God’s work: In Zulu it means “We are one”.

I’m very grateful for your support and prayers!

With love,
Betsy

Two Busy Months

Thembalethu Update
2 June 2007

A Saturday breather, and a chance to get some word back to you all finally. Thank you all so much for making it possible for me to get back here, to support this work. Your generosity has been amazing! God is good and I’m so grateful for your partnering in this work!

I can’t believe it’s already been two months since I arrived back here. After some initial settling back in, it’s seemed almost like I never left. Except of course for all the memories of lovely times that I spent with you all during a brief respite at home. Being back, my focus has definitely changed primarily to support the Home-Based-Care volunteers in caring for the sick and orphaned in their community. So, of course, the ways that I spend my time have shifted a lot. And, the team of people that help to oversee the project are a bunch of predominantly white South Africans, instead of Americans in partnership with Zulu teachers and field workers. Oh, and I suppose that I’ve been seeing a lot more HIV positive people on the brink of (or already into) full-blown AIDS. Oh, and I’ve joined the Winterton white bakkie brigade (bakkie means pick-up truck, and for some reason the majority of my farmers neighbors have white ones). And I’ve already attended too many funerals or mourned with far too many families of patients. But, despite all these changes, my favorite part continues to be working with the lovely Zulu people, and especially the ma’s and gogos who remember the age-old Zulu custom of ubuntu – caring for each other.

When I first got back to South Africa, I was a bit uncertain about how relations with the Winterton Methodist church would work. Afterall, I had just barely given them a project proposal, and didn’t have time for an in-person explanation before I left the country. So we communicated by email for the few months that I was in the US, and they remained absolutely solid in their commitment to the Home-Based-Care work, and certain of God’s leading in it. Yet, coming back and having a chance to explain the whole concept and, allay their concerns in person made a big difference.

After being here for a little more than a week, a meeting was set up to meet with the Church leadership committee. I sent out a prayer request for wisdom and discernment, for God’s unity in meeting together with the church. And God answered our prayers beyond my best imaginings.

At that meeting presented to the church leadership the same pictures, information, and explanation that I used in the United States. I wasn’t sure if I should cut some information out since it is their own neighbors that I was speaking about. I decided not to change a thing, and am glad of it. Multiple members said how convicted they were of their own apathy, their lack of understanding of the full gravity of their Zulu neighbors situation, and their renewed commitment to making the home-based-care project not just work, but thrive and continue – under the name Thembalethu “Our Hope”.

It was decided that the following Sunday, I should share the same presentation with the entire congregation. I think God must have been preparing me for this, as I had a couple practice opportunities in the US before I left. So I did the same presentation over again, this time integrating a challenge from the story of the Good Samaritan. I can’t say that things changed overnight, but I think people came away challenged, unable to walk away unaffected after being confronted by the situation in their neighboring village and an opportunity to help out.

Much like the blacks that I’ve come to know and love over the past few years, the whites also have their share of baggage from Apartheid. Until the end of the Apartheid system in 1994, the government, schools and even some churches spread an indoctrination of inferiority of the blacks in every aspect of their being, as well as spreading ‘swartgefaar’, the idea that blacks are by nature more violent, brutal, and criminal in nature. This indoctrination over generations to the whites continues to hold many in bondage, and fear reigns. But God is moving in their midst, and I’ll be taking some of them out with me in the next couple weeks and months to see for themselves the Zulu individuals and families that live so close to them, but are emotionally and socially and economically still so very far apart. Many citizens of the new South Africa have a lot of baggage from the past 200 years, and their own life stories that they need to unpack, and it is very exciting to see so much movement in the Winterton area to tear down the barriers in a big way.

From an HIV infected person to a pandemic

A crazy day with patients at the local Estcourt Hospital the other day opened my eyes to the reality of the health situation here.

I was bringing in a very sick HIV+ client to get her CD4 count redone. Sister Buthelezi (the nurse in charge of the Estcourt Hospital ARV rollout) came out to the pick-up to see the patient, to take her blood. She said she should be admitted to the hospital, so we waited for the doctor to come and check her, to write the admission letter. In the meanwhile, I saw another friend who was also coming into the ARV clinic to get her CD4 count retaken. I watched incredulously as box after box after box after box were being shuffled and placed under the clinic’s verandah. A stream of skeletal patients were struggling to move the 14kg (30.8 lbs) boxes, one at a time, from the back storage room, to the entrance. Three trips per patient – three big and awkward boxes of food to assist them: rice, beans, maize meal, immune booster porridge, salt, sugar, powdered milk are some of the contents. Some were lucky and had brought helpers with them to transport the boxes, those who didn’t were left out from assistance, unless they had money to pay for private transport. Once they made the three trips with their three boxes out to the ARV clinic entrance, they still had to find a way to get these three boxes to the hospital entrance, and, then to the taxi-bus stop, and then through the taxi-bus transfer area, then on the new taxi-bus, then on their taxi to their home areas. If they were able to make it that far, they could call additional family or friends, or the random child to come and help them carry the boxes up the dirt roads to their homes.

What lunatic thought this would be a good way to help the sick? Skeletal patients everywhere carried boxes from one side to the other. Three in all, because the shipment from the Department of Health had been delayed, and so three months worth of ARV nutritional support boxes arrived at once, and were distributed at once because of the lack of storage at the clinic. I felt many eyes on me, trying to figure out where I had come from, whether I might be able to help them cart their boxes home. Unfortunately for them, it was a very long day at the hospital, and I left too late for them to get my help.

I returned a couple of months later to hear that all the boxes had run out, and those who have become dependent on the food assistance are now left without any food to take home with them.

While I was still mulling over this crazy system, I was rushing all over the hospital looking for a gurney to get my very sick patient admitted to the ward. There was none in sight, and I discovered that the nurse in training I had sought assistance from at first, had run off instead. I cruised throughout the out-patient department, the emergency area, and through various wards searching for a gurney. Skeletal patients were everywhere.

While I know that it is a mass generalization, I have learned take keen notice in people’s appearance. Most every patient that I’ve taken to have tested for HIV so far has the same gaunt, sunken-eye look that I see all over the streets and pathways, and corridors of the hospital. And, without any real evidence for my assumptions, I saw them everywhere. Laying on benches, struggling to sit on wooden pews, sitting in wheelchairs, and gathering up the strength to walk the vast distances of the hospital. Likely AIDS cases were everywhere. In fact, I started to understand just what the AIDS epidemic here is doing to the health sector.

I normally end up feeling a strong sense of frustration and anger toward the public health system at the incompetence, inefficiency, and apathy I have noticed, and hear repeatedly from patients and caregivers. For once, I was able to see the huge impact that AIDS was having on the health sector. The hospitals and clinics are being flooded by countless emaciated HIV+ patients in every clinic, with every possible queue with every possible ailment. They go in with secondary infections and diseases (TB, pneumonia, terrible body rashes, meningitis, oral thrush, weight loss and STDs) and get treatment for these. This pandemic of AIDS together with a global brain drain and compounded nursing shortage that heavily pulls away doctors and nurses to wealthier countries where the pay is many times higher. For these ailments, sometimes it’s only calamine lotion and an asprin that the patients walk away with. More careful, passionate nurses and doctors refer them to get an HIV test, recognizing the possibility that all of these things have a primary cause.

And yet, anti-fungal cream on the blistered, boiled hands of an HIV+ boy is like putting a bandage on a broken arm, and not looking at the deeper problem. Many patients fear to get tested, and have difficulty accepting the possibility, then the reality that they have HIV. The AIDS epidemic is far from limited to the patients of the clinics and hospitals. The very same nurses and doctors are suffering a common fate. Memorial Services are held regularly to honour the life of a staff member who’s passed away.

A wave of sorrow and understanding flooded over me as I realized the gravity of the problem, that it truly leaves no sector, no life untouched. The sea of HIV continues to rise in this part of the world, seemingly with no end in sight…

Revival in Winterton

And yet, exciting things are happening in Winterton. Just last year a number of people gathered together multiple times to pray for revival in the Champagne Valley and Central Drakensberg region that include the small farming town. It is exciting to see how it looks like God is answering these prayers, though in unexpected ways.

A network of Christian people and organizations that are community-minded and Christ-centered are gathering momentum and coming together: My good friend Sofi, who is doing much the same home-based care support work that I am but in a smaller village called AmaSwazi, recently and quite vibrantly became a Christian. The local Matthew 25 orphan feeding project looks as if it is in the process of being revamped and becoming more community-minded. A new holistic and community-minded Christian organization has taken over the helm of a local orphan foster home. A lovely English couple has moved into town to integrate judeo-Christian morals and character-building (learning from the Jesus film and other materials) into local public schools. The Microfinance for Youth project continues under the Jeskes, a lovely American couple, to bring opportunity and entrepreneurship training to orphaned youth and caregivers. Economic opportunities are developing for Zulu artisans to develop their skills and market their high-quality woven and beaded creations. And Youth With A Mission (YWAM) making Winterton a discipleship training and outreach base for Christian youth from all over the world. And even better than all of these individual initiatives is what looks to be their coming together under the common umbrella of Winterton churches called Simunye. And a Friday morning Bible study in which many of us meet together to share our experiences and learn together about God’s word. We are all very eager to see how God continues to work in this community and bring hope, love and opportunity to this area that for so long has had so little.

So, this is a novel in itself. Thank you so much for your support!

God bless! Unkulunkhulu akubusisu!

Betsy

Thembalethu "Our Hope" Overview

Thembalethu, a project supported by the Winterton Methodist Church, is a response to expand local initiatives, caring for the sick and orphaned in the Amangwe Tribal Area (Loskop). Its vision is:

To share God’s love and hope to the communities struck by HIV/AIDS through training, empowerment and linkages to resources, assisting those infected and affected by HIV/AIDS and poverty.

The Situation:

* 40% of adults (officially, likely much higher) in KwaZulu-Natal, South Africa are HIV positive – making it one of the top global hotspots for the AIDS epidemic

*1.2 Million South African children have been orphaned by AIDS (UNICEF, 2005)

*25% of all South African children suffer from stunting due to malnutrition (UNICEF, 2005)

*The Amangwe Tribal Area has active volunteer home based caregivers (HBC), well-poised to advocate and care for the sick and orphaned in their communities, many have been caring for their sick and orphaned neighbours for over five years with very limited outside support or assistance.

The Project:

A group of well-trained HBC volunteers, working at the most grassroots level offer tremendous hope to alleviate the depth of suffering the Amangwe community is currently experiencing. As health promoters for the healthy, advocates for the sick and community caregivers for orphaned children these amazing volunteers can do a lot to bring God’s love and hope to this community.

Training home-based care givers: Training ranges from HIV/AIDS education, motivating people to get tested for HIV, Christian spiritual care, home hospice care, accessing and supporting patients on Anti-Retroviral medicines (ARVs), opportunistic infections, & community support of orphans.

Empowering community advocates: Informing and educating local volunteers in specified processes necessary to access government resources (birth certificates, ID’s, social grants) and assertiveness training to ensure that the needy receive assistance.

Linking communities to resources: Thembalethu works together with government community development staff, local hospital and clinics to better service the sick and orphaned in the Amangwe community. Interested HBC volunteers receive training and micro-loans to support home businesses (sewing, food reselling, etc).

Bringing assistance and hope to the sick and orphaned: HBC Volunteers help the sick access the medical assistance they need, help orphans obtain birth certificates and social grants, and sustain income-generating projects to provide an income source for orphans and vulnerable children.

7 May: New Wheels and Getting Started

7 May 2007

I feel I’ve really gotten started into the Emangweni community over the last week. The most exciting development is of course getting a new bakkie (pick-up truck)! I borrowed Sofi’s a couple of times over the past few weeks, but it’s been SUCH a blessing to not have to worry about the roads I drive on to get to meetings, to visit patients. And of course, having the capacity to transport patients regularly is exciting! The Home-Based Caregivers have been thrilled to see the snazzy new car, and know that it’s dedicated to helping them assist the sick and orphans in their community. It has a door-type canopy that is ideal for getting people in, and transporting lots of people in the back.

I have continued to meet with the various groups of home-based caregivers throughout Amangwe, and they continue to bring up difficult cases that seem to be stuck. In Tatane I went with the HBC to visit a 46 year old HIV+ man who had virtually been abandoned as a child by his mother, and thus has never had a birth certificate or an ID. He was not allowed to do a CD4 test to check his immune system strength because of this, thus ARV treatment (Anti-retroviral drug cocktail is the life-saving life-long treatment for AIDS) remains out of his reach. (This is actually against the law, as it has recently been changed to allow access to free treatment to all needing it, regardless of their documentation status.) I’ll be working with the ARV clinic at Estcourt Hospital on this one, as this is certainly the first case like this of many. Today, in fact, while sitting at the Injisuthi Clinic waiting for a patient to give blood for the CD4 test, I saw how all the HIV+ maternity cases were not allowed to get their CD4 count taken if they didn’t have their ID on them, much less if they didn’t even have one. I know that Sofi has worked out a system through Emmaus Hospital to get these sick patients without ID documents on ARVs anyhow, so I’m confident there’s a way forward.

Later in the week at HBC meetings in Mandabeni, they had called a sick patient, and the grandmother of orphans in to receive assistance. The sick mother lives entirely alone with her teenaged children and has no family to support her and no income. She is suffering from what appears to be a repeat case of TB, as well as being HIV+. I organized to take her in to get a CD4 count taken (again – the blood sample was wasted the first time), and take the TB sputum test. I took her in together with another patient from Mqedandaba needing to start TB treatment, and do the CD4 count. After one false-start at the clinic, and nearly being turned away the second time (because of lack of transport of blood samples to the hospital the first day and, because the VCT counselor was away, and then the blood sample bottles ran out), both patients gave blood for their CD4 counts today. Additionally, Xoli and I did home visits in KwaVala and Ngunjini to a 47 year old bed-ridden stroke-patient, a patient on ARVs (who was having very bad urinary blockages – we called the ambulance and he died the next day in the hospital), and a patient who was unwilling to reveal any health information to the HBC volunteers, but who committed to get tested.

Today I met with the social workers whose office is adjacent to the Injasuthi clinic, and who work under an NGO called (Amangwe) Child Welfare South Africa. I have been aware over the past three years of the tremendous turnover of social workers in Amangwe, and the tremendous backlog that has been created as a result. I spoke with them about these challenges of the past, and current mismanagement that has 60 cases of orphaned families waiting for over five months for the superior to sign off on before they go to court. As a result, these 60 families who are caring for from 1-4 orphans continue to be withheld foster care income to care for the orphaned children. At the social workers’ request, I committed to contact their superiors to follow-up on the gross negligence. Additionally, we made a plan to utilise the HBC and community health workers to assist them in contacting the applicants (from 2003 to the present) in areas that the HBC are working to check that their situation remains the same. The HBC will help contact the applicants in their areas, and I will help transport them to the Social Workers to save time in the process of checking up on their details and status to reopen the untended cases. I’m happy to see there is a potential way out of this big social welfare mess in Amangwe – a way to really help orphans in the area. And maybe a way to encourage the social workers into sticking around longer if their working conditions (ie. Less of a backlog) improve. Time will tell.

Hope for AIDS

“I just went to another funeral on Saturday in eMoyeni. A lot of people are dying out there. A lot of people are dying everywhere here. Come back and let’s fight for them.”
–Xoli Msimanga, Health Advocate and Friend, Amangwe Tribal Area

Hope for AIDS

March 2007

Above is a picture of my friend Ncamsile's grave. She was 21 years old, HIV+, and the mother of Nomvelo (in the blue dress with silly glasses). Her sister Smangele is in the black t-shirt. This family has two generations of orphans with a family plot of nine recent graves. The entire middle generation wiped out by AIDS. Families like this are increasingly common in South Africa.The tragedy and crisis of AIDS in sub-Saharan Africa is nothing new to the most of you. Many of you have been faithfully partnering with me over the past couple of years as I’ve gone in neck-deep in its epicenter, Amangwe Tribal Area, South Africa. Death’s shadow looms ever-present over the Amangwe community, and with it come ever-increasing numbers of victims to the plague – the mothers and fathers, and their orphaned children left in its wake. A Friday doesn’t go by without seeing funeral tents go up in numerous homesteads around the village. At last survey of the South African province of KwaZulu, Natal, 40% of pregnant women (the only ones to get tested in numbers) tested HIV positive.
Yet, the tremendous fighting spirit of the Zulu people isn’t letting AIDS get the best of them.

• A mother who miraculously survived death’s grasp with a non-existent immune system, and after months on AIDS treatment is now not only caring for her own children, but joyfully taking in orphaned neighbors. She also has her own garden from which she delivers fresh homegrown veggies to those in need around her. After her employer helped her access life-saving AIDS treatment, she now plays the same advocate role in the lives of numerous friends and neighbors around her.
  
• Community volunteers who rally their neighbors together to care to the sick and the orphans in the community by bringing them food, helping them access government resources, praying with the sick and holding their hand as they breathe their last.


• Home-based care volunteers who have taken up the cause of neighbors in need: helping a 30 year-old mother, paralyzed for life by tuberculosis in her spine, access a wheelchair and transport to the hospital for life-saving AIDS treatment as well as home physical therapy and spiritual support.

Yet, for each one of these victory stories, I’m confronted by the reality of hundreds and thousands of others that haven’t received help. I just called Xoli, my Zulu friend and co-coordinator with home-based care. “I just went to another funeral on Saturday in eMoyeni. A lot of people are dying out there. A lot of people are dying everywhere here. Come back and let’s fight for them.”

What is needed are volunteers trained to identify HIV before it is too late, to motivate people to get tested and to fight for access to life-saving treatment. This combined with spiritual support is the formula I see to prevent additional children from being orphaned by the disease. A mother or father that survives AIDS means one less family of orphans.

I am excited about this new project because it provides the opportunity to:

Be a Catalyst - The project is first of its kind for a small, rural church filled with white farmers hoping to use their resources to bring hope and healing to their black Zulu neighbors. The dynamics of a very separate South Africa (the old system of apartheid is the Afrikaans word for separateness, after all) means that approximately 90% of whites have never been to a black home, much less spent any time in a black community. After over two and a half years of working in the community, I can help to link them up to the network of volunteers.

Save Lives and Care for Orphans - During my last couple of months in South Africa, I was impressed by the huge community clout held by some of the prominent HBC volunteers. With very few resources, they are already looking out for orphans and the sick. With additional knowledge, skills and resources, they can more effectively help to correct the myths of AIDS, help with prevention efforts, care for the sick, and get sick mothers and fathers onto life-saving treatment. Also, find income-generating ways of supporting orphaned children.

Build on Momentum - This is a great chance to continue the momentum that developed amongst the Amangwe home-based care volunteers after the 10-day HBC course we organized back in November. These amazing women now have a good grasp of their role as advocates for the sick, trainers of family caregivers, HIV/AIDS and its treatment, tuberculosis and other HIV related opportunistic infections, as well as linkages to resources for orphans and vulnerable children. When I left, they were asking for training and resources to counsel and motivate the sick to get tested for HIV; stigma and denial being the paramount obstacles encountered in identifying the real cause of sickness.

Support the Local Church - Sensing God's call to "Defend the cause of the weak and fatherless; maintain the rights of the poor and oppressed" (Psalm 82:3, NKJV), I will be helping the Winterton church find a way to sustainably demonstrate God's love and care to their neighbors. Additionally, I will continue my involvement in a new bilingual (English-Zulu) church plant, hopefully starting a Bible study with my Zulu neighbors who I transported to church every Sunday evening over my last two months in South Africa.

How can you partner in this work?

Xoli and I will continue to train and support the HBC volunteers caring for the sick and orphans.While the project funds will be covered through the Winterton, South Africa church, I still have about $340 per month to raise to cover my salary. Many thanks to all of you who make this work possible!

Donate Online: online giving is the quickest and most direct way to donate. Go to University Presbyterian Church website and click on the online giving after you create an account, make sure that you specify “Missions-Global” and “Elfers-South Africa” in the fund and sub-fund choices.

Prayer Support: If you are interested in being a regular prayer supporter, please let me know so I can add you my list for specific prayer updates. I have seen the amazing power of prayer in my life over the past two years and am so grateful for the covering God provides through your faithfulness.

Bless you,

Betsy