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Six months in magnificent Manguzi
Manguzi is translated as ‘Mango place’ – and rightly so. Glossy leaved, wide-trunked, gnarled rooted trees heavily laden with fruit standing tall and proud are the ubiquitous scene in this lively, hustle bustle of a border town. A stone’s throw from Mozambique and the Indian Ocean, the town built on the foundations of sand... It is dirty, noisy, colourful, friendly, and it’s been the happiest of homes.
So, drive into the town, past the library, the gym (yes really!) and the cash and carry; dodge the cows, chickens, children, potholes, wave to the throngs of market sellers lining every inch of space along the roadside; turn left at the only left, past ‘kinky in my hair’ salon, through the guarded gates, and dropped off with nothing but backpacks and nervous grins at ‘OPD’, Manguzi Hospital.
My partner Tom and I had been planning a year overseas for several years – for me, an A&E nurse, it was easy – say the word and I am off. For Tom now tangibly close to completing his specialist training in emergency medicine – it took a huge amount of patience and persuasion to convince the deanery he could go and still have a job on our return. Odd perhaps, that the ‘brain drain’ in reverse attracts far more attention than the ethics of coaxing overseas doctors to the UK to cover shifts for the NHS.
For our year out we had given our word to complete six months of voluntary work in Northern India – and following this AHP could accommodate us both for six months and give us the rural South African medical experience we so wanted – sold.
And this experience did not disappoint. As an A&E trainee with anaesthetics and surgical experience – that pretty much became Tom’s role – oh and throw in obstetrician, psychiatrist, general physician, paediatrician and occasional medical manager. A close-knit group of colleagues, now a close group of friends supported one another through the exciting, complicated, sometimes funny, often desperately sad, daily challenges. Once he could see through the HIV/Aids fog that initially clouds all confidence and confuses all diagnoses – he began to thrive on this incredible experience and for the first time in a long time it was wonderful to see him loving his career once again...
My Manguzi experience was somewhat different to the one I had planned. I found the hospital overrun with nurses – and although it appeared that there was plenty I could have been involved with, education wise as least, my presence as a potential staff member was met with resistance, suspicion even, from the nursing management.
Perhaps I should have stamped my feet more and persisted with my quest for hospital work – but without a need for help being perceived, I think it would have been very difficult to contribute positively during the relatively short time we lived in Manguzi.
Fortuitously for me, a local NGO operating just outside the hospital gates was willing to take me on – and for the next six months, became my world.
‘Tholulwazi Uzivikele’ (TU) translated ‘empower yourself through knowledge’ was founded in 2002 by concerned staff members at Manguzi Hospital wanting to mitigate the effect of the HIV/Aids epidemic on the surrounding community. The organisation started with an emphasis on orphans and vulnerable children and home-based care, but has subsequently expanded to include programmes for poverty relief, HIV/Aids and TB prevention, and access to medical care and social services. With unemployment rates of 70%, a heavy reliance on subsistence farming and stubbornly high rates of HIV/Aids and TB in the community, to name a few key challenges, TU is critical for the livelihood of the poorest people of Manguzi.
With an adult nursing background, I resisted the temptation to pretend I would be useful in the orphan-care field, and instead took on the challenge of community health. In a nut shell, the community health programme relies on a large group of community volunteers who walk huge distances each day between homesteads to visit vulnerable people at home. The volunteers are an altruistic group of mainly women (with the exception of two men!) who are relied on as the eyes and ears of the organisation. As well as receiving referrals from the hospital, the mainstay of referrals come from these volunteers who living in the community, often remotely, identify vulnerable people to TU. Vulnerable generally implies people too poor, old or sick to access any services or to obtain welfare support.
With a huge community to serve, and a group of worn out volunteers, the programme was limping a bit and my role was to try to help facilitate its recovery. A couple of months of observing the volunteers’ training, monitoring and evaluation sessions, and bumping (some might say jumping) around the sand dunes in my little clapped out Suzuki jeep (much to the hilarity of all) to accompany volunteers on their home visits, gave me a very privileged insight into the amazing work being done in often tragic circumstances.
Sometimes a fresh set of eyes and a few new ideas can account for a lot and alongside the programme co-ordinator I was able to change the approach to teaching, monitoring and evaluating the work of the volunteers. A few nursing skills, a better understanding for the volunteers of the essential role they play in the running of the organisation, the lobbying for and then provision of some basic home-based care supplies (as well as new uniforms!) led to an empowered, motivated bunch of volunteers. We trained several health facilitators from nursing backgrounds to oversee, support and encourage the volunteers in their role and we endeavoured to improve the link between this programme and the hospital services. I greatly hope this continues having a positive impact on the level of care being provided and the security of donor funds to enable this absolutely essential community work to continue.
I loved working for TU and hope upon hope that my tiny contribution has in some way made a sustainable impact on the community health programme – time will tell.
For Tom and me working in rural South Africa has without doubt been a life changing experience. Recognising my shortcomings in working for an NGO I have now commenced a masters in International Public Health and Tom keen to update his knowledge further is returning to Cape Town later this year for an emergency medicine conference. What struck me most throughout my time in South Africa, but particularly since coming home (mid-UK riots), was the warmth, dignity and humour of the everyday people we encountered. We are acutely aware that despite any contributions we made, we are at the end of the day the ones that have benefited the most from our time overseas and we want to make sure we are even better prepared for next time.....
If you are interested in learning more about the work of Tholulwazi Uzivikele, visit their website: www.tuproject.org
