28-5-12

MUCPP Township

Summary

I attended the MUCPP and surround township today to observe and help educate the poorest of the poor in South Africa.  We went to people’s homes and filled out a nutritional survey on the household.  We assessed as a group (the lecturer, translator, South African student, and myself) on the plan of action and what was important to educate the person/family on.  All families were taught about how to prepare and provide healthier meals with the income they had.  To others we explained specifically what was going on in their bodies if they had diabetes, hypertension, TB, etc.  If necessary we referred people to different areas/doctors of the MUCPP Clinic for further treatment and assessments.

Detailed Account

We were warmly welcomed to the University of the Free State’s campus yesterday and moved into our dorms.  Kalie and I are roommates, while Brittany and Aubrey are living together.  We eagerly looked over our schedules to obtain information about what and when we would be doing different activities.  As we scanned over them, questions arose left and right, we were still quite confused about what lay ahead.  I tried to stay optimistic and decided to trust the system.  No matter what I would make the best of each situation and if I really didn’t like what we did, I knew it would change within a week.

That evening we were taken to a lovely dinner with the other 4^th year nutrition majors (the students we would be working with), some of the nutrition lecturers, and a few of the international affair staff and students.  During this time we asked lots of questions and got clarification for a great amount of our burning questions.  After dinner I was more than excited about attending Mangaung University Community Partner Program (MUCPP) the following day, as well as each of the different weeks of the internship.  This excitement continued throughout the evening resulting in a restless sleep, although I was still able to jump out of bed.

Let the internship begin!  The nutrition student I would be working with this week met me at Emily Hobhouse, my hostel (dorm), quarter till 8.  We walked to the nutrition department where we were picked up in a vibrant red VW van decorated with kids, healthy snacks, and the phrase “Good choices for better health!  Kgetha hantle, o phele hantle!”  I am surprised at how welcome I have felt in my short time in Bloem.  I entered the van and met the lecturer who addressed me by name before having to introduce myself.  Without hesitation we were on our way to the MUCPP Clinic and surrounding Chris Hani township.  During the thirty or so minute drive we caught up about ourselves and they answered all the questions I could think of, while explaining a little of what I should expect.

The van/our classroom and our wonderful security guard!

When we arrived to the clinic we said hello to the dietitians insides and had a mini lecture in the car describing what we would be doing today.  We then drove to pick up our translator (also a dietitian) and security guard before today’s location in the township.  The knowledge I learned today was so vast in so many ways.  I learned about the development of townships, the traditions of blacks and coloreds, the health and nutrition of people living in townships, the list goes on and on.

The townships are owned by the government and part of a Reconstruction and Development Program.  Most townships arise from a large amount of people squatting in a certain area.  They build shacks from tin and what little resources they can find in large open fields surrounded by great amounts of trash (in respects to what I have seen in Bloem).  When enough people live in these extremely poor and primitive locations the government comes and builds concrete houses, roughly 6-7 square meters) and gives them to the residents, which can range from 2 people to 15 people.  At this time the residents are supposed to tear down there primitive tin houses (Makuko), that usually are in their backyards, although many keep them and rent them for income.  Electricity is then installed in these houses followed by a sewage system.  The majority of the time bathrooms and sinks are located outside of the house unless one is wealthy enough to pay for it inside the house.

The household income is mainly received in two forms; from people working and from government grants.  If a person is a registered citizen some of them may be eligible to receive grants for income, but unfortunately many of these people don’t even have birth certificates or can’t be bothered with getting registered.  If the income is lower than a certain amount people can support themselves with grants.  For every child a mother has, and registers, they are able to get a 250 rand grant per month (roughly $33 USD) until the child is 14 years old.  If a female resident is above the age of 60 or a male resident is above the age of 63 they can receive an old age grant of 1000 rand (~$133 USD) per month.  If someone is unable to work because of disability they may also receive 1000 rand per month.  Lastly, many of the population between 25 and 40 have passed away due to aids, this leaves the grandparents to take care of a great deal of grandchildren.  If a resident is taking care of foster children they can receive 650 rand (~$87 USD) per month for each child.

With lots of new information and a bit of culture shock coming my direction we began our job for today.  We walked through the township looking for open doors or children playing.  When we located a house with someone inside our translator would enter and ask if we could come talk with them about nutrition, etc.  Every time we were welcomed into their homes or outside if they preferred.  Most people spoke Southern Sotho which  the translator would mostly dictate the conversation.  Others spoke Afrikaans where the lecturer and student would jump in.  One well educated lady also spoke English where I was able to help conduct the survey.

When we arrived at each home we completed a MUCPP (Nutrition) Community Survey.  Most of the time the women were at home doing laundry and chores while looking after the children that were under five.  It was good when no one was home, indicating that everyone was at work or in school and therefore caring for themselves.  We would begin by writing the name, sex, and age of each member of the household.  I was told that many households were confusing and nearly impossible to understand.  Lots were composed of a family with their children, along with grandchildren, sometimes a person you didn’t know how they fit in with their children, etc. the possibilities could be endless.

Doing a Nutritional Survey 

If people were present we would take their height and weight to determine their BMI and refer them to the MUCPP Clinic if necessary.  If children under 5 were present we would also weigh them and plot it on their growth chart.  For each child a parent is given a growth chart.  They take the chart with them to the clinic for check ups, where their child’s health is plotted as well as any notes the nurses & doctors have, and their immunization records.  All of the services at the clinics are free of charge so it is imperative that the children are taken there to check their nourishment.  All of the children we encountered today were not needed to be referred to the clinic for supplements but all fell between the 30^th  and 50^th percentile for their age category.  If a child was noted to be malnourished or abused the children would be referred for supplements and possible the caretakers to social services or the police would be called.

Following the head of the household was established as well as who and how many people provided money for the household (including employment and grants).  Access to fresh water was noted as well as the presence of a vegetable garden.  We tried to promote having their own gardens as a means of constant food and to lower expenses of healthy vegetables.  If they were interested in making a garden we provided them with spinach, beetroot, carrots, and cabbage seeds, as well as a pamphlet on how to have a garden.  Questions regarding going to the clinic for children and for sickness were asked.  If people didn’t go to the clinics we asked why and helped to explain how important it was for them to attend to remain healthy.

We then asked if anyone in the household had any of the following conditions; diabetes, heart disease, hypertension, peptic ulcer, loss of appetite, TB, overweight/obesity, diarrhea, constipation, weight loss, HIV/Aids, other.  To my surprise people were extremely open about their health conditions and most were thankful to have the clinic to obtain regular assessments of their health.  The most common conditions we encountered was diabetes, which they understood as high sugar levels, and hypertension, which they called high blood.  Many of the people who had been diagnosed with these conditions were unaware of what exactly they were doing to their bodies so we used pictures and simplified versions to explain why their body sometimes felt the way it did and gave ways for them to improve their health, while still acknowledging their limited resources and funds.  We gave everyone pamphlets on the three main food groups and how to prepare and eat healthy meals as well as pamphlets for certain diseases that were encountered within each household.

The other diseases we were aware of was the amount of people affected with TB and HIV/Aids.  I noticed more people with TB, and most being children.  If someone had TB they were required to take a supplement daily to help with their immune system, although I am unsure if they knew why it was so important that they do it even if it tastes bad.  If one person in the family had TB all children under 5 were tested and put of medication to protect them and be proactive.  People with HIV were also recommended to attend the clinic and receive supplements and treatments, especially when their CD4 count was lower than 200.  Although in each case the personal situation had to be assessed to determine what was necessary.

A question about family planning was always addressed.  It was common that most of the higher educated women understood how important family planning was and they were also the ones with one or two children.  Although most women took advantage of injections (1 every 3 months) some did not and many less educated women had multiple children, many of which they could not care for.  If injections caused unbearable side effects birth control tablets were administered, but rarely due to cost.  Lastly sterilization would become a possibility but almost never happened due to fertility being highly regarded to the African men.

This brought up a great deal of information about traditions in the black culture regarding wives.  Almost all black and colored men still, in some way, pay for their wives before they are allowed to marry.  Men will make an offering to a woman’s family, weather it be cattle or money, etc. in hopes of marrying.  Most of the time the man will make sure the woman is fertile by impregnating her before marrying her, and many times will not marry her at all.  In many instances it will take a man a long amount of time to come up with the sum to pay the family and by that point he will already have multiple children with his future wife, therefore supporting a family and paying for his wife.  This makes many men believe that they own their wives and therefore can have many children with them and highly regards fertility.  Surprisingly the more education a person receives nothing changes with this system except the woman is worth more money to the family.  I found this extremely interesting and surprising in more than one way.

Lastly the family was asked to do a brief recall of the foods the ate for breakfast, lunch, and dinner.  Most of their meals were pup (high in salt and porridge/grits like), milk, chicken (if they could afford it), and a vegetable, but usually only one or two of these at any given meal.  Obviously they were not able to get a well rounded diet eating only these foods so we suggested how to make their meals healthier with foods they could afford.  It was also very interesting to note that families with little money, little education, and many children would often be undernourished yet the parents still acknowledged they spent money on alcohol.  I observed that many mothers were slightly over nourished, children all somewhat under nourished, and men mostly under nourished and relied on alcohol.  It was a culture shock to see where their priorities were and we did our best to convey to them the importance of a healthy diet without being offensive.

If people were in need we would refer them to the clinic on all sorts of accounts.  If their teeth or eyes were bad they were referred to the dentist or optomologist.  This extended to people who needed psychological counselings, dietitians, AIDS treatments, social workers, doctors appointments, etc.

One of the most shocking families we visited was smaller, being just a couple and their one 4 year old child.  Surprisingly the 4 year old was the only one who put money on the table each month.  The mother did not work but kept the house clean.  The father almost lost his hand from a cut and had an operation.  He was on disability but was removed from it so now the family is surviving off 250 rand (~$33 USD) per month.  The child was just above the 30^th percentile on his growth chart, the mother slightly overweight, and the father average.  When we addressed what they ate they told us they would eat foods from eggs, to vegetables, to biscuits, to chicken, etc. when they could afford it but nothing was guaranteed each month or day except for alcohol.  It was heartbreaking to see the sweet, well-behaved 4 year old, whose eyes lit up when we gave him a balloon and then realize that his parents don’t understand the importance of his or their own health.

It was nice to know that when we were helping families and telling them how to improve their quality of life they seemed to be so grateful for us.  The children were sometimes a bit startled by us but it could be due to the fact that they might have never seen a person with white colored skin before.  The majority of the people were extremely receptive and seemed to really take their new knowledge seriously.

Although it was a big culture shock and an experience I will never forget I feel like this is a step in the right direction for South Africa.  There are not nearly enough people doing what these nutritionist are doing, it is a start.  We were mearly a drop in the oceans of townships but we educated and helped the best we could.  After today I believe a great majority relys on the education these people receive in order to change their lives and the lives of the next generation.  If we can teach one person in the family and if they can share what they learned with the others, etc. we can begin to improve the system.

Some township homes