Pedro Nadine Meyer – South Africa

Date: October 7, 2015
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A leader who seeks the best for those she serves

At the onset of this story, my view and experience as a leader of change was very limited but this made me realise that if I want to make a difference in the community, I had to change my views and be vigilant about change in the community.

When I started working as Community Based Coordinator in 2003, while working in the Hessequa area, I met a young 20 year old lady who was infected with the HI virus. This was a very new topic for me in those days and even though she was not my first HIV positive client, she was the first one in my new job. She was staying with a much older man and ran away from home due to very bad circumstances at home. I visited her because she defaulted on her TB treatment and I had to go and look for her because she had not started her ART treatment yet. In those days ART was only available in Mossel Bay and that was about 90 kilometres from Riversdale. After a long chat she promised me that she would go to the clinic and I did not see her again for a while. The mistake that I made was not following up to see if she did go to the clinic. A few months after the first meeting, I received a referral from the clinic for help with caring for a bedridden client. When we got to the house, it was the same young lady who was now bedridden, not on ARTs yet and very sick. The older boyfriend abandoned her when she became sicker and now she was back in the bad circumstances from which she ran away in the first place.

She was staying in a shack which she shared with her mother and other siblings. The window in the room in which she was sleeping was an opening covered with a plastic bag. She could not stay in a place like this and we arranged with an aunt of hers to take her in. The one wish that she had was to get to her 21st birthday. She became my special patient and between me and the care workers we prayed that she would reach 21. When that special day arrived we had a big party and even though she could not enjoy the cake with the family, her smiles said it all. A week after her birthday she passed on.

This for me was the beginning of my passion to make sure that every HIV positive client has access to treatment and also to make sure that young people have the knowledge they need to stay negative. Promoting a healthy lifestyle and disease prevention are part of my duties for the department, especially changing mind-sets regarding health in the community. Working with most of the organisations in town, I am able to have an impact. I focus on access to basic municipal services (water (houses on tap), electricity (indigent households) and access to basic medical treatment (clinics, hospital, home based care, ART clinics and mobile clinics). I can identify the problem or need area and ensure that staff and organisations work in those areas. As I assist organisations with global funding and governmental funding proposals, I can ensure that the different organisations focus on HIV and AIDS prevention, treatment and care. I focus on the education of peer educators to promote peer learning and uplifting women in abused or unhealthy situations by promoting entrepreneurship in the NGO system. I also focus on referral and assistance with identity documents, SASSA and other Departments. My brainchild, the first intermediate care facility in Mossel Bay, @Peace Care Centre, was realised in 2010 where terminally ill clients have the privileged to be cared for in a respectful and dignified manner.

To be a nurse was not part of my vision when I was at school. I became a nurse by default but I believe that everything happens for a reason. I started my nursing training on 1 July 1981 at Groote Schuur Hospital. I always see myself as someone who would rather work in community or in psychiatric nursing. After doing general nursing I did midwifery at Peninsula Maternity hospital. I then worked for five years at Groote Schuur Hospital before doing my psychiatric nursing diploma in 1990 at Lentegeur Psychiatric Hospital. As a child I went through a difficult time and this had an impact on my emotional development as a young adult. During my training as a psychiatric nurse, this matter was addressed and my self-confidence was significantly lifted. I then work as a psychiatric nurse at Lentegeur Hospital until 2002 with a three year break in between (1996 – 1999). In 2002 we moved from Cape Town to Mossel Bay and I was appointed as CBS Coordinator for the Department of Health in 2003 in Hessequa sub-district. In 2007 I accepted the same position in Mossel Bay.

When I started in Mossel Bay it was difficult to ensure unity of organisations or even establish sustainable community structures in the area. Each NPO had their own views and projects and there was often duplication of projects or services in similar areas. The relationship between NPO’s and the municipality was also very problematic and this had a negative influence on service delivery. In 2010 we started with the Multi Sectorial Action Team (MSAT) together with the Municipality and HIV and AIDS linked NPO’s to address HIV and AIDS related problems and projects in Mossel Bay. At this structure we decided on which NPO would concentrate on which area and what projects they would focus on. In 2011 the Mossel Bay Local AIDS Council was establish and the MSAT was then under the umbrella of this newly formed structure. This MLAC structure was established with the help and input from SALGA. The light bulb moment about the importance of gender work was at the first meeting that I attended with Gender Links on the 26 May 2011. Before the workshop I had not realised that what I tried to do in my duties was part of addressing the gender inequality in our community but also that I needed to be more vigilant in future efforts to make a greater impact.

To be a driver on change in the community focusing on cohesion between civil society and departments is part of my personal mission. Another focus is also to have combined sustainable programmes which have a direct and/or indirect impact on gender mainstreaming in Mossel Bay with a specific focus on HIV and AIDS and TB and general health. We need to provide projects to address the unemployment in the HIV and AIDS and TB fields, concentrating on capacitating women during income generating projects. By doing this, these women will be able to generate income by themselves at the end of the project. This will help not only to reduce abuse of the women (emotionally and physically), but also help when people are dependent on social grants.

As CBS coordinator, my main duty is to present to the department in the Mossel Bay sub-district and work closely with the civil societies and NPO’s. The department makes use of NPO’s to roll out certain services in the community e.g. home based care, intermediate care, and other projects in the community. We started off by advertising for the NPO’s to send in proposals for these projects. I had to identify NPO’s in the sub-district who can be capacitated according to the department’s criteria to apply for these projects. We arrange training via departmental organisations for the NPO’s to attend these trainings. Part of my duties is also to ensure that community structures are in place where health and social ills and solutions for these ills can be discussed and projects planned.

We as the department know what the burden of disease in the sub-district is and it is important that projects are being spread equally to prevent duplication of services and/or one area over-covered and another have nothing. For this reason it is important that we have a combined meeting with the different NPO’s before the proposals are due to discuss the sub-district’s needs and advise them as to which area they should concentrate on. This will make sure that everyone is not applying for the same area and same project.

Health promotion and disease prevention are also part of my portfolio. To do this effectively I need the support of other stakeholders in the community e.g. municipality, civil societies, faith based organizations, etc. This is, according to me, my most important duty because if we can change the communities’ outlook on how to live a healthy lifestyle, we have won the battle against many of the social ills.

In 2010 the HIV prevalence in Mossel Bay was 21% and we were in need of an intermediate care facility. Our department made the funds available and I then had to look for an NPO to provide this service. Today, nearly five years later we have a well-established 12 bed Intermediate Care Facility with a bed occupancy rate of 90% for 2014. Our HIV prevalence decreased to 12% in three years and even though it increased again, it is still well below what it was.

As the leading Department on HIV and AIDS, we advise the Local Aids Council in terms of problems or hot spot areas and make sure that HIV and AIDS is a priority on the IDP of the Local Municipality. I also supervise the home based care project in the sub-district and give support to the appropriate NPO’s. We have 71 CCW’s in the community, one school health CCW and 10 TB enhance CCW’s who support the TB rooms in the facilities.

Resource mobilisation for work on gender equality:
Community Based Service
– ACVV Kenani (HBC)
– ACVV Kenani (School Health CCW)
R1 185 400.00
R 48 000.00

CHBC programme –
school health support
– Hartenbos Care Centre (HBC) R1 317 000.00 CHBC programme
– @Peace Intermediate Care Centre R1 695 600.00
Intermediate Care
– Piet Julies Aids Action Group
– Income Generation
– Food Security

R 67 000.00
R 67 000.00
R 67 000.00
– APD – Life Skills R 67 000.00
TOTAL R4 514 000.00

I think the biggest challenge lies within the department itself. Being the implementer on the ground, the challenge is to ensure that the decision making authorities are on the same level. To establish gender change within the institution, I need to rely on the top management structure to secure budget and buy-in. In government the focus is more about the set targets being reached and in the process the focus is not gender-orientated.

The much needed outcome is sometimes compromised because HIV and AIDS is still a stigma in certain communities. The traditions in certain cultures also have an impact on the positive outcomes of gender equality e.g. the lobola tradition where the husband feels that he has bought his wife and therefore has certain privileges and that the wife does not have a choice but to accept his way of doing things.

Another challenge is that not all the NPO’s are on a par within the sub-district and need guidance and support to be well-equipped organisations. Not all of them are always willing to accept help because of various reasons and when they apply for projects and do not qualify, they are often unhappy about the outcome.

Legislation also raises challenges in terms of culture and traditions when it comes to sex without consent. The Constitution gives rights that are not in line with the criminal law of South Africa, resulting in people not disclosing rape due to these circumstances.

Although we promote sexual reproductive health, we also struggle to get the necessary access to the schools and that results in a high number of teenage pregnancies. We address this problem by parking a mobile bus on a field in front of different schools to make services more accessible for learners. Learners are not always keen to attend health facilities because of stigma and other issues.

I grew up in a poor and underprivileged community where most of the girls became pregnant while at school. Pregnancy and STI’s like gonorrhoea and syphilis were the thing that we had to worry about. These were the social ills that I had to live with as a child. I set goals for myself and that is how I did not fall prey to the social ills of those days. Today the youth have many more issues to deal with than just teenage pregnancies. There are teenage pregnancies together with drugs and STI’s but now these also include HIV infection. Research shows that women are more prone to be infected than men because of women’s anatomy.

I was trying to change the negative ills to positive possibilities even when I was a young school girl. Our friends set goals for ourselves that we would not fall pregnant while in school…. Due to my experience and how I survived in a negative environment, I am able to address the youth with empathy and put projects and support in place so that others can also experience the positive in a negative situation.

When I became involved with Gender Links, I had already tried to use my experience as a child to influence youth positively. Gender Links just taught me that change is possible in the community in a broader way. To build relationships, strengthen relations that result in people being empowered and standing up for what they believe in and by doing so achieve their goals.

Ms. Rita Kayster, Programme Manager, Piet Julies Aids Action Group.

The changes in the relationship between government, municipality and civil society in Mossel Bay has brought a positive outlook which leads to community cohesion. Where before we struggled to have sustainable community structures in the sub-district, we now have had a functional structure for the past five years. The municipality has also funded certain small projects in the community via civil society to address issues in the community.

Using my own experience as a child and the challenge of being a mom with teenagers, I was able to start a system at the department whereby the focus is broader. This includes focussing on fertility planning, STI’s and HIV or TB but concentrating on a personal value system, marriage, God’s will and why sex was created in the first place.

I feel that my way of thinking is rubbing off on my co-workers and it has started with small changes.

Working together with Alma at the municipality teaches me about the different ways the municipality can assist. We now have a team who work hand in hand with the municipality, trained ward committee members to assist as peer educators and the result is that the municipality and DOH are working together with the result that the Department of Health has started to focus holistically on an individual and not only on statistics.

Alma Kritzinger, HIV and AIDS, Mossel Bay Municipality, Gender and Disability Coordinator

Education is one of the most important components of all human beings. This education can be either formal or informal, in-service or life skills but without stimulating the brain in any way, the individual will stagnate and growth will not take place. In my field, I had motivated for a few CCW’s working for us to go and do formal training and one is already a registered nurse. One is an enrolled nurse busy with her training as a registered nurse and three are busy with enrolled nursing assistant training. For the past ten years several of our CCW’s who we had trained were employed in the open market at Life Bayview Private Hospital, old age homes and private agencies.

I am also involved with NPO’s in the field of HIV and AIDS and TB as an ex-officio member and I am involved in the training of community members. I also advocate for life skills projects with a disabled (mental and physical) group to ensure that they have opportunities like able-bodied persons have. The community easily forget that the disabled members of our community may be able to have employment, either self-employed or in the job market. Equipping them with skills for the open market can bring a change in the life of a disabled person.

Mrs. Johanna Joshua, Centre Manager of Benevolent Park OAH and chairperson of the local Older Person Forum and board member of Western Cape Older Person Forum.

A policy is a guideline to show the direction in order to get to the end result. When a new direction is given to get to the end result, we need to link the new procedure in the policy to take out any red tape in executing the direction.

When looking at the gender and HIV and AIDS and TB policies, it was necessary to make provision in politics to accommodate access to basic services as indicated on the gender score card and to make provision for implementation but also for monitoring and evaluation within the process.

Taking in account that the old policies were tabled before the gender desk was established, we had to ensure that all structures and systems put in place are captured in the policies to ensure a mandate to execute. The attached policies show the changes made to the policies marked in red.

Above is the result of cohesion between Municipality and DOH. The Municipal policies have changed to assist us as they focus on internal and external needs. However, practices have changed as explained above.

We now look through a gender lens at our clients, programmes, projects and the situations within the hospital and the community. We become more gender sensitive and realise the importance of education within the community.

As a representative of the department of health, my portfolio is to ensure that the NPO’s in the community have the capacity to render an effective service to the department when or if they apply for projects. The department, in conjunction with NACOSA, rolled out training for the NPO’s on proposal writing; reporting; monitoring and evaluation; project management and financial practice.

I received the following training during my work experience at the Department of Health and that capacitated me to be a better leader and gave me the ability to capacitate civil society. I was trained in people and project management as well as financial management and HIV and AIDS management for professional nurses. I also received presentation skills training.

During this year I did PACK training with all the CCW’s as well as sexual reproductive training.

Marceline Lukas, Administrative support at Piet Julies Aids Action Group.

I think the main challenge that I faced is that every organisation has its own dynamics and I just have to deal with them accordingly. As a representative of a government department, I must take into consideration that the NPO’s are organisations with their own rules and regulations. We need to be their partners and not think that we are the boss and they are the workers.

The relationship between municipality and civil society was very negative and this had a negative influence on the community. When a sustainable structure was formed and the social ills could at last be addressed, it gave way for change to happen.

The CCW’s working in the community come from different backgrounds and cultures and therefore they will address certain issue differently from others e.g. our black female CCW’s find it a challenge to talk to males about circumcision because in their culture the woman is not supposed to talk about this at all. We just rearrange our CCW’s and make sure that our coloured CCW’s are responsible for this.

Some of the NPO’s thought that I favoured others and they thought that I decided who would get projects and who not. After a meeting with all NPO’s to discuss how it worked and also making a special effort to help those who were struggling, they accepted that I had the community’s best interest at heart.

The Municipality is starting an external Gender Mainstreaming Forum as well as the Council of Stakeholders Forum, the LED Forum and Thusong Mobile Forum of which we form part. Training more and more community members as volunteers, we can increase the voices calling for gender equality in Mossel Bay.

I also plan to start an internal awareness programme with an action plan focussed on gender, a women’s network whereby internal staff can raise their challenges and their needs and be empowered. By working in the field with the community, I am always willing to serve, and by doing so I not only address ills in the community but end up filling our own cup.

I would also like to start a programme targeting teenagers, encouraging them to have a celibate lifestyle till marriage, bringing in the church leaders to bring back the basic norms and values in the community to ensure an HIV and AIDS free generation.



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