13 - 19 April 1984 - openSALDRU

Cape Town

AND DEVELOPMENT IN SOUTHERN AFRICA

~al health care - the tears am joy

by

M Ranphcle and R Rarralepe

carnegie Conference Paper No.204

13 - 19 April 1984

ISBN 0 7992 0651 5 ^{I '} ~

This paper sketches sore of the experiences of the authors CNer a period of seven years 1978 - 1984 as Ccmnunity Health 100rkers in the rural district of Tzaneen in the N.E. Transvaal; i t makes no pretence at a scientific presentation, but rather explores sore of the relationships, conditions and attitudes of a rural poverty striCken oommunity.

BASIC BACKGRXlND INroRMATIOO

1 • POPULATIOO ESTIMATEs

The 'Ccmnunity served consists of a mixture of Tsongas arrl North Sotho speaking people who have been living in this area for decades with int.ennarriage between the 0.0 Tribal groups on a very large scale.

The artificial divisions along "pure tribal lines" is a nightmare even for an enthusiastic South African H:::rnelaOO Government system.

The people live in settlements, largely new ones, created over the last 10 years, which consist of clusters of villages stretching eastwards fran T.zaneen along the Lydenburg road ta.Iards the Olifants River constituting the Magisterial districts of Naphuno (under Le!Jn,.-:l Governrrent) and Ritavi (Unckr Gazankulu Goverrunent). The fX.lpulutL:

estimates based on U1e 1980 census are 79,000 for each of these twr~

districts, which is a gross w1der estimation of actual population number which is closest to 100,000 in each instance.

2. SOCIG-EXXJN:t.HC CC1.'IDITIOOS (i) HOUSING AND lAND AVAILABILITY

The people live on plots of 30 x 30 m allocated to them by the varioos Chiefs in charae and the ~ize of these plots allows for the building of a house, a toilet and leaves space for a sizeable vegetable garder~.

The type of hOUSing varies fran shacks, neat rondavels to well built houses depending on the rneuns of each family.

2/'ItJere are ... .

There are 2 townships within this area with typical four-rocrood houses which people ilTq:>rove according to their financial neans.

The hardest hit people are the f.X'OpJe who have recently rroved off white-<lWl1ed farms to settle in these rural villages who are rrostly destitute and have the worst form of housing as a result.

(11) SOIOOLS

Information provided by the local Education Circuit Offices indicates - that there are a~together 125 schools in the area:-

Post Primary Primary

Technical School 29 95

The Post Primary schools include 2 teacher training oolleges.

There isn't a single operative Pre-School in the area - there are about 5 creches which are largely camumity initiated and run.

'!he teacher pupil ratio is on the average 1 : 5 with extremes going up to 1 I 100. This has to be seen in the light of another serious disability -unqualified teachers; 80% of teachers here have only J .C. and 2 years teacher training.

Matriculants with 2 or 3 years training are rrostly teaching at Post Primary schools and in sane cases up to Matric level. Graduates are hard to <XJIe by and !lOSt high schools have only 1 or 2 such teachers.

(iii) EMPLOYMENl' OPJ?ORruNITIES

These are limited on the whole, rut the situation is now reaching crisis proportions with the current dra.!ght and the econanic recession.

'!he I'IllIliler of registered work seekers (men) stands at 1000/mth at the local Magistrate Offioe withno prospect of finding -..ork.

~t people here -..ork as labourers in the Local Tzaneen town in the ocmrerical, industrial (rudimentary) and farming sectors with wages ranging fran R2a - RSO (farms) I R100 - R300 (camercial & industrial including transporation) and higher incc:mas for the small section of civil servants in the professional categories viz, nurses, clerks, poliOEllOOll, teachers and even soldiers.

3/Seasonal •••••••••••

3.

Seasonal fann labour is a category worthy of special Irentioo because of its prevalenCe and effects on the family life of people in the area.

'nle bulk of seasonal fann labourers are waren who are transported early in the IlOming on open trucks or trailors pulled by tractors fran as early as 4 a.m. and are brought back in the evenings up to 7 p.m.

depending on the distance fran the particular farm. Wages are the lowest in the area fran R28 - RSO, there are ro obligations on the part of farmers to provide rations, sick benefits, sick leave, accident cover or any service normally taken for granted in civilised IOOrking relations. Accidents are very oc:moon to and fran the fanns because of poor =nditions of the trucks or tractors, long IOOrking hours of the drivers concerned and the overloading \oIhich is a rule rather than the exception. The traffic authorities tum a blind eye to these road hazards even when people are maimed or killed there I S no redress to the families who 1OQU1d not know anything about third party claims and the like.

The people suffer all this in silence and the conditions are getting IOOrse with the present drought ~ing even this form of enployrrent difficult to care by.

'!here is a new phenarenon of enploying waren in formerly hard labour categories reserved specially for rren viz diggers on the road, darn building, building IOOrk etc. 'nlese waren suffer irnrense physical strains especially given their nutritional status, high parHy and the numerous household responsibilities. This practice stems from" the high rate of unemployrrent and the stated intention of haneland governments to provide enq:>loyrrent to all, but all is an exploitation of the IOOrst kind with waren being preferred "to

men

because the former can be paid lower wagers for the same jobs.

LOCAL POLITICAL REALITIES

'nle people we serve are designated citizens of either Lebowa or Gazankulu depending on tribal affiliation and are under the direct authority of Oliefs in the Hareland government system; the latter are paid gbvernment officials who have the power to grant residential sites, trading licences, permissicm to build camrunity schools and clinics in the area.

4/As a general .'

As a general rule this systan gives rise to a lot of cllrruption, nepotism and very few chiefs are sympathetic to genuine efforts at camunity developrent; the~' feel threatened by any activity in which they have no direct say or control over.

The harelandleadership is an extension of this local system and tends to share the same disabilities of corruption, nepotism and or inability to effectively curb these practises. Liquor licences are the pre- rogative of people with ears in higher places and it is not una:mron for the chief Minister with his whole cabinet to travel hundreds of kilareters to one one liquor outlet or the other in the narre of "progress and devel~t".

The greatest problem is the friction Ih'hich has developed between the two tribal groups as a result of this artificial division after decades of harrronious living together. People get fined up to RBO for tres - passing in one orot.~er area and vast new slums have been created by migration of people fran one tribal area to the "right one".

In one case Sotho patients were ,transported by buses, trucks and am- bulances fran Shilwane &lspital (handed over to Gazankulu in 1981 after a pericxl of disputed Administration by I.ebcWcI Government) to Meetse

&lspital 36Jan away. The situation borders on insanity.

Rural ,people are on the main apathetic, unpoliticised and easily ex- ploited by all these forces at play in these areas and the local folk here is no exception.

4 • S<X:IAL ORGANISATICN OF THE cx:M1UNITY' (i) THE MEN

Olawinism is very strong here, bordering on the ridiculoUs, especially in view of the fact that II'Ost rren are migrant workers and thus not available to play the role of father, head of family and

decision-maker as custan has it: ,House work and II'OSt family responsibili- ties are regarded as wcnen's work with few rren even prepared to share these tasks.

(ii) THE ELDERLY AND DlSABUIl PEDPLE

There is a predctn1nence of old wcnen over rren II'Ost are living with their children either l.I11llarried daughters or married sons;

5/there is ••...•.•••...

I

1

there is however a fair nunber of old people (this trend ,seerIS to be increasing) ....00 live ⁰⁰ their ^own with no 1Jmed1ate family member being prepared to take them into their hares. SCIte of these old people withoot family care tend to live very unsatisfactory destitute lives. '!he elderly are ho,,1ever a very inportant source of incx:rne for the hare by way of their biJronthly old age pensioo pay-outs of Rl14 in addition to serving a very inportant role of being child~ers.

thus releasing I10thers to earn additiooal 1ncare for the family.

"n1ere is a very sizeable number of old people beyond the age of 60 years ^who are not receiving any old age pensions ⁰⁰ the pretext that they have no proof of their age - how on earth! Exact figures are not available but estilnates based on inforroation fran Magistrates Offices are that 1000 are on the waiting list at any given stage with only a small perce~tage being approved eventually. 'l1le hcJreland governrrents just don I t have ~e funds to pay rot all necessary pensions and there is also a lot of oorruption within the system of approvals and pay-outs involving the clerks and sore other senior administrative personnel as a nUIT~r of sporadic disciplinary cases in rural areas have shown.

'l1le disabled are also in a sorry state and tend to have'to wait indefinitely for approval of their disability grants;

Sare

Medical persormel are

also oonniving with the systernof delay tactics by failing to declare 100% disabled people as such even when people are overtly mentally retarded.

(iii) THE aUIDREN

There is a very high birth rate in this area even though no re=rds exist w.r.O crude birth rates

ou,:;

experience with the patients we deal with is that the parity of waren here averages 6 with extremes of up to 1 B. By the same token there is no official re=rd of infant mortality rates, but oor ircpression is that they should be high.

OUldren are brought up mainly by their mothers and grannies and rarely is there a father figure constantly in the hare.

Olildren growup without really knowing their fathers who are once a year visitors with no meaningful relationships with their children.

Discipline and proper parental care is very hard to come by here with the added CCIll'lication of mothers who have to ~rk to supplement migrant

~rker wages.

6/'!he custan

The custom of circumcision of both male and females is still very strong here, but there is no real ser ious mutilation of females in the process. 11le problem re lates to the age at which children are circum::ised - 8 year olds iU"e known to be. involved and

the most distressing part is the hazards to which they are exposed viz. infection, burns and malnutrition. This custan has to a very large extent been ccmrcrcialised with er.trance fees up to ^R160 per child, hence the larger the number, the rore profitable the venture for the particular chief and headrren rU!1ning it. 'Ihe absolute minimum is spent on provision of food and proper traditional medical care.

011 ldren caning back fran these schools are then regarded as rren and ...aren in spite of their tender ages - the psychological trauma and damage to the developnent of these children is inrneasureable.

To add insult to injury these children with the men-child syndrare are then placed beyond the discipline of their mothers because of tiie fact that they are WCIlen, so they can' t wash them anymore or teach them proper personal hygiene. With migrant fathers one can imag,ine these children being lost to society with no hope of proper up-bringing. The oonsequences of this "man-child syndrare" are frightening injeed for these rural societies.

( i v) 'mE 'I'EENAGE proBLEM

The normal problem of adjustment and identity crises of teenagers are multiplied a thousand times here by the above factors and other problems relating to unstable families, uncaring and or incanpetent teachers, nurses and society as a whole denies the teenagers a reasonable chance of satisfactorily dealing with their problems hence t.'>e escape into alcohol abuse, dagga smoking, premature sexual experirrentation with resultant high prevalences of venereal diseases and unplanned pregnancies.

(v) 'mE \QIEN

These form the pillars of rural society shouldering all the responsi- bilities yet being denied any meaningful authority in their hares.

7/ Marriage

I

I

I

I:::

Marriage is regarded as the beginning of Jreaningful family life, although there are a very large munber of unmarried rrothers - 30%

and with all the. above factors leading to unstable family life, divorce, desertion and being widowed are very camon here; veri few divorced or deserted rrothers even bother to seek financial support for their children fran their former husbands and tend to have to slog to bring them up.

'!he high birth rates are partly due to the refusal of a lot of men to allow their wives to practice any family planning because of fear of infidelity or sane or other irrational reason. '!he..aren during child-bearing period are always either breast feeding or pregnant with no rest period in between the births of their children; there are alot of instances of nursing rrothers with 3 rronth old children who have to be weaned because of an unplanned pregnancy.

It is indeed surprising that these "-Oren still end up sane and can laugh and seem to be coping with life - they do cope far better than their husbands do - the miracle of survival. 'l11e power struggle between older and younger "-Oren especially the rrother-in-law syndrare can assume alarming proportions here with tragic =nsequences for family stability. Older "-Oren tend to vent out their pent-up feelings and frustrations built up over their earlier years of marriage against younger v.anen - reversal of roles - the former oppressed using ne"- c~Y.l!)d

authority to oppress fellow t.anen.

These tensions spill over into the general carrnuni ty affecting the possibility of forming strong waren's groups, care groups, literacy groups, etc. becaClse the older waren can wi thhold permission fran her daughters-in-law to participate in all these activities.

The cumulative effect of all these stresses and strains on rural WO!T\?n must be trerrendous - a lot of headaches and other psycho-sClnatic diseases treated symptcrnatically must be the end result of these tensions.

( i v) THE POVERTY CYCLE

play which are imrxxtant in the vicious poverty cycle operative' in this area.

8/ <Alr

/~\

. DISEASES UNSfABLE Fl\MILIES

DCPLOITATION - Cheap labour

- Unsafe working conditions - H.P. Malpractices

Inferior services - Political manipulation

OUr primary, health care work in this area is aimed at lessening the impact of these forces on the individuals and on the ccmnunity as a whole.

THE P~ PERSUED

OUr work is divided into the following categories:-

(i) CURATIVE CARE

( 11) PREVENTATIVE CARE -

routine consultations and treatment of various ail1rents done by the Medical Officer and the nurses.

Health Education

Inmunisation prograrrrre - awareness creation

Family planning

Dental Care

- actual administration - awareness

creation - administration

of <lepo, the pill, insertion of I U C 0 &

referrals for sterilization - restorative

- preventive

9/ (iii) . . . • • . • . . . •

,I

~ 'I

( i i i) PRCMJI'IVE CARE This involves a whole range of projects ai.Jred at promoting a better life in the community and are undertaken with the participation of the cOI'lr.=ity to a greater or l~sser extent depending on the nature of each project. It has to be _said at the outset that rrost of these projects altl,ough an~ring the rrost pressing

needs of the carrnuni ty, were not necessarily initiated py the people themselves but by the Medical Staff in response to the perceived rather than expressed needs.

(a) NlJI'RITIONAL SCHEME

ProviSion of free milk po.der to destitute mainourished children and elderly people; this was increased almost ~ fold towards the end of las,t year as a result of the drought and included dried beans, peanut butter, Soya mince granules, soup po.der etc. The total value of -distributions over tlle last 8 rronths anounted to - R2000.

sale of various food stuff at close to cost price to the local c:amrunity to encourage wage of high nutritious value foods. This prograrme is very popular oonsidering that sore of the prices are almost half the going price at local stores. We have been able to nm this schere with the assistance of Imqualife and the McLean Trust.

(b) SELF-HELP GroUPS

This project is a direct result of our ooncern with serious chronic malnutrition in the under 5 year olds and after proviSion of free milk to the child, the rrother is then enoouraged to join hands with other wanen in similar circumstances. These wanen in grcAlpS of 10 - 15 people involve themselves in:-

- Joint discussions of their problans.

- Health Education within the group Learning sinple skills - sewing

- knitting

- cooking to preserve nutritional value - cleanl iness

am

h<::rre-€OOflClllics - gardening

10/ ScIre

ScIre of the groups have progressed in to effective care groups who also involve themselves with prarotion of ccmnunity health in their various villages.

'lh1s is a group of 10ICIrefl 1Nho rreet regularly to knit and Sf'M articles for sale and thus generate revenue for the group. They sew very simple garments e.g. pinafores, kiddies dresses and knit schcol jerseys and other ccmronly used articles. 'nley are a very successful group which also give sare of their time to ~k as literacy =-oroinators (see infra).

BRICK foW(IN:> CLUB

'nlese waren "-'?re ::>riginally working at a local brick yard in town and leaving their children at hare with the grannies in the early hours only to o:rre back late in the evening. 'nley are I"lI:M producing c:arent bricks at their own pace which are sold to the local ccmnunity to improVE' hOUSing standards.

(c) auID C1\RE PJO.JOCr

This was started to afls;.>'~r the need of " .. :n:king rrothers who had to leave their children under unsatisfactory conditions to earn a living or to supplerrent inadequilte family incarc. We have tw::> Day care Centres under this scheme:-

Po. creche which was having running c(",S\ problems which has now been adoptE'd by Kinder Not Hilfe and take!'"· care of l.enyenye Township children.

II creche whi-:::r "'0:.' ~Ju·ilt in TickE'J'li:1^c • .. "'i::-h ta\;(>s care of the very needy ch i Idren there.

The main aims of this pro jet are:-

- To pro\,ide shelter and nlitriti'Jn fot' tiICS(' children

To provide a stimulation and love with a view to better preparation for schcoling later on ...

This programre is so popular that there is nON a carrpaign in each village to get tlle ccmnunity to build a creche, hOo'E'ver sirnple, to

an5'NeJ: the needs of their young children.

EDUCATION PROJEcr

This has several facets which ilre interrelated and aimed at alleviating sare of the urgent needs in the camnmity in the field of Education.

A BlJRSARY SOlD1E - lPOPENG BURSARY FUND

This provides money for needy children to enable them to further their Education. '!hese students need not be bright but should show progress to qualify for continued support.

Our fund provides assistance to Std V - X mainly, a number at teacher training colleges, post matric and techr.ical training. University fees are tco pro- hibitive tor us to handle except special categories for lNhich sponsorship can be arranged eg. Medicine, and Engineering.

Career guidance is an essential part of this scheme.

LIBRARY pOOJECI'

'!his is based at the Health Centre and provides books, magazines, newspapers and other reading matter to local students and people in general to encourage readership. We provide both novels and reference work in various subjects.

It should be noted that there are no libraries in our local school.

ADULT LI'l'ERACY SOiEME

'!his has been prcJ1tlted by the high illeteracy rate in the ClC.II1lUllity up to 60% in sare villages. We use the dialogue rrethod and work. hand in hand with Learn and Teach to run this scheme. The 1mrediate benefit to the people is remarkable and it also makes our Health Education easier.

A lot of the learning groups which total 63 al90 function as eelf-helf groups and in sare cases as care groupsdepencling on the level of awareness achieved by the group.

12/Assessment ••••

It is hoped that the lessons _ learnt in this area can be useful to other CXJI'IruI\1 ty develClpll!nt workers.

~ people find themselves resettled in a vast rural slum and 0CIII1ng fran different areas or fanns within the same ,area is i t fair to expect them to 11 ve like a _11 established close-knit Ccmmmi ty? ' '!he object poverty, ruthless, exploitation by the system within (tribal authority oorruption

am

hareland governnent trappings) and the system without (inhuman working conditions on fantlS, mines and other industries and the lack of political rights) is a sure recipe for dehumaJ)isation.

'!he unstable family units making up the carm.mity also oontribute to poor SOCialisation, high criIne rate and further weaken the foundation

a l 10hich to l:W.ld a proper cx:mro.m.i ty.

'Ibis is further CCIIplicated by Tribal divisions and results in friction.

(H) cnHJNrry DEVE!JJIlMENI' - WHAT'S THAT?

'!he novelty of the idea of people being able to work together for their oc::rrm:>n good is just too much for a lot of people here to get over.

'lhis is further worsened by the fact that a total stranger to the people cane to introduce the idea. Why must she run a clinic for service not for personal gain? Why can't she behave like an ordinary

"normal" doctor

am

make her noney and leave us in peace? We are doared to our type of existence anyway - s.l)e is probalJly wooing us into a trap so that she can exploit us rrore later on ...men we are off our guard.

'!he security police intimidation fanned a lot of these suspicions with the hope that the programne will fail to take off canpletely. ThE' saving grace was the fact that _ _ re providing an essential service ...mich was hard to cx:rre by in the area and _ also ensured that the quality of that service is beyond reproach; thus opening people's hearts to

13/ us and ••.•..••

us and what \<.e stocx:l for - taTmunication on an individual basis acted as a stepping stone to wider community discussions and active partici- pation in the various projects.

(iii) :-'JINrooIER f1ND MATERIAL RESOURCES

One of the fundanental tenets of community devcloprent is that the people's own resources must be utilised in any rreaningful progranme to ensure .self-reliance and to promote self-help. Putting this sound theory into practice is however a very difficult proposition frought with rrany problems viz, the prople are so poor any way that they think of utilising their limited resources only in the process of existing fran day to .day; for the poor forward planning is a luxury they can't afford; giving up an afternoon off to get involved in a

communal

project is too much effort - rather spend the time drinking for to- IlOrrow \<.e d:i.e.

Things happen to the poor, they don't decide; It is difficult to conceive of themselves as makers of history - they are just shuffling . along the shores of time eg., a poor wanan doesn't think she can plan

a family - she will passively wait for nature to take its course - 12 children la ter .

To find the manpower to run ccmnunity projects in a SOCiety like this is a nightmare; the few who are Educated are not properly IlOtivated for cammunity service and few i f any have any experience in cammunity developrent \o.Ork. There is also a lot of cases of breach of public trust by sane people purporting to serve the people and this creates a lot of undue suspiCions in the minds of people with consequent difficulty in securing the trust of the cammunity in any task •

. Financial support for ongoing progranme of this nature are hard to a:rte

by. sponsors IlOstly like to be involved with capital costs of projects but are loathe to ccmnit themselves to running costs on a long teon basis. Unfortunately, with this type of cammunity there is a limit to the extent to which one can stretch the internal financial rescw:ces of the cammuni ty - sareone sarewhere has to subsidise the service ccrnponents of the programre.

14/ (iv) Lack

(i vi U\CI( OF

KDELs

AND RELEVANl' TRAINING

Medicai training in this country wi th a few exceptions perhaps pre- supposes that doctors are to work either as private general practitioners, specialists or Medical Officers attached to one or other hospital.

'Ihere is no proper preparation for Medical Practitioners to initiate, run and develop c:x:mnunity health programres suitable for rural areas.

'lbere are few if any !!Odels that one can fall back on to assist scmeone out there in the back of the beyond, one has to rely on one's intuition, c:omon sense and ~.

o.rr

training should make us better able to act as leaders of c:x:mnunity health teams who must learn to listen and train other nembers of the team, to bring out the best in each one of them for better performance. The situation seems to be 1.nproving in sore Medical Schools but we still have a long way to go before the right calibre doctor is produced for this type of ..::lrk.

(vi OFFICIAL RED TAPE

'lbi!

proliferation of varioos levels of goverrurent with greater chances of corruption, inefficiency and bureu=acy presents serioos problems for rural oc:mimrlty workers. Finding the right office for ones request for a particular service is a nightmare eg., i t tcok us 2 years 2 rronths to get tap water installed in our Day Care Centre. We finally traced the problem dCMTl to an official who had refusL'Cl to carry-out the in- structions of his head office of providing the connection fran the main water pipe because of his prejudi.ce against the Medical Officer; the

fact that children were being put at rist of water-borne disease was of no importance to this official - he just didn't care. There are numerous examples of this uncaring bureucracy at various levels of one's dealing with

them.

(vi) AIL'ClOOL ABUSE AND PIUVI'IOO OF. ITS USE

Driving through rrcst rural villages, one is struck by the number of liquor ootletscanpared to other business facilities; there is a pro- liferation of bottlestGtes, lounge bars and home-brew beer gardens in alrrost all villages here CMned mainly by one or other homeland goverrurent offiCial, their friends or relatives. It is indeed the rrost lucrative buSiness in this poor community.

15/ Alcohol

Alcohol abuse is very ccmron in the people here - teenagers, middle aged and very old people are all victUns of this.

Althoogh there is a male predani.nance - there .is a practice here which is unique to the area - allowing waren with babies to sit the whole day in beer gardens drinking. Nobody cares IIUlCh aW..1t it - they are too busy making rroney to ~rry aW..1t its effects on the breast- feeding babies.

THE JOYS

Frcm the. above discussion one would think that with all the tears that fall here. there is little roam for laughter and real joy - that is actually the whole irony of the siutation here - people still laugh and genuinely share the "simple pleasures of the poor"; the resilence of the people is iII1reasureable.

Our ~rk cloen I t pretend to rreet the total needs of the camunity but is aJ.ned at enabling the people themselves to face the challenge of their env1.rc>rarent withoot being dehumanised by the burdens of poverty.

A few exarrples will be used to illustrate saoo of the positive responses of the camnmity which makes the whole effort ~rthWll1e.

(i) ACl'IVE PARI'ICIPATIOO IN J\Cl'IVITIES AND plUJEX:'TS

In the initial stages of oor prograrme we had ~t difficulty to a:mvince peop1ethat they have it in themselves to do ~s on their

own wit:hcAJt relying on the so-called ~ted people and goverment employees to initiate and run camunity projects. '1be ~test supporters of projects today are waren, saoo illiterate or semiliterate

...no

feel confident el'XlUgh to stand and be counted, they initiate ~ run their own self-help groups and even help organise those still laclt~ the proper motivation to do so.

We have today 70 C]roops of waren in the area operating as~ither literacy learner groups, sewing and knitting clubs, ~ groups and the more advanoed ones operate as care groups. Men have also ntJtI begun to get actively involved in membership of project camI1.tteas and a lot of tM initial misgivings are giving away to positive th1.rlItJ.rlg and active part- icipation. It was indeed a great pleasure to be a guest at a recent Official opening of the Day Care Centre at Tick.ey-L1ne ~ch was planned organised finanoed and run by the people t.hemaelves. He haw really

16/0Cl'IIB 0 • • • • • • •

cctTe a long way.

There is Also a lot to be learnt fran the wisdan of the elderly peOple here; people's custans, prejudices and fears have a l<?t of bearing on their responses to the envirorurent and other forces around them.

We

do draw a lot of strength fran their interpretation of events and suggestions on appropriate approaches to the ccmnunity issues to ensure desired responses.

(ii) G!OIIOO SUPPORI' rn::JoI CYrnER GIUJPS AND ORGANISATIONS IN 'mE AREA 'ltle greatest problem for o:mrunity workers is to enlist the support of groups which have support, legitimate

Or

otherwise in the camninity one is working in and a proper field force analysis is a prerequisite to proper planning.

Those totally against one must learn to ignore wi thout antagonising further lNhich one can least afford; those for the progranme should be continually notivated to ensure deeper ccmnitment and neutral ones have to be won over to the side of carmuni ty developnent by various means dictated by circumstances. '!he church is the single nost powerful

institution in rural areas but is largely neutral in the face of the crying need around her; this includes the African Independent OlUrches in the area lNhich are traditionally seen as soul clinics. We have succeeded in sare cases, to get positive ccmnitments fran local churches ~ich OCM seem their role in a broader sense. Sane of the

hameiand System

officials who might not openly identify with What we are'

doing

are nonetheless not obstructive and in sare cases have becare positiVe SupPorters of the work we are· doing. although one has to guard against their tendency to want to take aver projects in order to claim

Credit

thus stifling local initiative.

'!he

local Tribal authority has really cane a long way fran neutrality to 'positive iiwolvement even to th,> j:oint of gi'!ing the Ithuseng

~ity Association a blanket permit (a clear deterrent to local security police intimidation of the oommunity) to initiate INhatever projects we feE-I are reIf'vant to pranote he.Jlth care in the area.

What greater vote of confidence can we ask for?

17/ (Hi)

(iiil SYMOOLISM AS lINEFFEX:'TIVE 'llXlL FOR CCM1lMrIY a:wseUNI'ISATlOO

It can be and is argued in sore quarters that ^~ don't need expensive looking buildings and all the para:mernalia that ~ have in rur clinic and at' the Day Care Centres in Tickeyline to render the service - that we do, because the Capital cost involved is prohibitive and will thus discourage carrnunity initiative,. 'Ibis argunent holds water only to the extent that one is looking at the service aspect of the work, but if one is talking developrent of the total person fran a position of total dehumanisation, alienation and lack of self-respect to full meaning of the facilities provided.

r-t:>st people here

are

accustared and accept being treated as subhumans at work, in shops, in buses and taxis, in hospitals and private G.P.'s roans and in Society as a whole that they need a very loud ^rres~ge to jerk them into a different reality eg.

the

local rusiness pec.ple den' t have to put up a sign for separate racial facilities, the pec.ple know where they belong! 'Ibe cleanliness of the floors, the sheets on which they lie, ocrnbined with a friendly warm atnosphere nust be able to re- affirm their ,humanity and pave the way for a rreaningful discussion on personal hygiene and other matters relevant to self-respect.

By the Barre token the ch:ildren being a cared for at the Day Care Centre must feel that they are V I p's future and given the matter~f-fact way

in which people care for their children, ~ need a dramatic nude!. to raise the awareness of the carrnuni ty for the need for proper child care and the importance of children.

'Ibere is nothing prohibiting the ocmrunity to establish sinpler structures to serve their needs in the Medical and Olild Care fields rut t".hey have rrodels which have enabled them to say ~ are pec.ple. '!he CCIIII!UI'1ity is

in the middle of a campaign to establish a s1nple Day Care Centre for each village using their own recources to put up sinple functional structures.

IS/Concluding ~ ••••

- Although the problems of the rural poor are the same, priorities differ fran area to area and proper selection of an "entry service project"

will ensure oc:mnunity support for the service and q:lE!I1 up prospects for a nore developrental prograrnre.

- Each

professional group shcW.d and must make a contribution to rural developient rut based on our experience ^1Ne feel that Medical training for a

start,

shcW.d be radicalised to ensure a steady supply of properly motivated personnel to practice real cx:mprehensive primary health care as leaders of health teams.

'ihere

is a certain resilence in rural poor camn.mit1es ~ich might explain the miraCle of their survival in the face of all the odds against them.

OUr duty

is

to pI"OlTide that ray of hope at the end of this tunnel of misery - they ilre sure to errerge victorioos.

----000---

Second Carnegie Inquiry into Poverty and Develop- ment in Southern Africa, and were prepared for presen- tation at a Conference at the University of Cape Town

from 13-19 April, 1984. -

The Second Carnegie Inquiry into Poverty and Develop- ment in Southern Africa was launched in April 1982, and is scheduled to run until June 1985.

Quoting (in context) from these preliminary papers with due acknowledgement is of course allowed, but for permission to reprint any material, or for further infor- mation about the Inquiry, please write to:

SALDRU

School of Economics Robert Leslie Building University of Cape Town Rondebosch 7700

Edina-Griffiths

I!:

"

~ I