The vision is to train, equip, empower and inspire a movement of suitable people to become self-employed or volunteer “Community Health Workers”. How this is going to be structured has still to be worked out but for now I see three organisational systems that inspire me and give me confidence that we will find a way that will be sustainable. For now we call it “The Good Way” and these are the three movements:
- AA (Alcoholics Anonymous) is a movement that for over 100 years has brought healing to millions of alcohol addicts. Their members are passionate and totally committed to their own ongoing healing and that of fellow members. It is managed by members, funded by members and propagated by members. All of them have experienced the devastating power of addiction. Nobody is excluded in their healing work.
- The SA Taxi movement is vibrant and alive. Millions of people are taken daily from A to B. The informal taxi industry provides work for 100s of 1000s of people each of whom earns a living as owners, owner-drivers or drivers. It is self regulated by the taxi owner associations … and they get the job done efficiently moving people from A to B. Each journey is a fixed fee and the amount is set by the local taxi association. Each taxi will take between 7 and 15 people at a time. While there is a lot of room for improvement in a number of areas including customer care and safety the bottom line is people get from A to B without any state subsidy or any other subsidy.
- Stokvel community saving clubs are an informal community structure where a group of people support each other to save money. For example a group of small “spaza” shops will come together once a month and collectively they hire a van to get stock from a wholesaler. The name “stokvel” seems to have its origin in rural black cattle farmers of the Eastern Cape. These cattle farmers realised that the European cattle produced significantly more milk and beef than their own indigenous cattle. They needed to buy a bull to get the genes of the higher beef and milk producers into their herds. A group of stock farmers would club together to be able to buy a bull to share at “cattle auction”. The word “stokvel” is a local word meaning “cattle auction”. A friend of mine has for the last 6 years been part of a “stokvel” and I have seen how loyal he is towards himself and others in the group. He would get more interest if he put his money in the bank but without a support group he would fail to save.
My vision is that a Community Health Worker will be trained and equipped so well that each person will be prepared to pay a community health worker to get from health position A to health position B.
The public health system is not coping. In some areas like the Eastern Cape a number of newspaper articles talk about a “total collapse of health services”. Patients have to take a whole days leave to get medicine or see the doctor. For those with a chronic condition like diabetes these regular visits become costly in terms of time. Transport is not cheap and patients have to pay to get their file.
The private health system is expensive, too expensive for 80%+ of the population and it is rapidly becoming too expensive even for those who are earning reasonable salaries. I know of pensioners who are paying over half their pension to medical aid and I know of others who have had to cancel their medical aids as they cannot afford them.
I see significant hope in self care and health education. This has been shown to reduce medication, hospital admissions, clinics and doctors. “Prevention is better than a cure” has been a truth through the ages and it is no less true today.
We know that more than 80% of people currently who have diabetes could have avoided the condition by living a health promoting lifestyle. Almost 100% of HIV can be prevented by people being faithful. We know the condom message alone promotes the spread of HIV. References to research that back up these facts can be found on http://thegoodway.org/what-is-south-africas-hiv-status/ Up to 70% of mental health and depression problems can be effectively addressed by lay trained heath workers (see http://www.ted.com/talks/vikram_patel_mental_health_for_all_by_involving_all.html). There are many other areas of health that can be managed by patients with the help well trained lay workers and education.
Our business is to find ways to train and equip lay/community health workers so well that they will be able to make a living getting people from point A to point B with regard to their health. Resources and lessons will be collected on the website http://thegoodway.org/. Currently the vision is that the basic modules that all Community Health Workers will be given are:
- The Daniel Plan or an adaptation of The Daniel Plan and
- Training in leading or facilitating small groups
We will add electives as and when there is a demand for them eg
- Mindfulness based meditation for stress reduction
- Kingdom Sexuality (which will cover HIV)
- Mental health and depression and
- Addiction and support groups
Personal Journey that has led me to this idea
Over most of my life I have come to realise that I am energised and motivated when I am part of a team or in a support group. I did two exams last year, one studying on my own and the other part of an on-line study group. On my own I get much less than I hoped for but the exam where I was part of a group I did much better than I ever dreamed possible. My work as a diabetes educator has also affirmed my faith in group lifestyle education. I was privileged to be involved with a randomised control research project at Kalafong Hospital, Pretoria West in 2013 involving 120 patients. We looked at using small groups over 6 weeks and there is no doubt in the minds of all the research team members and participants that small groups were much more effective place to learn than one to one as normally happens in clinics. The need to have peer support groups in our suburbs, townships and rural communities for diabetes, blood pressure and cholesterol has always been obvious but what had not been so obvious before was the energy and enthusiasm that learning in groups generated.
Because the incidence of HIV in South Africa is so very high I have felt a need for me to add HIV to my understanding of Diabetes. I discovered that HIV is also a lifestyle disease although the medical profession puts it in a different category. To prevent a person with HIV from it becoming infected with the typical AIDS with the many opportunistic diseases he or she needs to reduce stress, eat well, exercise and find a way to get rid of fear and anger. There is such a tragic failure in HIV prevention. HIV is getting worse in SA in spite of R and $ billions being thrown at it. I have noticed good people’s passion being squashed. I think it is because of “failure fatigue”. Nobody likes to work in a system that seems to be failing. There is an army of HIV community workers in South Africa. They work for NGOs, FBOs and NPOs but paid what they call a stipend (currently R1500 per month) by the Dep of Health. I have spoke to a few of them and my impression is most of them are fine young people who could easily be trained and motivated to become truly effective in preventing HIV and other lifestyle diseases.
A funny story – but true and very sad
“ … law … bottled water and a condom to be sold with alcohol” was part of news item I heard on the radio recently (January 2014). This is the sort of idea that was most probably through up by group of drunken people discussing how to curb the HIV pandemic. It may have been a clever person who found some statistics that indicated most people got HIV when they were drunk (this is quite possibly true).
My friend Philemon tells me that in the township pubs, taverns and shabeens as people start to drink both men and women use the phrase “it is the same” which means “sex with a condom is the same as without a condom”. Basically they begin after a few drinks to believe that your chances of getting HIV is “the same” whether you use a condom or don’t.