As you know eight years ago we were driven to make a difference in Ndawana, South Africa. Our focus included health and education, with a sustainable health care initiative being our highest priority. Today Ndawana is home to a fully functional clinic facilitating over 1,200 patient visits per month. We are leaders in the United Nations Integrated Management of Childhood Illness (IMCI) initiative, having been recognized as the single best model in all of South Africa for early intervention with children under the age of two around HIV, TB, malnutrition, diarrhea and pneumonia through home based care. Ninety percent of mothers in our program who are HIV positive are now accessing treatment and their babies are being tested for HIV.

Sustainability has always been our goal and to that end we are in the final stages of making all our programs and services sustainable. It is our intention to transfer our health care programs and clinic operations to the KwaZulu-Natal Department of Health (DOH) and our training programs to TB/HIV Care, a South African NGO, on April 1, 2012.

We have already reached our goal of sustainability in the following areas: 

• The Department of Health and TB/HIV Care have absorbed 29 of our 31 employees;
• The health clinic is now an official government recognized South African clinic with a budget of R 2.1 million ($300,000 Canadian);
• Large scale gender justice and HIV education, counseling and treatment programs are in place, so positive attitudes and practices will continue to grow;
• Our preschool continues to provide early education and nutritious meals to local children. The South African government is now funding the teachers’ salaries and progress is being made toward long term funding.

Eight years ago we began the journey to assist the orphans of the HIV pandemic in Ndawana. Initially we were providing food packages including items like rice, powdered milk, oil and candles to over 200 orphans. We have now successfully obtained the appropriate government support for all but 62 of them. Sadly these are the children who have fallen through the government cracks with support being highly unlikely for reasons such as parents dying and no death certificate being issued. Without a death certificate it is impossible to prove that the children are actually orphaned. The estimated amount required to continue to provide basic food packages for these orphans until they finish high school is approximately $45,000 in today’s currency. We have not yet attained sustainability for this program but are working on a strategy for securing ongoing support either in South Africa or from Canadian sources.

As we draw nearer to our end date our hard work continues. This year’s projects include:

• Construction of a clinic waiting room that is designed to minimize the spread of infectious diseases, especially exposure to TB, which is a serious health threat to anyone with HIV;
• Addressing the crucial issue of housing for nurses with the construction of a nurse’s residence, which in turn assists in attracting nursing professionals to the community;
• Important new work in the area of gender equality as it relates to HIV prevention.

With these programs completed by spring 2012, we can transfer responsibility for our programs confident that the legacy of Edzimkulu will continue in the very capable hands of those entrusted to complete this work. Although Edzimkulu will officially wind down in the spring of 2012, our founders Jim and Chris Newton intend to continue a part-time presence in South Africa helping to ensure our sustainability goals.

While Edzimkulu is an amazing success story, the transfer to the Kwazulu-Natal Department of Health and TB /HIV Care on April 1, 2012 will be very emotional for all involved. Friends of Edzimkulu can feel very proud that we have accomplished what few NGO’s ever manage.

So again we say “Let’s celebrate!” You have been a part of a major success story in assisting the community of Ndawana and far beyond its boundaries to experience the caring and compassion of a community of friends half way around the world. Together we said, “we see you,” “we hear you” and “we care.”
Together we have Changed Lives.

With sincere thanks and gratitude,
The Board of Directors,
Edzimkulu A Society for Children of AIDS
Ngiyabonga – Thank you

A new waiting room was required because tuberculosis has become an increasingly serious problem globally but especially in countries most impacted by AIDS.  Up to 50% of HIV positive people are co-infected with TB.  Poor adherence and lack of support structures have resulted in many strains of TB are becoming resistant to front line drugs available for treatment.  While TB is relatively easy to treat once diagnosed, multi-drug-resistant (MDR) TB requires hospitalization and separation from other patients because it often kills. We now have MDR in Ndawana, and the likelihood of more MDR there is likely.

Our current waiting room was small and had little airflow because there was no cross-ventilation and there are only three windows.  Up to 60 patients sometimes wait in an area the size of an average bedroom.  Consequently, to protect patients (and staff and volunteers) from becoming infected with TB, the new waiting room with maximum possible cross-ventilation, because TB is airborne.

The room will be five times as large as the current waiting room and will have a total of 39 opening windows, on all four sides.  The waiting room will be connected to the other two clinic buildings, so that patients and staff will no longer have to go out in the cold or rain to move from one building to another. 

We are looking forward to this new space!

Now we have been asked to expand this program into the entire Sisonke District (500,000 population).  That program will begin in late November, with training of facilitators from an organization called TB/HIV Care and from the Department of Health, then conducting Stepping Stones, first with 100 TB/HIV Care employees, then with all the clinics in Sisonke, about 1000 people, and eventually with community members throughout the District.  

Meanwhile, we want to create a tipping point in Ndawana.  We now have started a Stepping Stones program for the HIV Support group and will then target students and mothers. We want to work deeply in Ndawana, where the population is 4,000, to make HIV prevention and gender justice a recognized part of the community culture.

These strategies will go a long way toward a sustained understanding of what is necessary to foster gender equality and change the attitudes and beliefs which keep the HIV pandemic going.

A few months ago at Ndawana, we trained people in gender justice, then as facilitators, and we started a different kind of programming to talk about the realities of the behaviours that get people infected, and how we can think about and change our attitudes and beliefs so that our behaviours become more  consistent with our knowledge.    All our employees, including the driver, maintenance workers, and all the healthcare people are coming and participating and learning and having fun together, and bonding in new ways.  There is a new buzz in the village, and no one misses these sessions.  Even the nurses say they are learning new things and changing their attitudes.  When Chris asked one of our people how it’s going, she replied “We’re having too much fun.”

On Thursday we showed our End Stigma DVD to the teachers in Ndawana, then invited them to form a group like the one we are running with our people.  They seem eager to start, and our facilitators will begin to work with that group in about ten days.  We left that meeting thrilled, because there is so much stigma in the teachers, and they seem almost relieved to have a new way to think about and deal with that.  And, they have agreed to work with us to better support all the children on treatment attending school – almost 50 of them.

Then on Friday we met with about 25 TB/HIV Care community health facilitators and managers in Ixopo, where I proposed a five year program, with them being trained in gender justice, then as facilitators, and running this program all over Sisonke District (500,00 population), first with their employees, then with other groups like teachers, or churches, or young people.  Thabi and Busi spoke about how  the program has had a major impact on them.  Chris spoke about the changes she sees in our people.   Some people in the audience were moved to tears as Thabi spoke from her own experience.

Before we left TB/HIV Care managers voted unanimously both to undertake and to pay for the programs we proposed, which we believe could have a huge effect on HIV infection rates.  I will train facilitators and mentor the trainers in the programs.

I thought I was ready to retire (again).  I guess not.

Jim

So what has happened at Ndawana and why are so many people talking about us? In order to understand our celebration, you need to know where we started and where we are now.

 Why are the indicators above so important? These are the factors that are critical to monitoring children’s health and to having a meaningful impact on infant and child mortality in the face of the continued spread of HIV throughout sub-Saharan Africa. From the baseline survey Edzimkulu, together with the department of health and the community, decided to focus on three things: nutrition of the child, preventing mother to child transmission and early access to treatment for children with HIV. (Malnutrition continues to be the leading cause of illness and death in children under five. Over 50% of children who are born with HIV will die before their first birthday without early intervention.)

What makes our current results so impressive is that in a small village in the middle of nowhere, with extremely limited resources, we are leading the country. In 2009, we received two separate recognitions at the national level from UNICEF, the Medical Research Council of South Africa and the National Government. One was for community mobilization in the area of prevention of mother to child transmission and the other as the best implementation of C-IMCI in South Africa.

In 2011, instead of recognition in publications, we are now getting so many visits by interested parties to benchmark our program that villagers shake their heads at all the posh cars attempting to traverse roads better suited to horses than motor vehicles.

In some sense you could say that we have accomplished what we set out to do. But communities are not a set of statistics and keeping children alive is not necessarily the same as nurturing these same children so that they have at least some chance of growing into healthy contributing adults. Much of the focus over the last years had been medically oriented, although with delivery of the services through the community rather than a clinic facility. Now we must look deeper and at the same time expand more broadly.

Children are our future — nowhere is that truer than in Southern Africa where the HIV prevalence rate among adults is over 30% and 900 people a day are dying of AIDS. Most of these deaths are parents in the income-earning years. We have come to recognize that parents and care givers don’t necessarily have the skills to ensure safe, stimulating and nurturing environments despite their best intentions and hopes.

With that in mind, as we begin to use the new pre-school, we have chosen to make it fully integrated with C-IMCI:

• On the nutrition front, we provide a healthy balanced lunch for the children and have banned junk food which is so cheap its consumption has reached epidemic proportions.
• To encourage learning nurturing and interaction skills, all parents have been asked to participate one day a month in the classroom to assist the teachers and are participating in a program that runs two hours a week for 20 weeks learning about everything from stimulating your child, proper nutrition, prevention of HIV and hygiene to recognizing danger signs of illness and getting the children to a health facility before it is too late. Those that successfully complete all sessions graduate with a certificate.
• There are 46 children (age range from 6 months to 16 years) with AIDS who are on treatment. The older children participate in a half day support group every month to provide psycho-social support and teach them to take responsibility for the treatment of their illness.

While we continue to strengthen the program at Ndawana, we cannot let Ndawana be a pocket of excellence surrounded by desperate under-serviced communities. In March, we begin training to conduct a baseline survey in an area called Lufafa just outside of Ixopo (about 160 Kms from Ndawana). This next phase is a partnership between the district department of health, World Vision and an NGO called Woza Moya, with Edzimkulu serving as the coordinating mentoring organization. Our hope is to create another pocket of excellence. Now the challenge will be to get enough pockets that they connect and we achieve overall coverage in our district with a catchment area of 500,000.

 At the end of her recent visit to Ndawana, Joan Machi from UNICEF South Africa said “We send people all the way to Brazil to study their community primary health care model. We need only to look in our own back yard to find a fully implemented successful community health model.”

So we send you a huge Thank You from the bottom of all of our hearts:

• From the community health workers who have been trained and supported your contributions who are truly considered to be the gold standard in South Africa,
• From the parents who are learning that even in the face of disease and poverty they can still earn and participate and create a better life for their children,
• From the children whose bright smiles and shining eyes tell us there is a future and they are the ones to point to that future,
• And most of all from the two of us and our Edzimkulu Board in Canada.

Without the incredible contributions from you and your staying power, we could not even have contemplated this work which continues to change lives.

Yours in continued community action,
Chris and Jim Newton
Executive Directors
Edzimkulu

http://www.cfp.ca/cgi/content/full/56/8/787

Edzimkulu is proud to announce that a new pre-school was opened on January 24, 2011. It will be the only pre-school operated by Edzimkulu and will replace the three previous ones operated in Pote, the community centre and Ndawana 2.

As the new building was in its final stages, a notice to advertise the position for pre-school teachers was posted and eventually two community health care workers, Nontengo and Jabulile were selected by the selection committee as the successful candidates. Applications on their behalf, have been completed and forwarded to TREE, Teachers Resource in Early Education, It is the hope of the committee that they will be accepted in the next course offered, and  they will met the qualifications necessary to provide training and certification to teach and prepare the Grade Rs (kindergarteners) for entrance to school at age 6.

Meetings were held with the SGB, school governance board, to ascertain their input about procedures, expectations and programming for the new school. They firmly emphasized that they wanted Grade R certification, at least fifteen minutes  of instruction daily  in the English language, and. that the  program run from 9 a.m. to 1 p.m. daily. Time was spent in explaining and discussing the difference between a creche and a pre-school and the committee were happy with this concept, because their intent is to prepare the children in their community for eventual school enrolment.   They agreed that parental involvement be a part of the structure and that each parent/gogo or their representative attend at least once a month to help assist the teachers in the implementation of the daily program.

It was explained to the original committee and to those in attendance at the subsequent committee meeting, that Edzimkulu organizers wanted to make IMCI, integrated management of childhood illness, an integral part of the program. The committee recognized and supported this goal, and were in favour of banning all junk food and snacks at the pre-school, especially in view of the fact that a nutritious lunch would be provided daily. This would include peanut butter sandwiches, served on brown bread, a fruit in season, and a milk supplement. At the committee meetings it was explained that the teachers would follow the guidelines established by the national Department of Education.

Once these decisions were agreed upon, a meeting for interested parents was held at the community centre and these suggestions were put forth to them for their acceptance, and their thoughts. Those in attendance were in accord with the proposals and heartily endorsed them. They were informed that each parent/caregiver, at registration, would be asked to sign an agreement  stating they would support the pre-school program by helping out at least once a month ,and attending a monthly meeting. It was agreed a monthly rota would be posted so each parent/ caregiver would know when their presence was expected. The purpose of this meeting would be to keep the parents abreast of the program and to engage their support in working alongside their child.

Due to limited space, it was agreed that students/learners would be accepted on a first come, first served basis, and that the age distribution would be 14 for each of the three age categories (ages 3, 4, 5).

Amid a flurry of activity, the pre-school did open on January 24. The room is spacious, bright and still in need of some work to bring it to its full potential as a child friendly learning centre. Donations of toys have been provide from families in Johannesburg and more recently from Clouds of Hope, which runs a pre-school program where I also volunteer two days a week. The recent acquisition of toys are more suited to free play, rather than toys with learning potential, but we will continually solicit to gradually obtain  a supply of appropriate toys and tools for learning over the next few months. We were delighted to find that several children’s books, written in Zulu, were salvaged from the fire of 2009, and although a bit smoke damaged, are useable. Our goal is to acquire more books which are age appropriate and culturally sensitive.

While awaiting their teacher training, the teachers are being mentored by a previous creche teacher, and supervised by Matu and myself.  It is a learning curve for everyone, but the children’s’ enthusiasm is apparent when I visit the classroom or get them participating in an outdoor activity. Inside they are quick to share what they have already learned in the first two weeks of attending. There is a sense of excitement and anticipation as they arrive daily , and as  little as they are,  they appear open to new learning experiences, whether it be drawing a picture, painting , miming or singing,  or simply engaging in new social interactions. Their smiles indicate they are happy to be with adults who are teaching them, challenging them and caring for them!

I consider myself very fortunate to work alongside the members of the Edzimkulu team. Jim’s experience is invaluable, as he knows all the resources to tap, and, there is no one who understands her community quite like Matu. She helps keep us “grounded” and gently reminds us to always respect that we are in South Africa, where things sometimes unfold at a different pace than we expect. Whatever the pace, I have learned that by all of us working together, parents, teachers and community leaders and volunteers, we can, and are, building a brighter future for the children in the village of Ndawana.