Mental health is not only the absence of disease, but also the ability of people to cope effectively in and contribute to society. A person’s mental wellbeing is shaped by their interpersonal relationships, their community and the society they live in. Our history of human rights abuses, racial segregation, displacement of communities, repression and poverty has affected the psyche of many South Africans. This presents itself in high levels of violence, alcoholism, drug abuse and depression as well as anxiety disorders like post-traumatic stress syndrome and mood disorders. A lack of understanding of mental health issues, limited resources and a lack of psychological or psychiatric support in many communities exacerbates these problems and prevents their cure.

Traditionally mental health issues were dealt with in large institutions, but increasingly the responsibility for care is being devolved to community clinics, support groups and residential rehabilitation programs, slowly increasing access to care. An increase in this kind of support is essential in supporting people infected with HIV/AIDS and their home-based caregivers who are both highly vulnerable to depression. Education around mental health disorders is also essential in reducing the stigma associated with mental disorders and increasing the willingness and ability of people to seek help.

Several Connect-123 interns have been involved in doing occupational therapy, counseling and social work in mental health programs, whilst others have been involved in psychiatric research. The lack of staff and resources in the sector means that additional skills are highly valued and with the right skills there is a lot of potential to get involved in some very interesting projects.

The World Health Organization has identified chronic diseases of lifestyle as the leading cause of death in the future and it is very important that these issues be addressed through proper education and initiatives to promote physical activity, especially amongst younger populations that are particularly vulnerable.

South Africa displays high levels of both infectious diseases related to poverty and chronic diseases of lifestyle (CDL). Increased adoption of a Westernized diet without sufficient education on nutrition or the importance of exercise puts significant numbers of South Africans at risk, especially in urban areas where “junk” food, high in carbohydrates and saturated fats is cheaper and more readily available than fresh, healthier food.

Obesity in South Africa, especially in woman (40% of population) is very high. Bigger woman are considered more beautiful in many African cultures and this contributes to and exacerbates the problem. As HIV/AIDS and tuberculosis are associated with weight loss, slimness is seen as an indication of sickness and the stigma surrounding HIV/AIDS discourages South African woman from attempting to lose weight.

Physical education and sports are no longer part of the national curriculum in South African government schools, meaning that many younger South Africans are not exposed to any forms of exercise, increasing the likelihood that children and adolescents will continue with sedentary behavior into adulthood.

Connect-123 works with several sports development, exercise promotion and health education organizations in Cape Town and Buenos Aires where CDLs are also an increasing problem. These organizations promote life skills, healthy eating and participation in sports such as rugby, athletics, soccer and basketball or community-run, age appropriate fitness classes. The work done by these organizations is integral to developing healthier attitudes and healthier people in South Africa and Argentina and the assistance of Connect-123 interns enhances their capacity to engage with and assist local communities.

Coming up to the halfway mark now, World Cup fever is leaving no area untouched! It has offered an exciting distraction for so many South Africans not excluding the littlest ones. At the Red Cross War Memorial Children’s Hospital, the staff have gone out of their way to hang flags throughout the hospital and even installed a life size Zakumi in the main foyer. Doctors have even added colorful hats to their typical scrub attire in support of the festivities (which makes quite an impression in the operating theatre).

These days, it is every child’s dream to become a professional soccer player and mini vuvuzelas and soccer balls litter the wards. Toddlers have been outfitted in green and yellow “Bafana” beanies and Zakumi tattoos – completely unaware of their allegiance (and how adorable they look!).

Connect-123’s child life program has taken full advantage of the excitement and utilized the diski dance as a means of getting the children moving, soccer facts as conversation starters, and has coined the games, “name that flag” and “what else could this vuvuzela be?” The latter could also be called, “let’s think of something else to do with this besides annoy everyone around us.”

Even in a place where illness and injury don’t take a break to follow the matches, World Cup excitement is high. It is everywhere. Pride resonates from every corner. Even though our passion for soccer ranges from person to person and our country of allegiance may differ, we have all been touched in some way or another.

But the World Cup fever will have already infected the city with the Cape Town Welcomes the World Party taking place at the Grand Parade in the centre of town on Thursday. The celebrations start at 14h00 with an excellent line-up of local music acts. At 19h00 we will witness the switching on of the Adderley Street soccer lights, which also heralds the beginning of the Carnival Parade.  The 2,000 people strong parade will the led by the famous Cape Minstrels, and will represent the incredible diversity of the Mother City.

The Grand Parade is where the FIFA Fan Fest will be located; open every day from 11h00 to 23h00, all 64 World Cup matches will be shown with live performances from local music acts between the games to keep us entertained. Musical highlights will include Goldfish, playing on Sunday 13th June, and Freshly Ground, playing on Saturday 3rd of July. The Fan Fest has a capacity of 25,000 people and entry is free.

The Connect-123 Cape Town team is definitely geared up and ready to enjoy this once in a lifetime experience – and to help our program participants do so too. Seen here getting into the spirit on the last Football Friday before kick-off, their message to all our Cape Town interns is this:

“Feel it, it is HERE!!!”

With the highest number of HIV-infected people in the world, South Africa is faced with a hyper-epidemic. UNAIDS estimated that in 2009 5.7 million people were living with HIV and it was estimated that 400 000 people died during this year. Whilst the number of HIV infections per year started to decrease from 1999, there was steep increase in the number of deaths over this period. A recent national household survey puts HIV prevalence at 11% of the population and a sero-prevalence study done on pregnant woman indicated that in 2008 29.3% were HIV positive. Anti-natal prevalence is often used as an indicator of infection amongst the sexually active population who are most likely to spread HIV. It also indicates high potential for mother to child transmission of HIV/AIDS, a major cause of new infections. Although these numbers seem to be slowly leveling out, the approximately 500 000 new infections per year still present a serious challenge to the South African healthcare system.

April 2010 saw the launch of the South African governments new HIV Counselling and Testing program (HTC) which aims to provide voluntary counseling and testing to 15million people by June 2011 as well as provide anti-retrovirals to mothers earlier on in their pregnancies to prevent transmission as well as providing treatment to all HIV-positive infants under the age of one.

This is a step away from previous denialist policies where government refused to provide anti-retrovirals in government facilities because of their toxicity, advocating healthier eating and lifestyle changes instead under the premise that poverty rather than HIV causes AIDS.  After heavy campaigning by human rights activists, public access to ARVs finally began in 2003, far behind the rest of the world. Rollout of treatment was extremely slow, with poor access to medicine still existing in many areas. The delayed reaction by government, confusing messages around the disease and high levels of poverty and related social problems have allowed the disease to grow to an uncontrollable size, killing millions of people since the late 1980s.

Whilst the introduction of ARVs has meant that HIV infection is no longer an immediate death sentence, there is still no cure for the disease. With an HIV vaccine yet to be developed, prevention programs are an important part of slowing the onslaught of the pandemic. Educational campaigns to reduce the low perception of risk amongst South Africans and altering sexual behavior are essential in tackling the disease.

Connect-123 works with various HIV organizations involved in education, voluntary counseling and testing, social and clinical research. This provides the opportunity for medically and socially interested interns and volunteers to get involved in much-needed efforts to prevent and treat this disease.

Sources:

Republic of South Africa Country Progress Report on the Declaration of Commitment On HIV/AIDS, 2010

Avert Website: http://www.avert.org

The Cape Town Connect-123 team are also getting into the spirit of things, showing their support by sporting soccer tops for “Football Fridays”, a nationwide campaign to get South Africa behind the World Cup by wearing their chosen team’s colours on Fridays.  So if you’re currently getting ready to come to Cape Town – don’t forget to pack your soccer jersey! And get ready to hear the sound of the vuvuzelas, the metre long, brightly coloured plastic trumpets that local South African football fans love!

As Connect-123 looks forward to welcoming over 100 interns in June and July, Cape Town also eagerly awaits its chance to welcome the world for the World Cup 2010! Yebo!

South Africa has a high burden of tuberculosis infection and was reported to have the 10^th highest number of people in the world living with tuberculosis over the period 2007-2008. As only the 24^th most populous country in the world, this indicates a very high prevalence of infection in the South African population. According to Globalhealthfacts.org 606 people out of every 100,000 were treated for tuberculosis between 2007 and 2008, with 906 new cases for every 100,000 reported during that same year.

In most other countries the incidence of infection (the number of new cases per year) is dropping, but unfortunately in South Africa this number is rising due to the high prevalence of HIV/AIDS in the country. HIV-infected persons are more vulnerable to contracting infectious diseases such as TB. They become sicker quicker, take longer to recover and are far more likely to die from the disease – tuberculosis is the biggest contributor to HIV/AIDS deaths.

Tuberculosis requires a long period of drug treatment – from 6 months to 2 years, depending on the type of tuberculosis contracted by the patient. Poor management or failure to complete treatment regimes has led to the development of multi-drug resistant and extensively drug resistant strains of tuberculosis. These difficult-to-cure forms of the disease present additional complexities in treatment and a growing challenge to the South African healthcare system.

But it’s not all doom and gloom! There are some fantastic non-profit organizations, research departments and national partnerships that are doing work around prevention through awareness and education, direct observation of patients undergoing treatment to prevent non-compliance, patient care and rehabilitation.

The city of Cape Town recently won a United Nations award for improvements in service delivery around TB, achieving a cure rate of 80% last year – greater than any other city in South Africa, despite having a significantly higher TB rate than the national average. This tremendous turn-around in one of the worst affected areas in South Africa was achieved by training unemployed school leavers to monitor TB patients to ensure that they stick to their treatment regimes.

There is a significant amount of work to be done in the area of integrated TB and HIV/AIDS care and the support of interns and volunteers is important in helping local public health organizations to address these issues. With World Tuberculosis Day coming up on the 24^th of March, it’s a great time to get involved in helping to tackle this disease!

Thousands of refugees from surrounding war-torn and destitute African countries flock to South Africa in hope of a better life, or just a means to at least feed their children.  However, life is not easy for them when they get to South Africa, a country that itself has huge levels of unemployment and poverty.  The refugees are faced with dealing with Home Affairs to get their asylum papers, a lengthy and difficult process. They are often faced with xenophobia from South Africans in the communities they are trying to stay in, who see them as unwelcome and a threat to their employment.  They find themselves, having escaped the horrors of their home countries in a desperate situation, now having no access to basic necessities like food, clothing, shelter, and water, let alone employment and a positive future for themselves and their families.

In order to make this difficult transition easier, there are several non-profit and human rights organizations in Cape Town that aim to assist this needy population.  Connect-123 has partnered with these organizations that include refugee centers, orphanages, activist organizations, legal aid clinics, and organizations that offer humanitarian assistance, and skills training and development.  Our interns and volunteers come and apply their skills to assist these organizations in helping these desperately needy people.

This is an area that needs great assistance and we look forward to welcoming more people to help in this area.  Whether you have an interest in human rights, are able to speak French, have a legal background, social work skills, are interested in research around issues of migration, or you simply want to help, we need you!  Many of our program participants volunteer their extra time to assist refugee orphans with their homework, and even donating unwanted clothes and toiletries goes some way in helping to give these people at least some dignity and a chance for a better life.

Having a large number Child Life students working in the hospital over this period opened up the possibility of extending Child Life services beyond the burns ward, the site of our original pilot study. Part of their work involved assessing the wards where Child Life services would be most beneficial as well as leaving behind materials that would benefit their allocated wards or the greater hospital on a more long-term basis. In addition to all their hard work at the Red Cross, the Ohio group also contributed their time and skills to a pediatric HIV clinic and a pediatric convalescent home, engaging children in activities from singing and crafts to medical play.

The volunteers were also fortunate enough to be given the opportunity to visit a clinic in the township of Khayelitsha where they were able to experience a community healthcare setting, greatly enriching their understanding of the South African healthcare system – several of the volunteers even witnessed babies being born during their visit!

During their stay, the high-energy group also managed to squeeze in a safari, bungee jumping, a soccer tournament, a trip to the beautiful Cape Point, an African-style dinner, Thanksgiving and Christmas celebrations and plenty of trips to the beach!

A clear message rang through the group’s final presentation to the Red Cross medical staff at the end of their stay – Child Life services significantly improve the quality of care and support provided to patients and their families. Based on the students’ work, the decision was taken to extend permanent services to the oncology wards with continued expansion planned throughout the hospital’s in and outpatient wards and operating theaters as the program grows and develops. With the Cape Town Child Life program celebrating its first birthday in February, the program is looking forward to the meeting new challenges that lie ahead for 2010, not to mention welcoming plenty more passionate and energetic volunteers to Cape Town.

Before they left we asked the group what advice they would give to future volunteers – here is what some of them had to say: “Just to keep an open mind about the Child Life lens and to do the best at what we have learned with the resources we are given. It’s about the creativity and the ability to adapt to new settings. That little things make a big difference”. “I loved having the close one-on-one involvement with the patients. In the States this would not be possible as a student in a practicum. This helped me to gain confidence. Take advantage of every single day here. The time flies by. Don’t be afraid to jump in, feet first. Many sisters and doctors are very accepting and helpful.” “Don’t be afraid to step out of your comfort zone. It may be frustrating and scary at first but it’s well worth it.”

Past blog entries for Child Life Cape Town:
Child Life Healthcare Project in Cape Town
Child Life Program Update

The New 7 Wonders Foundation is taking international votes to nominate the New 7 Wonders of the World with the philosophy that “Our Heritage is Our Future”.  Table Mountain has made it to the final 28 contenders to take the superior title of truly being one of the World’s Wonders, and rightly so…

Table Mountain is one of the oldest mountains on earth, six times older than the Himalayas and five times older than the Rockies. Its story begins eight hundred million years ago when sandstone began to form underwater. Around 300 million years ago the mountain was still at sea level during an ice age. It is the ice sheets that flattened the layers of sandstone creating the flat surface that gives the mountain its unique shape and name.  When the continents split apart, the layers of rock were forced to rise, slowly becoming the kilometre high mountain Cape Town prides itself with today.

It is not only the mountain’s iconic flat surface that gives it the right to contend for a position as one of the 7 New Wonders.  In addition, Table Mountain National Park has more plant species within its 25 000 hectares than the whole British Isles or New Zealand!

Only one other African site – Tanzania’s Mount Kilimanjaro – made the list of finalists, which include some of the world’s most spectacular natural attractions including the Grand Canyon in the USA, the Galapagos Islands off Ecuador, and the Amazon Rainforest.

The New 7 Wonders of Nature campaign aims to raise awareness of the incredible variety and beauty of nature around us.  Votes for the 28 finalists will continue throughout 2010 and into 2011 to result in the New 7 Wonders of Nature.   Make sure our beautiful mountain receives the recognition it deserves and cast your vote now!

In the meantime, be sure to hike up one of the spectacular routes to the top so that you can say you made it to the top of one of the 7 Wonders of Nature!

The following is a small sample:  

• “It takes her mind off the pain and motivates her to get better.”- Grandmother of a four-year-old burn survivor.
• “She made me laugh and happy. She did fun things with me.”-  Twelve-year-old burn survivor
• “Even if my child is going to dressing, they are there for her.  Even when she is going to theatre, they are there holding her hands.  They did not do this for my child only but for the whole burn’s unit.  They play with our children and take their minds off pain.”-Mother of an eleven-year-old burn survivor

Collaborating with professionals including doctors, surgeons, anesthesiologists, occupational therapists, physiotherapists, and nursing staff at RCCH has truly made this program a multidisciplinary effort.  Without their support and continued enthusiasm regarding child life services, this program would not have been possible.  Here is just a small sample of some of the amazing feedback the child life team has received:

• “A happy child heals faster. I am sure this has reduced pts hospital time and allowed us to open beds for more patients…. I can see the huge impact that they have had and would love to include them in our team on a permanent basis!” S. Warren, Professional Nurse
• “I definitely saw a big difference in the children and heir families when the CLS worked with them- they were less confused, less anxious, more compliant with treatment and generally the ward atmosphere improved with all staff being more attentive and aware of the children’s mood.”- J. Kuum, OT
• “It helps to know that there is a child life specialist available to talk to the child, parents to help ease their fears or just hold their hands and provide comfort” M. Miller, Professional Nurse

As feedback has been incredibly encouraging both from those treated at RCCH and those who work there, the next phase of the program development will involve efforts to ensure the sustainability of these services.  International child life volunteers contributing their time, enthusiasm, and skills is essential to continue positively impacting the children and staff at RCCH! Child Life Specialists who are interested in learning more about this amazing opportunity to profoundly impact the lives of deserving children are invited to contact us with enquiries.

Child Life Specialists use therapeutic and recreational play in order to reduce the fears and fantasies that children associate with the unknown hospital environment. Separation from parents, the unfamiliar environment, procedures and equipment as well as pain, all create anxiety within children who feel threatened by what they do not understand. Specialists also provide emotional support to families who may unwittingly transfer their own stress onto the child.

The idea of Child Life was introduced to hospital staff and management by Bobbi Jo Pansier, a Child Life Student from the University of Wisconsin-Lacrosse and will be extended with a the assistance of a Caroline Hargrave, a volunteer from Wheelock College. A pilot study will be run by Connect-123 volunteers in Cape Town between Feburary and May 2009.

The Shadow Buddies Foundation and Connect-123 are making a joint donation of specialised dolls to the hospital and our current Connect-123 interns have been hard at work creating photo books which will guide patients through their hospital experience.

As no certification for Child Life Specialists exists in South Africa and hospital resources are limited, the involvement of international volunteers is imperative. So far, we’ve been thrilled by the international Child Life community’s response and are confident that, with increased interest in volunteering and interning in Cape Town, the program will be sustainable far into the future.

The project involved fund-raising, teaching 125 students from Khayelitsha and Nyanga to use digital cameras, working with the students to edit their favorite images, and finally displaying the photographs at the library as part of a photo exhibit entitled “Through My Eyes”. The original exhibit launched today Khayelitsha with about 200 people in attendance and it continues as a very successful yearly fundraiser for the organization. This year’s project culminated in the publication of a book of photographs and poetry composed by the students, also entitled “Through My Eyes”.

In June 2006, Connect-123 interns Kyla, Allie, Stephen, Katherine, and Sarah gave local students digital cameras to use for 3 days and asked them to document their lives in the townships. As part of the editing process, the students chose those images that were most meaningful to them and then wrote about why they made their selections. These paragraphs were then displayed next to the images at the exhibit.

The entire process, from first holding a camera to displaying their work at their exhibit, took only three weeks. At the exhibit, the local students’ sense of accomplishment and pride was self-evident.

To increase awareness, the Connect-123 interns exhibited the photo’s back home in Canada. In addition, in November 2006, “Through My Eyes” travelled to Singapore for an exhibit to raise money for a new Khayelitsha-based learning center.

Every year Connect-123 interns are involved with organizing the exhibition and festivities surrounding it and Connect-123 is proud to be associated with such a great, dynamic organization.

Up until recently, volunteering was reserved for those who could afford to take on the high costs associated with travelling overseas and doing unpaid work. Several organisations have realised the value in creating the opportunity for a more diverse set of volunteers to travel beyond American borders and several fellowships have been set up to this end. The GSFP Act aims to double the number of American volunteers abroad by offering $50 million dollars per year to fund fellowships for 100 000 volunteers. By removing financial barriers, this initiative would create greater heterogeneity in America’s group of representatives abroad. This would greatly enhance the capacity of international organisations to make a real difference on the ground.

Connect-123 is a member of the Building Bridges Coalition, a consortium which is aiming to double the number of volunteers sent abroad, improve the quality of volunteer service and to maximise the impact of this service in community. In our experience, international volunteers can create substantial local impact, while enhancing their own understanding of other cultures and building valuable life skills. We  strongly support all efforts to lobby the US senate to pass the Act.