I know it’s been a long time since I’ve written. Before I
jump in to today’s topic, I’ll throw in a quick personal update.
The people I came to Swaziland with more than two years ago
are mostly gone. They’ve closed their service and moved on to the next steps of
their lives. Five of us chose to stay for a third year, and I’ve started my
third year work assignment now. Two months ago, I moved to Mbabane and started
working with the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF). I’m still
a Peace Corps Volunteer, but third years frequently partner with NGOs or other
development organizations to work on organizational capacity building in
addition to the individual capacity building we’ve been doing for the first two
years. I live in a nice little flat with running water, a hot shower, a
microwave, an oven, and a great big closet. Life in the city is nice; I’m
walking distance of a grocery store, a restaurant with sushi, and a decent
mall.
So far, I’m still settling in to my job. I’ve edited a
report for printing and distribution, and I’ve also done data analysis and
report writing on another research study. I’ve also been working with a team to
attend rural communities, where we have a day for HIV: testing, discussion
groups, skits, songs, dances, and food. However, it was editing that first
report that has allowed me to look back on my service with a new attitude.
The report was on a study we did with PSI exploring the
reasons why so many women seroconvert (become HIV+) during pregnancy. We were
exploring both sexual behaviors and healthcare access. We interviewed focus groups
of men, women, and healthcare workers. Something one of the healthcare workers
said really stuck out to me, and I’ve been mulling it over for some time.
"A long time ago there used to be community nurses.
They would take a car and go to the communities [to provide HIV education] but
those projects have since died... maybe it's because our numbers as health
workers have gone down or the strategies for accessing communities are no
longer functional. But sitting in the health facilities, we are not winning the
battle, be it tuberculosis, be it HIV, we are not winning it."
Rural communities
have clinics, several rural communities and clinics compose the catchment area
for a public health unit (PHU) or bigger clinic in a particular area (called an
inkhundla), and several tinkhundla PHUs report back to a clinic or hospital in
an urban area. This health care worker worked at a health facility in an urban
area and not in the rural communities. She was expressing her frustration at
being unable to reach rural Swazis who have limited access to money, transport,
time, and other resources that make clinic visits a possibility. At first, I felt
a sense of sadness and defeat reading that quotation, but then I spent some
more time thinking. Do you know who lives in the rural areas and has
strategies, resources, and motivation for reaching these underserved
populations?
That’s right – Peace
Corps Volunteers.
When you live in a
rural community, your community is your life. You live and work and learn
there, and the people you serve are there. You know your clinic and your school
and your inner council, but you wouldn’t necessarily work at a level beyond
your community. You wouldn’t have access to those nurses who work at a bigger
level of healthcare, and you wouldn’t hear the passion and longing they express
to have the resources to change their country. You see your nurses, your
clinic, your teachers, your school, and little else. That’s what makes Peace
Corps special – this access to and focus on underserved rural communities
instead of resource-rich urban areas.
It’s also what
makes Peace Corps frustrating. As an American, you can’t gain an understanding
of a foreign country’s entire complex healthcare system in just two or three
years. As a PCV, you work hard to just understand the structures in your own
rural community. When all you see is a clinic that ran out of ARVs or can’t
keep funding food at support group meetings, you feel frustrated. Sometimes it
feels like you’re the only one who cares or who is willing to work for change. When
you have the rare opportunity to work in a city in an NGO at the highest levels
of healthcare, you are able to look down the lines of the system and see
something else.
People care. Your service
matters. Swazis in the urban areas express a need for the roles that we fill to
be filled. We’re part of a puzzle that fits together intricately, but seeing
beyond your own piece is challenging.
I’m not saying that
my faith in the system is absolute now, but what this quotation and the past
two months have taught me is that the limited number of people we meet during
service can’t represent the system as a whole, and it’s so much more
complicated than we could have ever imagined. I’m able to see my work in the
context of national development instead of local development, and it gives me
renewed hope. Development is a challenging field because we’re bringing Western
ideas of what it is to be developed and what needs to be done to get there into
a society with its own cultures, traditions, and challenges. We’re frequently
hitting walls and having our ideas dismissed until we learn how to work within
the culture instead of trying to work against it.
The beauty of a two
year assignment is the ability to gain an understanding of and an appreciation
for a culture that isn’t Western and isn’t your own. You build relationships,
gain and give trust, and become part of a family and community you couldn’t
have imagined before coming here. The beauty of a third year is an added
understanding of development as a system of structures and partners, with
individuals being the key players but not the large-scale change agents. What PCVs
do in the communities and what we do as part of NGOs are different roles that
contribute in different ways to the larger picture of development and service. Her
smile is a small part of the Mona Lisa, and the entire painting is what is
considered the masterpiece; in the same way, the many PCVs and projects and NGOs and
partners and Swazis make up this complex and beautiful painting that is
Swaziland and development.
