One of the ethical issues that is at the forefront of peoples minds is the community involvement in volunteering abroad placements and this is clearly in the Community Health and Home Based Care and HIV/AIDs Education and Orphan Care in St Lucia, South Africa. Community members are involved in the design, running and direction of the projects both up front and on an on-going basis. Here is how.
One of the most important relationships is the one that exists with the Induna, or chief, of two large rural communities. Before any work was undertaken the needs and direction of the activities were discussed in depth gaining consent to work within the communities and a clear understanding of their needs. Once the scope was established regular meetings were set up to review the progress and impact of the projects, changing elements of each project as necessary. This is very much a collaborative process and essential to the sustainability of the project, and something that any participant should be looking for from their volunteer abroad placement.
On the Community Health and Home-Based Care project here are some of the steps taken to ensure that the needs of the community are being considered:
- Shwele, a Zulu lady who lives in one of the communities, leads the project. She speaks the local language, understands the customs and has a great rapport with the community, as well as having a nurse management background.
- Community care and community health workers covering large areas on foot liaise daily with Shwele and the project ensuring that those who need urgent medical attention, support with clinic visits, medication or home visits are prioritised.
- At the clinic a good relationship has been formed so that the elderly, disabled or chronically sick are seen quickly, so more patients are able to access care, and have access to visiting medical specialists.
- Following up with home support once patients have consulted visiting specialists ensuring better adherence to treatment plans e.g. physiotherapy for those with injuries caused by strokes and car accidents, both common in the area.
- Providing home-based care visits to support those struggling to live positively with HIV, with most cases being referred by community carers. With over 45% of the population infected in these communities, managing drug use, a healthy diet and general well being can be a struggle and the regular team visits provides this service.
- Regular groups discuss health related topics such as nutrition, living positively with HIV, childbirth etc. Group members very much determine the topics that are discussed.
On the HIV/Aids education and orphan day care project the involvement of the community is as follows:
- Nok, a Zulu lady who lives in one of the communities leads the project. She speaks the language, understands the school system and has a great rapport with the children.
- A curriculum, established through collaboration with the Induna, is being rolled out to 8 pre-schools, and aims to prepare children for their places in mainstream education. It is proven that good pre-school gives children a huge advantage at primary school.
- Local teachers are being supported with lesson planning and running classes as many of them have little or no training. This is developing capacity within the community and the teachers are delighted to have some support.
- The community have welcomed a static library and weekly reading club where children are able to access a huge range of books and receive reading support.
- Regular meetings identify those who are more vulnerable in the community that need extra home assistance. For example, where children are caring for elderly or sick relatives, assistance is provided with chores enabling the child to attend school. These children are often referred by concerned neighbours or highlighted as a priority at community meetings
- The community requests support for those who cannot access water to keep themselves, their homes or their clothes clean. By obtaining large volumes of water this removes the stress and enables those in most need to focus on getting better.
“Home Based care is very important (..to the community) because clinics and hospitals are far away from homes so may people are dying at home as no one is encouraging them to take medication correctly or taking them to the clinic. Some of them don’t even know how to take their medication correctly”