Giving back to the givers: volunteer caregivers from Mtunzini graduate in home-based care training

For the 72 volunteer home-based carers of Entabeni in northern KwaZulu-Natal, March 23rd this year was not an ordinary day, and for once they did not visit households to care for sick people. It was a very special day when a dream came true, and they celebrated their graduation as fully trained and accredited home-based caregivers.

A research team from HIVAN had come to know this group of dedicated community members over many months, while studying responses to HIV and AIDS in this remote rural community in Mtunzini. Senior researcher Yugi Nair and fieldworkers Sbongile Maimane and Zweni Sibiya planned and implemented numerous activities in consultation with the local stakeholder representatives on the basis of the research findings. One of these was a home-based-care training programme for the volunteers, with a special focus on people living with HIV and AIDS.

Yugi, Sbongile and Zweni are deeply impressed by the challenging work done by these volunteers under harsh conditions. They were already aware that in South Africa, many thousands of such caregivers work tirelessly to ease the suffering of their neighbours without compensation. ?They walk long distances in the sweltering heat, climbing steep mountains and going down into the valleys where the households are located,? observed Sbongile, who engaged closely with the volunteers and documented their training process.

?When our team started doing research in this community, almost all the caregivers had no training on HIV/AIDS and how to care for people living with the disease, and acquiring this knowledge was one of their main concerns. We explained to them that we could not train them ourselves, but that we would find a qualified trainer for them.?

The researchers partnered with a medical training organisation for this purpose, and when they told the group that their tuition would soon start, the women volunteers were very excited. ?It was really good news for them,? recalled Sbongile. ?One of them said that she couldn?t wait for the day she would have that certificate in her hand, and that she?d pinch herself to check that it would really be happening.?

Preparations began and everybody got involved. The training of the first group was conducted over two weeks in a community hall, followed by another two-week course for the second group. For the researchers, preparing for this event was not always easy: ?We had to find accommodation for the trainer in the community,? explains Sbongile, ?so that she would be part of the community and easily accessible; also, the person hosting her had to commit to the responsibility of taking care of her while the training took place. For the trainer herself, staying in the rural community wasn?t easy for a lady from the city. When she was about to drink river water for the first time, she said that she too would be learning something new to her!?

Once it was realised that several volunteers could not follow parts of the course because of certain information being relayed in English, the trainer translated these sections into isiZulu. However, she also encouraged those who did not understand to try to learn the English terms, as they were likely to come across such words in clinics and hospitals. According to Sbongile, the trainer told the volunteers: ?I am not training you to be fake home-based carers. I want you to understand when nurses ask you questions about diseases and to be able to respond with confidence. Some of these diseases don?t have isiZulu names.?

The volunteer group included a range of age groups and both male and female caregivers. In going through their training, the younger caregivers were required to break with tradition and address their elders in the group by their names. As Sbongile watched the group?s progress with affection and admiration, she noticed that one particular youngster felt uncomfortable about this apparent lack of respect for older people, and declared that this practice would cease once the training was over.

?The trainer punctuated her teaching with jokes,? recalls Sbongile. ?When the participants took some time answering her questions, she would say, ?I don?t like people who ride snails. You must be sharp!??

The trainees enjoyed their learning experience so much that they were somewhat sad on their last day. One of the caregivers mentioned how thrilled her children were to see their mother waking up with them and preparing to go to ?school? every day, and how her family were eager to know what she had learned. Her husband had been very supportive of the training intervention and the research study, and had helped to lift the researchers? car out of a muddy ditch one day, removing his shoes and lifting his trousers to plunge into the brown water. When the car wheels rolled, the muddy water splashed all over him, but he was only too happy to help the team to reach the training venue.

The trainees? certificates had to be printed more than 100 kms away from the community, so it was arranged for a special graduation day to be held a few weeks later. The caregivers prepared the programme themselves with great enthusiasm and pride. Despite their lack of income and the remoteness of their community, as empowered graduands, they arranged to hire academic gowns for the entire group, so that they could all celebrate the triumphant spirit of the occasion and their personal achievement, in deservedly grand style.

?The day was spectacular, and all the proceedings were taped and filmed on video,? reports Sbongile. ?The inkosi, the local chief, had given permission for the graduation to take place in his traditional court, and traditional leaders from the community graced the event. One woman leader praised the caregivers, especially the male volunteers, noting that their involvement was unusual at council meetings, and that home-based care was clearly most worthy effort. The local traditional healer, who is well-known in the area for treating HIV-positive patients, also complimented the caregivers; admitting that he used to look down upon what they were doing and wondered why they ?walked up and down like lunatics?, on that day he recognised the results of their hard work.?

Members of the community, including many small children, joined in to watch the ceremony and enjoy the festivities that followed. Sbongile says that after each musical item, there was great applause, ululating and dancing. Family, friends and neighbours looked on with joy and approval when the caregivers received their certificates.

The positive effects of this training and the accomplishments of the volunteer caregivers will be sustained through this community, as their work and skills have no doubt inspired others to join them in caring for those in need.

As Sbongile explains, her team?s research efforts are carefully designed working in full partnership with the residents of Entabeni. The training itself was subsequently evaluated in six individual interviews and two focus group discussions. ?All the stakeholders, both internal and external, were fully involved in the study from the outset, and we not only reported our findings to them,? she explains, ?but continue to work with them to address the many problems created by HIV/AIDS, poverty and lack of basic resources.?

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