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South Africa Trip Report: Keiskamma Trust

April 9, 2009

By Zaida Bastos

I visited the Keiskamma Trust in Hamburg on February 26 — 28, 2009.  The objective of the visit was:

  • To visit the Keiskamma Health Trust Program that has received support from PWRDF;
  • To better understand the scope of the programs run by the Keiskamma Trust and how they relate to the HIV/AIDS health sector, which seems to be the foundations of Keiskamma Trust community work;
  • To discuss continuing funding from PWRDF.

Carol Hofmeyr is a South African medical doctor by training and the force behind Keiskamma Trust (in this report, Trust and Keiskamma Trust are synonymous).  As Carol put it, the Keiskamma Trust began with an insignificant embroidery project with the aim of involving local people to use their skills to improve their living conditions.  Unfortunately, the health issues affecting the population in the Peddie District were staring Carol in the face.  With help from friends she began a small program of providing ARVs for people in Hamburg.  The program grew large and became the Keiskamma Health Program, with focus on HIV and TB care and education.  

The Trust also runs other programs that complement the health program. As many other grassroots organizations, Keiskamma Trust understood that good health is more than just taking care of the various singular components that make up the physical body.  Once patients with AIDS were released from the health clinic, they were faced with the challenge of how to live a positive life as a HIV positive person.  To address this issue, the program offers other components that add value to the HIV and Health program.  These are the programs: a) Keiskamma Art Project; b) Heritage Program; c) After School Care Centres; and d) Organic Gardens Program.

Brief description of programs

HIV/AIDS Health Program — In 2008 the Keikamma health program worked very closely with the government to improve trust and better services for patients being treated by the Trust.  A committee made up of government, community and NGOs was formed to jointly deal with the epidemic at local level.  This approach helped government to better understand the role that NGOs and community play as partners in the fight of the pandemic.  As a result of this initiative, the Keiskamma health program has a better collaboration with the Nompumelelo hospital that is the closest hospital to Hamburg. The Trust feels that this will hugely improve accessibility to patients to treatments that cannot be provided at the Keiskamma health centre.

The Trust also trains and works with village health workers in 33 villages.  The work consists in developing the capacity of the village health workers to keep accurate records of the patients that they were serving.  The Trust carried out by-monthly meetings with the health workers.  This initiative has strengthened the program because it has improved the record-keeping of patient’s status and subsequently can provide a better accompaniment.  Among the many services that the Trust provides to people living with AIDS are: a) treatment literacy; b) ARV therapy; c) counseling; e) mother to child transmission.
The Keiskamma Health Program had as plan to begin to phase out the in-patient program and scale up the pediatric, education and community health and preventive programs.  However, the demands for the in-patient program did not diminish and the health centre treated a total of 200 patients which 198 were put in ant-retroviral therapy, including 65 children in 2008.  The Trust had to recognize that there is great demand for the in-patient services that the organization offers and that the public health sector cannot absorb the enormity of people with AIDS and TB in the area.

The Trust recognizes that the in-patient program is very expensive and time consuming but it is also a necessary service to provide to the community.  In terms of the pediatric clinic, the Trust had to review its decision to create an exclusively pediatric clinic.  This decision was taken because it is part of the local practice that children with AIDS usually stay in the clinic with their mothers.  The clinic does not have the necessary set-up to and support services to keep the children by themselves.  So, during their hospital stay they are accompanied by their mothers whom provide the appropriate emotional and practical support to their sick children.  The arrangement seems to suit everybody and the pediatric program is fully operating in a different configuration than it was initially conceptualized, which in its initial proposal made provisions for the construction of a separate building to operate the pediatric clinic.  The Trust also set-up an OVC (orphans and vulnerable children) program which partly fall in health and partly in education.  This program operates from Lovers Twist and Mgababa.  Presently the program assists 300 children daily.

Keiskamma Art Project

The art project is the one of the most known programs of Keiskamma outside of Hamburg. 
Picture: Veronica Betani is the coordinator of the Art Program.  Many of the women working in the art program are HIV positive.
The women that work in the program come from very poor households and many of them are HIV positive.  The Canadian public became acquainted with this program through the Keiskamma Altarpiece that was exhibit at St. James Cathedral in Toronto during the International AIDS Conference in Toronto.  The art group also created the Creation Altarpiece which has been exhibit in Cape Town, Johannesburg and will possibly be bought by the Johannesburg Art Gallery.  The work of this program is very well appreciated in South Africa and has been exhibit in many galleries and the towns in East London mainly but also throughout South Africa.  

The project also produces embroidered pillows, bags and other art articles that they sell in their shop in Hamburg.  The work of the group is getting recognition and during my visit the workers were putting the final touches in big order of tapestries for a South African bank.  This is a very effective and well run program.  During the year 2008, the group as seen an increase of 25% in their sales of small commissions.  The group has a range of catalogues with nice graphics that speak of the work.

Organic Garden
The organic garden project is a pilot garden and nursery project that has as goal to complement the Health Program.  AIDS recovering patients and people living with HIV/AIDS are encouraged to have a diet rich in fresh foods, including lots of vegetables and fruits.  In order to make these dietary changes, people are being taught how to grow their own vegetables and fruits to ensure an affordable and sustainable supply of produce.  

An organic garden Coordinator has been selected within the community, and under the guidance and leadership of Franck Danais (a French expatriate) she is beginning to organize training workshops to disseminate how to grow vegetables and fruits using organic techniques.  Interested members of the community are learning how to protect their gardens against wind, birds, worms, etc; how to prepare the soil and use of organic repellents and fertilizers; use of water; mulching; plant association; rotations; environmental issues; health issues and the benefits of organic gardening.  A variety of vegetables have been introduced in the community through the organic garden project.  So far 20 families have begun to grow their own vegetables.

There is a great value in introducing organic garden in an area where the population does not have a great tradition as farmers.  The local population is mostly pastoralist and cows are revered and are everywhere.  In addition to that poverty is rampant in the area.  By growing their own vegetables and fruits the local population will improve their dietary practices and cut the cost of their food bills.  It has been proved that by growing their own vegetables and fruits people can save up to 25% of their grocery bill.

Education Program

The Trust currently supports three education centres in Hamburg, Mgababa and Lover’s Twist.  This after-school program has as goal to identify children that need remedial help.  The education program spans all aspects of the projects run by the Trust.  Besides the after-school program it also provides art education, music education, and organic community gardens.  The main target of the program is HIV orphans or vulnerable children and helps them cope with their loss.  The program provides a range of services to these children, ranging from meals, academic help, to school fees.  The music component of the program is very successful.  A group of students have performed in several venues in East London and beyond.  At the present the after-school program is feeding approximately 300 children from the three villages covered by the program.

Heritage Site 
The Trust is running a heritage site program that has an incredible historical value. 
Picture: a tapestry made by the women of the Art Program.
The heritage program brings together the story of the Khosa people in Ciskei bantustan (apartheid name) which today is part of the Eastern Cape Province.  Cows are omnipresent in the Khosa culture.  It was explained to me that when the British invaded South Africa a healer went to the elders and told them that the ancestors came into her dreams and told her that the British were after the cows (which was the wealth of the Khosa people) and they would leave if the cows would disappear.  In the hope that the British would leave the elders agreed to kill all cows.  Unfortunately the British never left.  Today, the cow is a revered animal.  They are everywhere.  In the gardens, the roads, the fields.  Cars have to yield to them.  

The heritage site has a nice panel telling the story of the Khosa people, their battles and their traditions covering the walls of the centre.  The compound in which the Heritage Site is located has several constructions depicting a traditional Khosa house and its rounded room where every family worships the ancestors; a traditional corral where the cow-killing ceremonies take place; and other cultural and historic information.  As said before, the initiative is very laudable because help local people to reacquaint themselves with their traditions and history.  The place is used a lot by history teachers and school children make a good use of it.  However, the project seems to have run into some problems.  The Trust is working with the Amathole District Municipality and the Department of Economic Development and Environment Affairs to decide how the program will move forward because the initiative has the potential of becoming a good economic development program with an income generating component for people in the area.  

PWRDF Monitoring Assessment
During the visit, PWRDF staff had the opportunity to meet with a diversity of staff and beneficiaries of the program.  Overall the program is well run. Nonetheless, as any growing organization, the Trust is facing several challenges including fundraising:

The Health Program
This program is dealing with the typical problems encountered by NGOs working in the field of HIV/AIDS.  Often, people that are initiated into the ARVs therapy have the perception that once they feel better they can drop the therapy and resume old habits such as consume alcohol.  Men more frequently than women tend to drop the ARV therapy.  It is a challenge to make people understand that the ARV therapy is for life.  What the Trust is doing to address this situation is to set-up a door-to-door education accompaniment of AIDS patients.  The Trust has hired a very talented Community AIDS Activist that is a member of the AIDS Campaign Network.  She is also HIV positive.  The role of this staff person is to visit past patients and make them understand the purpose of taking ARVs.  She also works with support groups and provides education on how to deal with stress, which can affect people that are HIV positive in a very negative way.  One of the strengths of the Trust is the use of HIV positive people in their staff.  It helps de-stigmatize the disease.  

Institutional Issues
The year 2008 was a very challenging year for the Trust.  The former Administrator resigned and a new team was put into place.  The new team is a strong team mostly made of expatriates.  Many of the people in the new team are Canadian volunteers.  Volunteers bring both risks and opportunities.  The opportunity is that they bring skills-set that are needed locally.  Therefore, they can train a big number of local people and help organizations to review their systems, policies, and other institutional practices.  This process can help organizations to become more performing.  Volunteers also have the advantage of usually coming from wealthy countries.  As a result they can become good ambassadors/promoters of the programs once they return home.  

The risk is that any indigenous organization that relies on volunteers needs to be intentional in terms of setting up processes for skills transfer.  Every volunteer should come with a clear process on how he/she will transfer the skills/knowledge that they bring, and how these skills will add value to the program/organization.  If this does not take place, the volunteer experience can become a lost opportunity and the presence of volunteers will be reduced to “Donor-Tourism”.  In addition to that, the host organization always spends a lot of organizational time and resources in helping the volunteer settle in. If the volunteer does not contribute in-kind by training people and transfer knowledge, at the end the organization will not get any value in return.  A volunteer exchange should always be a win-win situation for the parties involved.  

Recommendations from PWRDF:
•    That the Trust develops a volunteer placement strategy that benefits the organization.  The volunteer strategy should help to build a well equipped local work force that will be able to replace the volunteer once they return home;
•    To develop a fundraising strategy that is focused and does not spend unnecessary resources going after funding that can be more of a hindrance than a benefit. The Trust has a strong program and should be assertive in presenting its approach to HIV/AIDS as a multi-layered approach that engages the individual/patient for the long haul.  Donors that understand this approach will buy-in in the concept.
•    To develop a research/advocacy strategy that will create a platform for Keiskamma Trust to advocate effectively for their approach to HIV/AIDS as an emergency/developmental crisis that is unique in nature.  The need for this strategy stems from the fact that the HIV/AIDS pandemic has in itself the contractions of an emergency and a developmental issue.  It is an emergency because of the evolving nature of AIDS and NGOs need to be able to read the context accurately (i.e. decision to not open a pediatric service that excluded the mothers and isolated the children in a new environment), and adjust to the moment.  In terms of development, NGOs working with AIDS patients need to plan for the long-term.  ARVs are giving patients a new lease in life.  People are living more than 10 years or so, after beginning taking ARVs.  Once patients have recovered and leave the clinic, how do organizations plan (in a very poor environment) to give hope to people?  This is an essential question for NGOs working with people living with AIDS.  Keiskamma seems to have found a way of answering this question.  The income generating activities through the embroidery program and organic farming are all paths in the right direction.  However, in order to be sustainable, Keiskamma Trust needs to articulate this message in a way that has appeal to the donor community.

Zaida Bastos is the PWRDF Africa Program Coordinator. 

Picture: a view of Hamburg , the Keiskamma river and the ocean from the Heritage Centre

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