Who will live? Who will die?

            The follow day, July 21^st, Taylor and I were invited to observe a multidisciplinary meeting within Grute Skoor’s renal unit.  We met up with the renal unit social worker and two Western Cape university social work interns.  He quickly explained that we were about to observe the meeting held between doctors, staff, social workers, and interns about the status of a patient.  The social worker then ushered us into a small meeting room with about 30 other professionals. 

            As the room filled, the room became quiet and the head doctor requested for the meeting to begin.  One by one the group listened to presentations on the patient’s medical history, current status, and the psycho-social prospective.  After each of the presentations, the group decided whether to accept or deny the patients into the dialysis program and subsequently the transplant list or denied.  As explained, the patients are categorized as either Category 1, 2, or 3.  Depending on whether the patient is category 1, 2, or 3 determines whether or not he or she receives treatment.  Many times the social worker’s assessment is the tiebreaker that determines whether the patient in accepted into the program. 

            By the end of the meeting and debrief with the social worker, Taylor and I reflected on the system of categories and what we had just witnessed.  As we looked at our notes, we realized that two patients were accepted into the program, two were placed on the waiting list, and three were not accepted due to their category 3 status.  We left the hospital with the knowledge that we were apart of the meeting that decided whether seven people were going to live or die. 

A Day in the Life

            The South African government, like most governments, don’ t have enough resources to support all of the programs or people in need.  The South African public health care system is allocated about 25% of the health services budget and the remaining 75% is allocated to the private health care system.  While the private health care system in South Africa is estimated to be one of the best in the world, the public sector struggles to provide life saving services.

 Grote Skoor Hospital

            On July 20^th, I had the opportunity to experience a day in the life of a hospital social worker at Grote Skoor Hospital.  My fellow social work interns and I arranged to meet with the social work department.  The department allowed us to each shadow a social worker.  Stephanie shadowed the Medical social worker and Taylor shadowed the Maternity social work.  I shadowed the Renal and Transplant unit’s social worker. 

            I met the renal unit social worker in a flurry of paper work, nurses, and clients.  After a quick introduction, we delved into his daily work.  I helped him interview and inform patients about their medical situation, grants, and job status.  I also observed an end of treatment discussion with a man whose transplant was failing him.  While we ran from ward to ward to check up on paper work and patients, the social worker explained how the renal until admitted patients. 

            The social worker told me that due to the lack of resources the unit is unable to treat all patients in need of dialysis and a transplant.  Therefore the unit decides who is admitted into the program based on a list of criteria.  The criteria are formed into three categories.  Category 1 patients are young and healthy South African citizens.  They cannot have any medical complication such as obesity, diabetes, or be HIV positive.  These are the patients that are put onto the program immediately.  Category 2 patients are employed South African citizens that may have a few health issues or be older than the recommended age with a family to support.  Category 3 patients are unemployed, have a number health issues, and maybe incompliant to following medical advice.  They are not admitted into the program and are “sent home to die”.   The social worker told me that, “they do the best they can with what they are given”.  I agree.

           

Children’s Act of 2005

            On Tuesday, I lead a discussion around South Africa’s Children’s Act of 2005.  The mission of the Children’s Act is to support and promote children’s rights as outlined in South Africa’s constitution.  A child’s rights as outlined in the constitution are that all children (Under the age of 18) are important.  All children have the right to safe and healthy lives regardless of their gender, problems, cultural or ethnic background, spoken language, ability, religion, or race.  All decisions made in regards to the child have to be in the child’s best interest and the child must be informed.   As defined, the child’s best interest can be defined as thinking about the child’s family (caregiver, siblings, biological parents etc), culture, history, health and well-being.

            Within the act certain terms and processes around serving children are defined and outlined.  The act defines and outlines services around these key areas:

·      Parental responsibilities

·      Child Protection Services including CPS agencies, non-profits, foster care, adoption, international adoption, segregate motherhood,  and cluster foster care.

·      Partial care including schools, crèches, educares, and child and youth care centers (CYCC).

·      Children’s Court

·      The reduction of harm to children from cultural practice such as female virginity testing, circumcision, female genital cutting, and underage marriage. 

·      Children’s Health including access to HIV Testing.

·      Enforcement of the act including visits, stats, delegate’s responsibilities to members of social development etc.

            Though the Children’s act the best intentions, the agencies lack many of the resources and capacity to fulfill many of the outline guidelines.  The act also lacks clarity in many of the key terms such as “best interest”.

Escape

Cheetahs and little boys

            I took the day off on Thursday, July 7^th, to help Stephanie chaperon her boy’s group field trip.  As an intern for Home From Home, Stephanie’s most meaningful project has been working with a group of boys ages 8-11 once a week.  Over the past five weeks she has planned fun activities for them to do as a little escape from the daily routine like school, siblings, and house moms.  Taylor, Stephanie, and I went out to Khayelitsha to the Home From Home office to wait for the boys to show up.

            Once we had all the boys seat belted and happy in the van, we made our way to the Cheetah Sanctuary in Stellanbosch.  Stephanie, like any good community organizer, convinced the sanctuary to give a tour to the boys for free.  We arrived to the preserve after a sunny drive through Khayelitsha and some South African wine land.

            The boys pressed their faces to windows to get a better look at where we were going.  Wonga, our driver, dropped our group off at the front of the entrance.  After entering, we explored the enclosure for a while before our guide came to fetch us.  The Boys, while we waited, took turns taking pictures of the cheetahs on the other sides of the fence.  Each of the boys was chatty, wide eyed, and fascinated by not only the cheetahs, but also the act of taking pictures. 

            After the guide came, we were escorted into a classroom.  The boys sat cross-legged on the wood floor.  The guide presented all of the amazing facts about cheetahs and wild life conservation.  The boys sat in awe listening intensely to every fact for about 45 minutes.  After the presentation, the guide took all of us around to the different animal habitats.  The boys eagerly moved from habitat to habitat taking pictures. 

            By the end of the day, the boys were tired, but happy.  It was a good day.  Stephanie could see that she was giving the boys a taste of adventure and dropping them safely back home. 

Surf's Up

False Bay & Surfing           

            On June 25, after a long week, our group went on a search for adventure and stress relief.  Taylor, Stephanie, Kristen, and I made our way to the Rose Bank train station to catch a train to False Bay.  We hopped on the afternoon train to Muizenburg.  I had made arrangements for surfing lessons at 2:00 with the Surf Shack.  We arrived at the Muizenburg beach with our towels, swimsuits, and spirits of adventure in tow.  I was eager to meet our instructors and get into the water.  I couldn’t wait to touch the ocean and attempt to catch a wave. 

            Up until the surfing lesson, I had never had the opportunity to swim in the ocean.  I had, of course, walked along beaches and let the water come up to my calves, but I had never swam in the ocean.  The instructor thought I was joking when I asked if I should be worried that this was my first ocean experience.  As I squished in a wet suit, I wondered if I should be concerned about swimming in the ocean, but adrenaline and my friend’s encouragement quickly erased all my fears.

            After a short discussion about shark safety (False Bay hold a large portion of the Great White population), we grabbed our boards and followed our instructors into the great blue.  The ocean was freezing, salty, and beautiful.  I don’t think I have ever felt so amazing in all my life. 

            For over an hour, Kristen and I met wave after wave with no fear.  I pushed myself up on my board time after time riding the wave for a few seconds before falling off.  By the end of the day, my feet were numb, my abs were sore, and I was incredibly happy. 

A Little Glimpse of Hell

“For a minute there, I lost myself”-Radio Head

            The last two weeks of June, I lost myself.  I did not intend to lose myself.  I intended to support Safe Line and help a few families in the process.  I wanted to help children on the Safe Line’s waiting list obtain therapeutic services while continuing to participate in community work.  I knew that many of the children had been waiting over a year.  As forensic interviews and case files began to pile on my non-existent workspace, I began to lose sight of myself and the reason why.

            I began seeing up to four clients a day for up to an hour and a half each.  During one week I saw twelve clients, attempted to organize a parent support group, struggled to write client reports to be allocated, and managed to set up follow up appointments for other clients.  I also connected certain clients with resources from local hospitals and Rape Crisis.  I was clearly making an impact on the caregivers’ lives, Safe Line’s waiting list, and building my understanding of forensic interviews. 

            Though I was connecting clients to services and providing a little relief to families waiting to be seen, I was leaving the office exhausted and disturbed.  I was not being debriefed or supervised by anyone at the office.  It was difficult to get answers to any of my questions.  It was also difficult to obtain information about how the allocation process worked and how to set up appointments.  I had to track down key forms and appointment conflict information that no one bothered to tell me about.  Some days I would show up to work only to be handed four new files and told I was seeing a client in the next five minutes. 

            With so much weighing down on my own shoulders, I couldn’t help but wonder about all of the other social workers in the office.  Who was supporting them?  How was each of them dealing with the stress of forensic interviews and play therapy session with traumatized individuals?  How could a service agency like Safe Line provide sustainable services without supervision for their staff?   

            I saw myself drowning…..and I could see everyone else right there with me. 

Secondary Trauma

            Secondary trauma is a phenomenon that is being discussed among helping professionals.  Secondary trauma is a set of symptoms related to post traumatic stress disorder (PTSD) in which a therapist or helper begins to change his or her behavior due to the stress or empathetic response to hearing a client’s story or trauma.  The symptoms vary in each person but can include sleeplessness, unsubstantiated fear, nightmares, depression, bursts of anger, and a lose of connection to people in one’s life. 

             Until my time with Safe Line, I had never read about or discussed the impact of secondary trauma on helping professionals.  I had recently learned how to accept and work through my own trauma and grief, but I had little understanding of how I could absorb someone else’s fears, anger, and sadness.  When I began having nightmares, outbursts, and gripping anxiety, I realized that I was not coping well.  My normal positive outlook and behavior was quickly over shadowed by darkness.  Day after day of listening to stories and pleas from parents, aunts, and grandmothers to help his or her child or grandchild cope with surviving rape or sexual abuse, left me hollow.   I began questioning my self as a social worker, the people around me, and the world I lived in.

            It took my support group (Stephanie, Scott, Kristen, and Taylor) and my CCS supervisors to push me to acknowledge that I needed help.  After an uncomfortably public break down, I discussed ways I could reduce my stress and why supervision is key to taking on interpersonal practice. 

The Plan

            My experience these past few weeks have challenged me to think about my lack of a self-care plan.  I was hit hard by working with traumatized caregivers.  I needed to think about what that means for my future work with individuals and communities. 

            My current thoughts are that I need to schedule in time to talk about my feelings around my work.  I can’t hide from the fact that I am working in a difficult field.  I also can’t hide the fact that I need to work through my guilt around having these feelings.  I need to think through these reflections and build up my own protective practices instead of preaching to others about self care. 

            Some stress relieving activities I need to build into my daily life are my yoga practice, journaling, cooking, and spending time with friends.  For years, I have placed these beloved practices on hold for the sake of “education” or “being too busy”.  Now, it is time I start giving myself some time to grow and leave work for the work day. 

The Garden Route

Stephanie at the Cango Caves.

The crew at Cango Caves

Conservation Safari-A family of Giraffes.