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Do you think South Africa is currently doing enough to make women aware of womens health issues?
I dont think we are doing enough around womens health. We still live in a maternal health paradigm that prizes women as mothers and not as women in themselves and possibly mothers. This is seen in many arenas where women deny themselves and dont easily take care of themselves.
The vertical transmission programmes illustrate this well in that what is termed prevention of mother to child transmission, which emphasises the prevention of transmission to the unborn treating women has fallen off the agenda. We know that if we treat women, the prevention of transmission is reduced significantly, but only a third of those who need to be on treatment are on treatment.
Women dont access contraception well and there is not enough focus on finding a contraceptive that really suits an individual and on working towards negotiating safer sex. Similarly, the cervical cancer screening programme is not well implemented, with us only reaching 20% of the 70% target! Cervical cancer remains the cancer that kills most women in SA. Lesbian health is not on the agenda.
We dont address issues of violence against women an epidemic well in our health settings, and issues of mental health and addiction in women are not managed either. Sexual and reproductive health and rights care is also not well planned and provided for.
What does your work entail?
I manage the Treatment Monitor at Health Systems Trust (HST). The aim of the Treatment Monitor is to support the implementation of the National Strategic Plan 2007-2011 (NSP) in South Africa through a variety of activities, including monitoring, information dissemination and research that will contribute to strengthening the development of equitable, effective and efficient health systems.
Ultimately it aims to identify and share information on models of best practice and lessons learnt in order to stimulate and promote the ongoing improvement of effective and efficient HIV treatment
and care and health services in general.
The Monitor is working towards the creation and strengthening of networks between important role-players across the various health sectors, disseminating relevant information obtained through
meetings and workshops with key stakeholders. It has invested in and created strong links and collaborative initiatives that share information, strengthen debate and enhance the process of policy
development. The Treatment Monitor also aims to work closely with all stakeholders to identify gaps in health systems research, and to support the development of essential health systems research to strengthen the health system in providing comprehensive HIV/AIDS prevention, treatment and care at all levels.
There is a focus in exploring the impact of HIV and AIDS on women and their ability to access services. We acknowledge that the HIV epidemic is feminised with most infections infecting and affecting women. We support integrated services that are decentralised and as such we would want to advocate for provision of women receiving HIV care within a sexual and reproductive health and rights framework. We are also concerned about issues of human resources the burden of care acknowledging that
nurses have had to task shift and are bearing the brunt of care.
Where do you see the nursing fraternity assisting in this process of creating awareness around health issues?
Nurses have a real opportunity in this setting to give women clients tools to enable them in the process of negotiating their health. We are respected in the community and are often asked for advice we need to use this privilege wisely and to value the role that we can play in transforming peoples lives.
What are the biggest challenges that South Africa faces in improving our health system and the communication around these issues?
Nurses are undervalued and under-remunerated and I know that DENOSA has done a fine job in working towards dealing with these issues. At the same time, nurses unfortunately have gotten
a bad name for care that is not acceptable. It is well documented that some nurses are abusive to patients whether verbally or physically. Clients are shouted at for coming late or showing up
for repeated complaints. Some nurses beat patients in labour or withhold services pain relief or care. This has resulted in many women being scared of nurses and they postpone going to a clinic
when they have a health problem.
This is a culture that needs to change. We need to work out what is frustrating us and to deal with it and not take it out on our clients. It is okay to say that we are frustrated, we must not deny these feelings, but we need to work with them and address them. We are carers and nurturers, and we will get tired, angry and frustrated it is important that we have support from our families, employers and unions in addressing this.
We can also make more use of educational material and educate waiting patients. At the moment some sit there for many hours and watch all kind of nonsense on TV instead of making use of the hours they sit there. Soul City programmes would be good to have as an example.
I support the transformation of our health services into integrated and decentralised primary healthcare services as a means of creating accessible healthcare. I think the challenge is to ensure
that sexual and reproductive health services are fully integrated into the package of primary healthcare. This would mean a better contraceptive service that includes counselling on the range of
options, including skills on negotiating safer sex practices.
We need to integrate sexual and reproductive intentions into the continuum of STI and HIV/AIDS care. Cervical cancer screening, mental health services and screening and referring for violence against women also need to be incorporated into the package of services. Abortion services need to be scaled up, including medical abortion in the public sector, and women need to have the ability to choose and access services to either have a healthy pregnancy or the choice to terminate a pregnancy. Currently only 55% of designated abortion services are operational. This would be a good start.
What do you suggest in terms of creating awareness around womens health issues?
We have suffered a setback recently with the decrease in funding for womens health due to the global conservative funding agenda.
Some donors interpret sexual and reproductive health to mean only abortion. They limit work on sex workers and also recently equated contraception with abortion. As a result, a number of donor-funded NGOs and partnerships with bilateral organisations and government have decreased over the past 10 years or so.
We need to continue efforts to be innovative with spending and the creation of spaces to create awareness and advocate clear messaging on womens health.
We are fortunate that the South African government has progressive policies and a legal framework in the form of our constitution on these issues. We now need to translate these and to utilise spaces and processes to affirm womens health messaging and services. This needs to take place in both rural
and urban areas. We also need to support other cadres of people doing this work, including community health workers, journalists, teachers and learners and policing/safety and security workers as
we all know healthcare stretches beyond clinics.
However, I think it is always important to consider and reflect on ones own health and to put in place ways to affirm ones own physical, sexual, spiritual and emotional health as a woman whether in ones work or family. Before one can care for others one needs to care for oneself and to have a conscious sense of this.
What is the one thing you would like to teach other people?
I am not really a teacher but consider myself a facilitator. I find that it is in learning and listening in partnership that I gain new insights and knowledge. I am also a space maker and connector, and try
to seek and create spaces for processes of learning and sharing.
A lot of womens health work is stigmatised whether about sexually transmitted HIV/AIDS or abortion. There are few safe spaces for women, including nurses, to talk about these issues
openly. We need to forge these spaces and to encourage listening to each other. This also requires women to be able to reflect and to use their voices to communicate instead of being silenced. I also cant emphasise enough the need to heal oneself and to spend time nurturing ones own health before one can nurture and care for others.
You have recently returned from Mexico. Tell us about your experiences what did you learn during your time there?
It was huge over 22 000 delegat es in a city of 29 million people. There was a packed programme at one time there might be about five things one could attend out of a programme of 30 parallel events. There was a lot of sensory overload. My presentations and sessions were good.
The issues of womens health in relation to HIV/AIDS are starting to be incorporated more into policy and programming and this was good to see.
It was wonderful to meet inspiring people internationally who are working on similar issues, most of them from the ATHENA network. But HIV/AIDS has a personal face and some of the interactions with those who shared their personal stories in and alongside the scientific sessions, whether on their struggle with sexual violence or their desire to have a child as HIV-positive women, will remain with me as strong memories of the need for womens health to be a right for all.
Marion Stevens: nurse, facilitator, wife and mother
I worked for a year as a research assistant at the HSRC Centre at UCT in Gerontology and in 1994 moved to Johannesburg to work at the Womens Health Project at Wits University. It was then
that I met a number of nursing leaders who were transforming SANA into CONSA into DENOSA, and I was inspired by them. I was the policy analyst at the Womens Health Project and led the policy development process for the 1994 South African womens health conference, which developed 13 different policies on womens health. In 1996 I started my Master's in Public and Development Management with the Faculty of Management at Wits University, graduating in 1997.
I met my husband on campus and got married in 1997. In 2000 I left South Africa and worked for an interfaith group Religion Counts in the US, doing progressive interfaith work following up on the UN International Conference on Population and Development (ICPD) and the UN Fourth World Conference on Women in Beijing.
I returned to South Africa in 2001 and worked at the Centre for Health Policy as a project manger coordinating an EU-funded HIV/AIDS in the Workplace research project. I had my first child in
2002 and then another in 2004. We left in early 2005 to return to Cape Town. I started working at the Health Systems Trust (HST) in 2007, managing the Treatment Monitor.
What inspires you?
When I was 17, having grown up in the privileged suburbs, I started nursing at a regional hospital. In those days the wards were still segregated and my first ward was a black female ward.
I was completely traumatised and grew up very quickly. I cared for women dying of cervical cancer and septic abortions, and saw how poverty impacted on health. I spent time taking splinters out
of a womans vagina after a sexual assault with a broomstick.
These women remain with me and I remember them. These illnesses and dis-ease could have been prevented. Some 24 years later women still present with these illnesses and diseases. We now have HIV/AIDS added to the pot and women are bearing over 60% of the epidemic. This injustice and denial of womens access to health is what makes me get out of bed and do the work that I do. I know that
I also need to nurture myself and so have consciously moved to Muizenberg, where I can go walking on the beach and spend time in my garden with myself and my family. The sea is a space of healing for me and gives me space to reflect my emotions: the stillness and huge waves or storms.
What are your plans for the future?
The treatment monitor is grant funded and I would love to continue to do the work that I do. We currently need to raise funds to sustain the project from donors. But, whatever happens, I do know that I am passionate about womens health and, given the amount of work that needs to be done in this area, I am sure I will be able to continue to give expression to this passion. |
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