I LOVE THE KINGDOM OF SWAZILAND!

We arrived safely in Swaziland late Sunday afternoon, checked into Veki’s Guesthouse where we met Rose, who takes good care of all the guests. We talked briefly with Rose, who taught us a few essential SiSwati phrases and then went for a drive to locate the Ministry of Health building, so we would be prepared for our early Monday meeting. I have never met so many friendly, helpful people. We pulled out our map at a stoplight, and the gentleman in the car next to us rolled down his window and got our attention just to ask us where we were trying to go. He gave us directions and let us pass in front of him from the wrong lane to make the turn up the proper road. We got lost again, and when we asked for help, the woman, whose name is Wisdom, had us follow her in her car so she could lead us right to the Ministry building. Upon our return to Veki’s, we found Rose busy at work writing out a long sheet of SiSwati phrases for us to study. By the end of the night, we felt thoroughly welcomed, and the warm welcome was reinforced after our meetings with the Ministry of Health today.

We met so many friendly people, who seemed genuinely happy that we were there and eager to learn from what we might find. In addition to the signed approval letter, I have received all kinds of support in coordinating introductions and schedules with the hospitals. I leave every encounter completely blown away by how productive it was. I know full well that things could take a turn at any moment, but it’s hard not to feel like everything is going to work out fine after such a great 24 hours in Swaziland.

On other news, we actually made it to the US-England World Cup game, which is a whole story in and of itself (more on that later with pictures and video). For now, let’s just say it was well worth the effort of getting the tickets.

One Down and Cape Town

I still can’t believe I pulled it off.  One country.  9 days.  5 key informant interviews.  4 focus groups.  10 expert reviews collected (so far).  It’s certainly been a very full 2 weeks, and I feel like I’ve got more than enough for a dissertation already with two countries still to go.  I honestly didn’t know if it was at all reasonable to get everything done in two weeks, despite my concerted efforts to convince my advisors that it was absolutely possible.  Whadya know…it is possible!  Of course, I don’t want to get ahead of myself since I still have a ways to go, but I have a meeting at the Swaziland Ministry of Health at 7:45am on Monday morning, so I’m (cautiously) optimistic.

I’m writing now from the airport in Cape Town.  It’s my first time to Cape Town and the extent of what I saw of the place (before and after a really great interview) is in the picture below: Table Mountain towering over the Cape Flats.  It’s amazing, though, how much can be crammed into one photo.  The shuttle driver shared quite openly with me about her own experiences as a colored woman growing up and then raising children during apartheid.  She showed me the shanties where the blacks were placed and the run-down homes where the coloreds, including herself, were placed.  So many years later, and so many people are still living in these conditions…waiting for their number to be drawn to grant them a better existence.  She talked about her present-day experiences with the whites who, of course, had no knowledge of what was going on around them or who conveniently claim to have been away during the worst of it.  I could have talked to her all day.  In all the times that I’ve traveled through South Africa, it’s the first time that anyone has told me their own story of struggle, survival, victory, and forgiveness.  It really hit me today that such atrocities occurred in this place during my lifetime.  And then it hit me that such atrocities are still happening elsewhere.

Table Mountain towers over the Flats.

Table Mountain towers over the Flats.

It feels a bit odd to be writing this while I’m sitting in the Cape Town airport with vuvuzelas blowing all around me celebrating the opening of the World Cup.  The unified celebration with ALL people decked out in green and gold (Bafana Bafana!) distracts from my own glimpse into a segregated South Africa.  Rather than leaving me feel somber, my brief peak at South Africa’s history has given me a whole new appreciation for the significance of the World Cup celebrations and gives me hope for other countries that are still on the other side of freedom from racial and ethnic persecution.  So when you see the green and gold of Bafana Bafana, be sure to ululate loud and clear! (When you’re not ro0ting for the US, of course.)

Focus Groups

I have now completed focus groups with two hospitals, one mission and one Government.  I don’t feel that I’m learning nearly as much at the hospitals as I’m learning from the key informant interviews in terms of actual content.  People are talking, and we’re getting some good examples of the benefits and types of issues they are facing, but I wouldn’t say that the information is new to me.  I think the real value in the focus groups is the general sense of buy-in and enthusiasm (or lack thereof) that we are getting from the hospital staff.  Overall, though, I’ve been very impressed with how knowledgeable the hospital staff is about accreditation.

Despite the fact that arrangements had been made in advance for my first focus group, the group didn’t actually get put together until we arrived at the hospital (after more than six years working in Lesotho, I still don’t know how I was surprised at this).  But we were pleasantly surprised when we got such a diverse group with representatives from maternity, inpatient and outpatient nursing, lab, pharmacy, radiology, and administration.  That was what we asked for, but it turns out that we may have had too much diversity in the group.  There was some decent interactive discussion in talking about accreditation more generally, but the standards are so department-specific that the discussion was much more a turn-taking one than the interactive one I had hoped for.  But in both groups so far, we had at least a brief time where I would describe the group as lively and engaged.  Overall, not too shabby.  I may have already met the point of saturation (no new info), but I’ve got the last two focus groups tomorrow with very different hospitals, so we shall see.

A series of ridiculous events (post by Elena)

Last night, Lauren and I drove up to Leribe from Maseru (about 100 km) to stay the night there so we would be closer to the hospital where we would be holding our focus group in the morning. We arrive in Leribe around dusk. First, we drive for about 20 minutes on the same 3 pot hole ridden dirt roads until we get the key and find the trailers where we’ll be staying for the week. We drive into a plot of land about the size of an acre. We’re knee deep in weeds. Sheep roam and 4 trailers owned by LeBoHa (Lesotho Boston Health Alliance) surround us. LeBoHa graciously offered to let us borrow a trailer for a couple days since our interviews are in the northern part of the country this week. We open the door to our friend’s trailer to get the keys for our trailer. On a table in her tiny trailer is 5 bunches of keys. We grab them all to start trying on own new homestead. Finally, one key works but after jiggling it, I hand it off to Lauren to put her muscle into it. Lauren gives it a go too, and then tried leveraging it with another key, and then: snap. The sheep are laughing at us. The sun is almost down and we’re standing in weeds and sheep poo with a broken key and an early morning meeting in the mountains.

We circle the trailer. There’s an open window. Lauren hints that I’m the one to launch in the window (that is three feet above the tops of our heads) because she thinks she can lift me. I’m resisting. We pulled a trash can around to the bottom of it and Lauren starts climbing on top of the trash can, the ground is so uneven, I’m trying to hold it steady. We’re laughing pretty hard. I’m thinking if Lauren falls, she’s falling into this crunchy sheep poo which we hear under each and every one of our steps. A Basotho couple is watching us. Lauren starts to tell them that our key broke off so they don’t think we’re breaking in to the trailer. Without hesitation, the Masotho man jumps up on the can and wrangles himself into the trailer. A hero. We think this is great until we realize that he can’t get out the front door unless he manages to open it with the broken off key inside. Lauren tried taking off the door knob to open the door so the lock is pretty messed to begin with. We give him my pocket knife and flashlight to aid in his valiant effort. In hindsight, allowing a stranger to break into our abode and giving him a knife and our only source of light may appear misguided. But really, no one enters this area to steal And there was a guard and we just felt safe. Despite our boy’s efforts he’s unable to open the door and we also decide that we wouldn’t feel safe sleeping in a trailer that doesn’t lock. We tell him it’s okay to give up, at first he resists – our silent hero is determined. But finally, he makes his way out the window, onto the trash. We thank him profusely. But without a word or even a pause he hands me my flashlight and (now warped) pocket knife and walks off into the sunset. “We’re staying in our friend’s trailer tonight” we concluded.

We unload into her itty bitty trailer. There’s a small room with a futon, and a kitchenette/living area and a bathroom. Lauren insists she would be fine sleeping on a love seat that was no longer than 3 feet; she’s afraid she’ll accidently smack me in my sleep. I insist that I have my sleeping bag and wouldn’t feel it anyway. And then we hear a knock on our trailer door.
After a few minutes, Lauren walks back into the trailer with a key with a baffled look on her face. Earlier, our friend mentioned that another trailer was available but that the volunteer doctor had accidently taken the key with him and they were in the process of tracking it down. It had been weeks so they were sure it wouldn’t be available for us. Apparently, the doctor went to Cape Town but the brother just happened to come that night to return the key and we just so happened to be there to get it. We’re shocked by the incredible timing. Of course the key didn’t work though (because the lock had since been changed). But we did discover a new room in our friend’s itty bitty trailer (how did we miss it?) so we had our own beds. We decide to stay in, drink wine and eat whatever snacks we have. We watched Chuck and called it a night.

In the morning, it was below freezing. We escape. The focus group at Manohau Hospital went well and the drive in the mountains in our faithful roller skate was gorgeous. I took hundreds of pictures; the vast majority are crap though. I would upload some now but internet couldn’t be slower.

Thanks for joining us on our journey!

And We’re Off

We had an amazing visit with my good friend, Qachile, and her family yesterday.  She has the cutest grandson, Bohlokoa.  We brought him a soccer ball and balloons, so he warmed up to us pretty quickly…we’re shameless!

Tonight we’re driving up to Leribe to stay in the LeBoHA trailers for the night since we have a focus group out in the mountains tomorrow mid-day.  We’ll either be there 1 night or 4 nights depending on whether we can make it back to Maseru before dark.  Our access to internet will be questionable.

Data!

I have now conducted three of my key informant interviews.  I am so thrilled to have real data.  Lee Strunin and Barbara Bokhour (my qualitative methods professors) would be very proud of me as I am diligently taking detailed field notes after every interview and have begun my transcription.  On Thursday, I had my first interview at 11 and my second at 3:30.  I managed to start transcribing the first interview before the second, and I was so glad I did!  My incessant use of verbal cues (“okay,” “right”) makes transcription a big pain in the butt, so I tried to use more nodding and smiling in my second and third interviews.  Do I really need to transcribe every “Mm hmm”?

People have been so generous with their time.  My first interview went a full hour and then the interviewee took me to her office and loaded me up with all kinds of useful documents.  My second interview lasted an hour and 20 minutes…20 minutes past closing time.  And I was afraid that it would be difficult getting people to talk!  My first interview transcript is 16 pages single spaced!

I had to do my third interview this afternoon without Elena since she was coordinating logistics for next week’s focus groups at the hospitals.  I realized that a hidden benefit of having a second person present is that it’s a lot easier to break eye contact with your interviewee when a second person is present for the interviewee to talk to.  I found it rather awkward to break eye contact to look at my interview guide, so had to rely on memory more than I wanted.  I covered all the major points and I think it went well, but I think it flowed a bit smoother with Elena present.

Her visits to the hospitals were certainly well worth it though.  I’ve now got 3 focus groups scheduled firmly, and one that is scheduled, but questionable.  Getting Elena to work with me was certainly one of the best moves I could have made!

Roller Coaster

Today was quite a roller coaster.  Quite excited by the news yesterday that the Director General “agreed to approve” the study, I stayed up until 3:00 am printing 25 surveys for delivery to leaders at 3 hospitals over the course of a day (it took 17 minutes to print each 42-page packet and I already used almost all the cartridges I bought).  I was determined not to leave the MOHSW this morning without my approval letter signed by the DG, but of course, the best laid plans…

Rather than wasting another day waiting in Maseru for a letter, I made the decision to drive out to the hospitals to at least explain the research in person (which is usually more effective than by phone or by e-mail) so that the surveys could then be dropped off later in the week along with the MOHSW approval letter.

On the way to the first hospital, we got pulled over at a routine traffic stop by a cop who seemed to purposefully lure Elena into gliding through the stop sign and pulling over to the side of the road rather than coming to a full stop at the stop sign before pulling over.  She threatened to arrest Elena unless we gave her R200.  I love Lesotho so much, but at this moment, I felt like I was in a completely different place than in the country I have come to call my home away from home.  The cop had no problem admitting that it was a bribe and that it was illegal (her words), but insisted nonetheless.  How is this not considered mugging?  I felt (and still feel) like a victim.  Supposedly bribes are more common in other parts of the region, so perhaps this was our training for our post-Lesotho travels.

At our second hospital stop, I was able to reunite with many of the Leribe-based LeBoHA staff and it was such a joy to see friendly, sympathetic faces.  We went out for a traditional lunch with Phil Elkin and Sandy Phoenix, who gave us warm hugs, great conversation, and just made us feel a whole lot better overall.

On the way to the third hospital.  I got a call.  The approval letter was signed and ready for me to pick up!!!  By the end of the day, I had scheduled 2 of the 4 focus groups and delivered 6 surveys, 4 of which are likely to be completed next week.  And I conduct two of my key informant interviews tomorrow.  So with just a few adjustments to schedule, it looks like I may actually get the data I need in Lesotho after all (though I’m not completely sure this ride is over yet).

Can you tell that I'm a bit excited about the letter?

Can you tell that I'm a bit excited about the letter?

Relief

My day was made today when the Director General agreed to approve my research. I’m still waiting for the official signed approval, but I’m fairly confident that I’ll get the letter tomorrow morning, at least I hope so since the plan is to deliver all the surveys tomorrow.  We are now asking our experts to complete the survey in just 2 days, so there will be a great deal of pleading going on. I now wish I had planned for some form of compensation to the experts in my IRB application, but I’ll just have to hope that I’ve built up enough good will over the past 5 years that I can get the surveys I need. We shall see.

Elena hard at work finalizing our survey.

Elena hard at work finalizing our survey in the (cold) LeBoHA office.

Elena here, Lauren’s research assistant.

The Blue Roller Skate

The Blue Roller Skate

Being my first time in Lesotho, or Southern Africa for that matter, so much is new. Foremost, the people are so friendly. Each person Lauren introduces me to greets me with a warm hug –shop owners, waitresses, old colleagues. We’re staying with a Basotho friend of hers, Me’ Zinia. Me’ is a respectful term for a woman, like mother. It’s so nice to spend our time here in Me’s home. She opens our windows when we’re out during the day and closes them and turns on our heaters at night so our rooms are nice and toasty when we get home. She works at the local casino, we have opposite hours so we don’t see much of her but when we do it’s all smiles and cheer.

Lauren showed me around central Maseru today– the capital of this small country landlocked in S. Africa. It’s safe and easy to get around in. Some roads are paved and others are dirt with big potholes but the blue roller-skate (our awesome ride) perseveres. Most of the time when we reach for the indicator we hit the windshield wipers but at least we’re sticking to the left side of the road.

The weather has been chilly but sunny. Peak winter is approaching in July/ Aug so our timing isn’t as synched up to the coldest temperature as I anticipated initially. We’ll be up in Leribe next week though and it’s certain to be chillier up there in the mountains.

Overall, I’m pleasantly surprised with how safe I feel in Lesotho. The people couldn’t be more welcoming. On our way to Lesotho from Johannesburg last weekend, we were pulled over by a cop. I instantly thought they were going to ask us for a bribe. To my surprise, Lauren broke out in beautiful Sesotho (the language spoken in Lesotho) and her and the officer had a pleasant exchange. Then we went on our merry way. Lauren said that kind of stop was routine. Interactions like these have put my mind at ease and helped me enjoy this amazing culture and experience.

So Far So Good

Our flight landed safely in Johannesburg only a couple hours behind schedule. Both of us were quite impressed with the food on the plane…Milano cookies and perfect strawberries!!! Then we hopped into the cutest, bluest little car. We got a little lost, but Elena’s navigation skills got us back on track and we only went 50 km out of our way. Fortunately, our little roller skate gets great mileage! Our accommodations for the night are lovely, and we’re both looking forward to a good night’s sleep.