Reflections from South Africa

I write this on a flight between Cape Town and Johannesburg, fuelled by caffeine and weary after a few days by the sea to attend an HIV conference.

I write this on a flight between Cape Town and Johannesburg, fuelled by caffeine and weary after a few days by the sea to attend an HIV conference. (I’m excited to report that our conference poster on enhanced adherence counselling won a prize, but more about the importance of HIV counselling another time. And let’s not mention the fact I didn’t know we’d won until a friend SMSed me from the closing ceremony to ask where I was. I had already left. Oops). 

My first two years as an MSF anthropologist and researcher in South Africa have just come to an end, and I currently find myself moving from spare room to spare room as I wait to go on my next assignment. (Luckily I have very generous, sympathetic friends who don’t mind me and my ‘exploding suitcases’ cluttering up their homes for a while). I’m heading off to Liberia for the Ebola outbreak in a few weeks, followed by a couple of months in Kenya…but for now let’s stick to South Africa, anthropology and the world of rural HIV.

This is my first MSF blog post, and my confession to my reader(s) is that many of these posts will be back-dated: ethnographic ramblings from the past, if you like. My blogs will reflect upon daily life in the (literal) field with a few tales of “life as an MSF ex-pat” thrown in for good measure. My first year in the project was spent as an anthropologist, my second as an operational researcher with some ethnography on the side – MSF, as people are often surprised to learn, doesn’t just employ doctors. Working as an anthropologist involves spending a lot of time in communities with local people to understand their needs and how MSF can make the health services they provide relevant and acceptable. The operational research side of my work was more about documenting and analysing project activities, and conducting studies to assess the impact of our interventions. Both were equally fascinating.

Working with MSF in South Africa has been, in many ways, the stuff of my undergraduate dreams. I return from the metaphorical (and often literal) field covered in mud, notebooks full of semi-legible scribbles, my head spinning from the stories I’ve heard and the words scrawled on my page. The social sciences - and the methodological tools that accompany them - are increasingly incorporated into humanitarian aid work, and MSF works with anthropologists to gain a deeper understanding of the places they work and the people to whom they are providing medical assistance. As my next few posts explore, understanding people’s perceptions of HIV and of the ARV treatment they need to save their lives is an essential part of providing health-care services, and is a field that is becoming more and more recognised. 

It’s all very practical work: rather than sitting and writing for hours as I did as a student, I now have to turn days of observations into a series of bullet-point recommendations that can be understood and acted on by the medical team. They want practical tips on how best to reach people for HIV testing and how to help them access their ARV treatment: they don’t want pages of thick description. Sometimes I miss the calm and regularity of academia, but joining MSF in 2012 was definitely the right choice for me to make.

The next instalments of this blog will bring tales of HIV testing on sugar-cane farms, stories of HIV-related stigma and discrimination and a look at why young men in South Africa don’t access HIV testing services as much as we would like. In an area of South Africa where 52% of women my age are living with HIV, there’s a lot to write about…even if it has made it onto the page little bit later than planned.