Improvising to Change Lives in Last Mile Communities ES

by Gqibelo Dandala, Country Director, One to One Africa

Necessity is the mother of all invention, or so the saying goes. Thomas A. Edison said “If there’s way to do it better – find it.” Either way, the message is clear – when current problems do not have current solutions, thinking beyond what has always been done must become the norm.

And so it was that I witnessed ‘organic’ innovation in rural Last Mile communities around Tshani village where One To One Africa runs its largest project, the Enable program. Last Mile communities are literally villages furthest from the main tar roads. Tar roads are a linkage to urbanization, and by default resources, development and all that that represents. Conversely, distance from tar roads correlates with impoverishment; the greater the distance between a community and a tar road, the more severe the impoverishment. Last Mile communities are just beyond which there is nothing! No resources, no services, no development, no employment, just about nothing. We serve such Last Mile communities.

The natural, untouched beauty of Tshani and surrounding villages belie the abject poverty therein. The abject poverty belies the strength and resilience of the women in these communities, ordinary women we have trained to become Mentor Mothers, which are effectively community health workers. The smiles on their faces don’t reflect the harsh realities of their daily work, walking many kilometres in harsh conditions to go door-to-door to each and every household in the village, bringing health education and advice to those households, their bright green shirts have become bright beacons of hope within the communities. The challenges they face in their work demand that innovation become par for the course. On my last visit I witnessed this first hand.

We visited a household with a pregnant woman suffering from high blood pressure. She lived a walking distance from a medical clinic, yet our Mentor Mother had to walk several kilometres to her house every two days to closely monitor the high blood pressure. Upon seeing my confused expression, it was explained to me that the clinic had no doctor, the maternal nurse visited once or so per month and the clinic was often out of stock of necessary medication for the mother-to-be.

So our Mentor Mother took it upon herself to visit and check on this client every two days instead. However worried that this would in the long run impede on visits to other clients, the Mentor Mother decided to give this mother-to-be a blood pressure monitor, taught her how to use it and then called the mother-to-be her daily to monitor the blood pressure. A simple solution to a potentially life threatening situation.

In a different household, we walked down almost an hour to visit another client. This hour long walk was from the closest place we could park our 4×4 vehicle. The vehicle was parked about ½ km from the side-road. The side-road is another approximate ½ km from the main road. The main road itself is gravel and over 20 km from the tar road. Public transport is only available on the main (gravel) road. Public transport is not a bus, mini-bus or train. The public transport is a van.

About ¾ of the way down we came across the communal tap, a single short tap designed to serve a community of households scattered on mountain. I mention short tap because people typically bring a 20litre bucket to a tap to collect water for their household. However the tap was too low for a 20litre bucket to fit, meaning less water per household. 20 litres sound like a lot? An ordinary bath holds 100 litres of water, a shower typically uses 20 litres of water per minute, a single flush of the toilet uses 6 litres of water.

But back to our downhill walk. When we finally reached the house at the bottom of the mountain, we found a mother with a 3 month old baby. My first thought after the long walk down was “Where did she give birth?!” I asked our Mentor Mother who then told me that she’d given birth at a hospital. My temporary relief was replaced with shock when she continued that this mother had had to walk up to the main road at the onset of her contractions. Aware of the dire conditions mothers in these communities come from, hospitals nearby (that being over 35km away) had built rondavels called OLindela (Prenatal rooms) to accommodate such women to ensure that they were near the facility when full labour began!

As rudimentary as the structures were, the innovation to have such ‘awaiting / early labour’ units has saved and continues to save many women and babies. However to be accepted into OLindela, one needed to be in early labour, meaning that our client had walked up the hill, past the side road and onto the main road to await public transport (a van being highly unsuitable for a full term pregnant woman) to travel to the hospital.

Secondly, the family was malnourished, they simply did not have enough food to eat. In response to their plight, our Mentor Mother provided nutritional advice on the vegetables they should eat, and thus plant in their small field. She provided them with seedlings and izithole taken from her own garden to plant in their field. As a result, our team asked that we have a community garden from which to feed the poor and share the seedlings with households to grow their own food.

I’m in absolute awe of the responsiveness of our Mentor Mothers who go beyond the call of duty and their job descriptions to ensure the health of our clients. For them, it’s merely par for the course. They provide pro-active solutions and promptly share those successes with the rest of the team at the monthly meetings, thereby ensuring constant improvement in our work which translates to improved health outcomes for our communities! I am proud and humbled to be a part of this team, One To One Africa.