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Bridging the Gap – The experiences of an Ububele Home Visitor

By:  Khosi Sithole

I was born and raised in Alexandra. I am a mother and I am a home visitor at Ububele, amongst other things. I have been part of the home visiting project for over two years. One of my neighbours had seen the application form at Ububele and persuaded me to apply. She appealed to my love of babies in order for me to apply. I was not sure exactly what home visiting entailed when I applied for the job. According to the form, they were looking for mothers around Alexandra, women that are warm, understanding, and able to walk long distances, amongst other things. I thought I fitted the bill perfectly as I possessed all the listed requirements. We were short listed to take part in the training process that lasted for two months. These were one of the most emotional and taxing weeks of my life. The training required participants to be honest and open about their experiences about motherhood, childhood, relationships and feelings. I remember thinking: “What are they trying to do to us? Why are we asked to think about our feelings and thoughts? Why do we begin everyday sitting silently in a circle”? Note that sitting still was one of my biggest struggles, as I was always fidgeting and uncomfortable in the silence. As the weeks went by, a few people dropped out of the training for various reasons. For most of the training, it felt like being led to a destination using an unknown path. The methods used were completely different to any other training that I have ever found myself in. In the beginning, I felt uncomfortable and unsure because of the manner in which the training unfolded. None of the participants knew exactly what the panel was looking for at this point in the process. “Please be yourselves and do your very best” that was mostly the answer we got. Wheels in my head would spin as I wondered what if “myself” is not what they are looking for? It became clear to me that the only thing I could do was to be me and in that way I would not regret pretending to be someone that I am not if they did not choose me. I was chosen! I was part of the second group of home visitors ever to be trained at Ububele. The first group was trained in 2012. Currently there are six home visitors. It was not easy coming into the field of mental health. The nature of the work requires one to be constantly aware of one’s own feelings, thoughts, and the impact that these have on one’s relationships. I did not know much about infant mental health and its impact on the development of babies. I was one of those people that believed that babies do not understand and that the most important thing was to be physically healthy and being able to provide financial support. I never considered how my own mental state influenced my baby until I came at Ububele. It is common knowledge in my community that you must not breastfeed your baby if you are experiencing negative feelings, as these will affect the baby. I never really took that to heart, as I thought that it was old wives tales. The training helped me to realise that actually it is fact that both negative and positive feelings have an impact on baby’s development and how important it is to be aware of one’s own personal feelings.

Umdlezane Umdlezane is an Nguni word used to describe a woman who has recently given birth. It also refers to the period where the woman who has just given birth is in the care of the females in her family. They would rally around the mother and the baby. It is in this time that they would help the mother with her daily tasks. For example cooking and cleaning the new mother’s house. The women also look after and support the new mother. The need for the mother to be totally with her new baby is of the utmost importance. This facilitates the process of bonding and attachment between mother and baby. In a place like Alexandra, where many women have their families in the rural areas, the Umdlezane period can be lonely and unpleasant. The support of family in this fragile time is very crucial. This is where the Home Visiting Project comes in. We are not there to take care of the household chores but we are there to support the relationship between mother and baby. We are there to acknowledge, witness, think and reflect on the experiences of mothers in Alexandra in a non-judgemental manner.

The Invitation It is an honour for me to work in my own community. Alexandra Clinic is where I am stationed, the very clinic in which I was born. Expectant mothers and mothers with infants are invited to the project at the various clinics in and around Alexandra. I stand in front, greet the mothers and have a “talk” with them. Each home visitor has their own style of inviting mothers to the project. I strive to speak about some of the changes that are occurring in their lives as new mothers or as pregnant women. I try to highlight a need for a space to share all the good, the bad, the high and lows and everything in between about being pregnant, being a mother for the first time or being a mother again. It is entirely up to the women to decide if they are interested in being part of the project. The women write down their details and we follow up with them as soon as possible. It is not easy to stand in front of strangers, and speak to them about the value of having a stranger come into your home and allowing them access into your and your baby’s life. There is still an understandable resistance and scepticism from the women. We see this in the number of women who will give out their details but, in the end, they do not take up the visits. We make follow-ups by telephone and set up appointments with interested women. At times, mothers would sign up but change their minds in the early stages of the visits. This is what we call “duck ‘n diving”. It is in the supervision spaces that we get to share our experiences and feelings around the nature of recruitments and think about how best to proceed. These weekly sessions help me to think with my supervisors and colleagues about aspects of a case that I feel has a need for more minds. These two spaces contain me as a container in my supporting of mothers and babies.

The case of Thandi and Thoko It was in 2015 that I met Thandi and unborn baby Thoko Thandi lives in a shack with her partner in Alexandra. It was difficult to find Thandi’s home as she stays in the part of Alexandra where the signal is not very good. On other visits, I would phone the mothers to ask them to fetch me from the gate, but in this instance I had to find my own way to Thandi’s home through a maze of shacks. Eventually, with the help of one of the neighbours, I found Thandi. At the time of our meeting, she was seven months pregnant and a mother to a twelve-year-old boy. The boy stays in the Eastern Cape with his paternal family. She was thirty and the pregnancy was unplanned. This was her third pregnancy. The second had resulted in a miscarriage two years previously. In the pre-visits she communicated her anxiety about the amount of movement that the baby was making. She was concerned that this particular baby seemed to be not very active. Thandi had consulted her doctors and they had told her that the baby was fine and developing well. She would compare this to her prior pregnancies and this would raise concerns for her. This allowed us to talk about the uniqueness of each pregnancy and how this might be an opportunity to see how different baby is. I thought about how movement in the womb is a sign of life and how lack of movement may be interpreted as a sign of death. Given Thandi’s history, it was easy to see why she would be so anxious about the amount of movement in her womb. From the onset, one of the themes that were carried was of life and death. She revealed her HIV positive status and how she had contracted multi-drug resistant TB. She shared her experience of being in isolation and alone in a TB hospital. Each day she would watch other patients dying around her. It was terrifying and she wondered whether she would be next. The absolute terror, feelings of hopelessness and despair were not shared with any of her family or her partner. She felt her environment was not conducive enough to share those terrifying moments. They were only able to manage the woman who came out of the hospital and not the woman who lived in hospital for a year. The miscarriage had hurt Thandi very much. There was no logical explanation as to why it happened. She felt she did not want to have other children after it. The pain she felt and the fact that she felt she was too old to be having other children motivated her decision. Her partner was the one who informed her that she was pregnant. Thandi was in denial about the pregnancy. She thought the TB treatment had hindered her ability to have children and she had no desire to be pregnant again. She was shocked, disappointed and scared when the test confirmed her partner’s suspicions. It was hard to watch her excited partner, as she did not share that excitement. She questioned her body’s ability to carry to term, the impact the treatment might have on the baby’s development, and what would happen after she gave birth. My role as home visitor allowed Thandi to shine a light and share the feelings and thoughts she holds about her experience in the hospital and the miscarriage. I faced my own mortality and my fears as to what would happen if I died. I found myself questioning my capacity to contain Thandi, who seemed to have gone through a lot in the past. She had been in a dark pit with no one. As a home visitor, I went down with her and stayed with her. There were initial thoughts of fleeing and escaping the pit. Will I be able to get out? How will this experience shape our relationship going forward? Will we make it to the other side? It got to a point that I started exhibiting symptoms of TB. It was in the supervision that I realised that my body was responding to the overwhelming feelings that Thandi had placed in me. I realised that maybe this is what she might have felt herself. This we refer to as transference and counter-transference: the exchange of feelings between us. I brought this back to Thandi who admitted that she does feel unsure, anxious and overwhelmed by the prospect of being a mother again. Another theme that was present was separation and loss. Thandi had a son who she only visited occasionally over the holidays. She expressed how she feels like she is a first time mother even though she had given birth before. He was initially raised by her family, and later moved to live with his paternal family. It seemed a good idea at the time not to raise her son. She felt he had everything he needed because they were well off. In the course of the visits, she expressed her regrets and pain of separation from her son. “At the time it was a good idea”, she would say more than once. This reminded me of many South African children are raised by grandparents and other family members for various reasons. One of the main drivers of this is a need for economic stability. There are many parents in South Africa living in the urban areas without their children. This was an opportunity to engage the other side of separation from the view of the parent and not only of the child. The sacrifices that parents make in order to provide for their children are painful and difficult. The time lost can never be regained in the growing up of the children. When Thoko was born, she was surprised by how she coped. Things were not the way that she had imagined them to be. The actual delivery was very painful compared to her first one. She did not have any complications. When we met three months later, the happy woman in front of me pleasantly surprised me. We spoke about her journey and experiences. She was alive and well. Her baby was also doing fine, without any disabilities, as she had feared. We looked back and realised how brave she was. The anxieties are still there, but they are not as crippling as they were before the visits. The mind is a powerful tool and without proper guidance, nurturing and control it can conjure up monsters. As the saying goes “Monsters grow in the dark”. I believe that through the Home Visiting project, we are able to shine a light on the “monsters”. I was left feeling in awe at the amount of struggle that Thandi had overcome. I felt that what she needed more than anything that I could offer, was someone to hear and listen to the other side of mothering; that is not all cuddly and fluffy. I was honoured to have been the bridge that carried her over her fears, anxiety, pain and insecurities, to a better connection with Thoko. My task was not to bury the pit, but to facilitate a pathway to the other side. My role was to reassure her and remind her that she had come out of the pit. I was not there to take away her troubles but I was there to think with her about those troubles and support her on her journey. It can be frustrating knowing that there is a pit in your path to happiness, having a bridge does not make the pit disappear but it allows for the crossing over to the other side.

Acknowledging, witnessing, thinking, reflecting, supporting and encountering monsters along the way; it is all in the day’s work of a Home Visitor.

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