MENTOR MOTHERS ZITHULELE
Mentor Mothers Zithulele (MMZ) was initiated in 2010 to pilot Philani’s outreach model in a remote rural area of the Eastern Cape. Funded under the UCLA research project, the pilot is based at Zithulele, the site of a mission hospital, in the still underdeveloped former Transkei.
THE ZITHULELE COMMUNITY
Zithulele forms part of the Mqanduli subdistrict of OR Tambo district, acknowledged to be one of the poorest areas in South Africa. Unemployment is well over 90%, and most families live in dire poverty. Although homesteads often provide better quality housing than township shacks and the potential for subsistence farming, water must be carried from nearby rivers and dams, and access to electricity is nearly nil. Illiteracy is extremely high, with many of the older generation (who often become caregivers) never having been to school. HIV and TB are extremely prevalent.
MENTOR MOTHERS ZITHULELE
MMZ utilises the positive deviant model, having selected 15 outreach workers in collaboration with local leadership. These women have been trained in nutrition, breastfeeding support, HIV and basic child health, and offer a service to over 2000 households. Through house-to-house growth monitoring of children under 6, they identify those who are underweight, as well as pregnant mothers, to whom they offer the Mother to Besupport and education. Underweight or growth faltering children are followed up, addressing the many issues leading to malnutrition. They support families to access grants, provide nutrition education, and refer children to health services where needed. In the near-absence of social worker input in the area, they address issues of neglect and alcohol abuse, often assisting in the child’s transfer to the care of a relative where needed. Where child-headed households are identified, MM’s provide crucial support to ensure access to social grants and proper nutrition.
Two Mentor Mothers (MM’s) work part-time in the district hospital, providing education and supporting mothers to establish breastfeeding immediately after birth. They administer a referral system which allows routine referral of new mothers to MM’s in their area on discharge, as well as home follow-up for every child discharged from the paediatric ward to a MM area. MM’s cover most of the communities immediately surrounding Zithulele, which account for well over half of the patients seen at the hospital. Doctors and allied health professionals may also refer patients from the outpatients department, and from Zithulele’s active HIV program. Close relationships with hospital staff allow for a team approach to managing malnourished children.
THE RURAL CHALLENGE
In a hilly area, where roads are poor and public transport sparse, MM’s walk many kilometres to reach households in remote areas. The many services and organisations available in the city are lacking here, and much creativity and skill is required to overcome the many difficulties facing rural families. The MMZ program manager and assistant coordinator work closely with other organisations (Social Development, clinic sisters, hospital staff, NGO’s etc) to address barriers to service provision, and to develop a stronger health service for mothers and children.
Although the program has many challenges ahead of it, our experience suggests that the Mentor Mothers model can work in a rural area as well as in a township, and that it offers the possibility of better health to those living in seriously underdeveloped and under-resourced settings.