Skillz Street

So I’ve been meaning to write about Skillz Street for awhile and it seems that I’m finally getting around to it. First, I have to give mad props to my roommate, Lindsay for implementing the first ever Skillz Street league in Kimberley. It’s also the first girls-only league, which, I must add, is awesome. Although the intended target has always been girls, until now, the model has failed to come to fruition as boys naturally dominate the soccer scene. She has done an amazing job organizing it and even stepping in as a coach when one of our beloved coaches dropped out the morning of the first practice (Unfortunately, in the words of our site coordinator, Mandla, “We’re facing a bit of a challenge” when it comes to coaches. We currently have only 6 coaches in Kimberley and need to reach 5,000 kids with our program this year. The Training of Coaches we have in early January cannot come soon enough). All of the girls were thrilled to see that Lindsay was one of the coaches on the first day. Their faces lit up with excitement and I even saw a fist-pump from a girl assigned to her team.


Skillz Street at its simplest is an organized soccer league for youth after school. However, it provides much more than just a safe space to play twice a week. For example, one of its major tenants is the incorporation of Fair Play rules, which are based on respect and self-officiating. Before starting their matches, the two teams gather together in the “Skillz Zone” to agree on three additional Fair Play rules. The most popularly chosen rules are helping an opponent up when she falls and having both teams celebrate when a goal is scored. I was initially hesitant as to whether these rules would actually be followed. When’s the last time you saw a twelve year old celebrate when they were scored on? But to my surprise, this rule has been beautifully adopted. I’m often astounded at the celebrations in which both teams take part after a goal is scored. They’re often so loud that teams on neighboring fields turn to watch. Players on the sideline run onto the field with coaches to exchange high fives and hugs. I tried to capture the essence in some of these pictures, but they really don’t do the experience justice.



In addition to the emphasis on Fair Play, every practice has a theme. They have included such vital topics as teamwork, gender, and self-efficacy. Lindsay creates questions for each theme and the teams discuss them in the Skillz Zone for ten minutes after the game. These topics are important, yet too often unaddressed. The idea is for the girls to feel comfortable talking about such issues at Skillz Street. It offers them an intimate space where they can express themselves and ask questions. Thus far, the discussions have been relatively successful. Although some questions need to be reworked, the girls actively participate and contribute insightful thoughts. I love seeing these girls, who are limited in so many ways, take charge and find solutions to the inherent problems they face.

We also decided to add Skillz Core to Skillz Street (Skillz Core is the 8 practices that teach about HIV and AIDS). It was advertised to the girls as an optional component of Skillz Street, but to our blissful amazement, nearly all of the girls who had not already graduated from Skillz Core decided to attend these sessions before their games. Even girls who had graduated from the program came back to do it again. Such a positive turnout was a necessary reassurance in the initial days of the league. The other great part of Skillz Core with Skillz Street is that we get to see our assistant site coordinator, Thuso Jones, teach all the lessons. He’s usually too busy with office duties to be a coach as well, but seeing him in action is nothing less than beautiful. Although normally shy and reserved, Thuso bursts into a new energetic persona when he’s coaching. He teaches the lessons as they were meant to be taught, emphasizing key messages and keeping the girls engaged. It seems as though he was meant to be a Skillz Coach. After practices, the girls swarm him, joking and just trying to be near him. If only all of our coaches could be like him…

Playing Find the Ball - the girls pass the pall behind their backs and the other team has to guess who has it when Thuso says "stop". It's usually tough to figure out who has the ball. The ball is labeled "HIV" and is supposed to signify a person who has HIV. The message of the game is that you cannot tell just my looking at someone whether or not they have HIV, just as you cannot tell who is holding the ball just by looking at them.


Since attending and assisting Lindsay with all of the logistical duties of Skillz Street, I have managed to amass a personal fan club that ranges anywhere from one to fifteen kids on a given day. They love to hold my hand, braid my hair, sit with me, climb on me, ask endless questions, and generally help me with anything and everything. Needless to say, I thoroughly enjoy it. I’ve also become the unofficial photographer and the kids love having their picture taken. I included some of their fun pictures here. I can’t get over their beauty and saucy personalities. Just when you think one of them is shy, they bust out a sweet dance move or dramatic impersonation. I love that they are so much more comfortable with themselves and outgoing than American kids. Every time, someone new joins and I instantly become attached. I could seriously just play with them all day. Alas, I have to make due with the snippets I get on Tuesday and Thursday afternoons.


My favorite girl is on the far right. Although she's normally shy, she got a little attitude for this picture.

Yesterday, we celebrated Thanksgiving! We delayed the holiday until Saturday so that we would actually have time to prepare our delicious feast. It officially marked my fifth consecutive Thanksgiving away from home. Sad, yet, it felt much more like the 4th of July than Thanksgiving with the 95 degree heat. Our menu was so extensive that Lindsay had to go out and buy three extra pans so that we would be able to cook everything. My favorite dish was the sweet potato casserole, which my mom makes for all the holidays. We also had mashed potatoes, green beans with almonds, scalloped corn, stuffing (and gluten free stuffing for Lindsay!), chicken (couldn’t find turkey), pecan pie, and pumpkin san crust (i.e. sans gluten). After the sun had set, we dusted off our dining room table (read: black plastic) outback by the bbq pit and Hooter lit a fire. We set the table and had an amazing, candlelit, Kimberley Family Thanksgiving. The warm night felt great. Since we rarely eat at the same time and I usually eat on the floor, the table feast made it feel like a true holiday. It was one of my favorite nights thus far.

A Face to the Disease

While visiting the hospital last week, I was lucky enough to sit in on some meetings between HIV patients and their adherence counselors. As it turns out, one of our old coaches, Vicky, now works at the hospital as one of these counselors. She was thrilled to see me there and ran down the hallway to give me a huge hug. I was glad to have a friendly companion for the morning since the pharmacist was out sick. After introducing me to all of her coworkers, she led me to her counseling room to sit in on a few sessions.

In reality, counseling is a rather generous term to describe the process. The patient enters, hands his or her file to Vicky, and sits quietly while Vicky counts the number of pills left (to make sure the correct number has been taken since the last visit – this is the vague measure of adherence). The only questions they answer pertain to their first and most recent CD4 counts. CD4 counts measure a type of immune cells in the body. Patients, who are very sick, have low CD4 counts, whereas patients who are healthier and able to better fight off infection have higher CD4 counts. CD4 counts are often used to determine whether a person needs to be put on ARVs. A patient is generally put on ARVs when their CD4 count is below 200.

During one of these quick 5 minute check-ins, Vicky had to leave for a few minutes to speak with a coworker. I quickly realized what a rare moment I had and took the opportunity to introduce myself to the female patient and ask if she would be willing to talk to me about her experience living with HIV. Although shy at first, she slowly began to share.

In 2003, she was pregnant and during a visit to the hospital, a nurse suggested that she take a voluntary HIV test. At that point, she had only ever had one partner – her husband – and so she thought she had nothing to fear. She agreed to the test, only to be stunned with the positive results. Immediately, she knew that her husband had been cheating on her. To my surprise, he apologized, admitted that he was at fault, and agreed to be tested as well. In most scenarios, it seems that men will blame the women even if they know that they are at fault and they will adamantly refuse to be tested. When he tested, like his wife, he found that his results were positive. Sadly, when I asked about their baby, she said that it only made it to ten months. Although, she did not reveal the cause of its death, we both silently acknowledged the truth.

Luckily, in 2004, things began to turn around for her, as ARVs became free in South Africa. She jumped at the opportunity and began taking them as soon as possible. In terms of side effects, she said that the first 2-3 days were the hardest part. Now, the drugs are just part of her life and she doesn’t seem to be particularly bothered by them. I was, of course, interested in adherence, so I asked her if it was hard to remember to take the ARVs everyday or if she was embarrassed to take them in front of others for fear that they would know she had HIV. She replied that neither were a problem, saying “It’s my life”. I was also surprised that she was open about her status with family and friends. In fact, she attributed much of her success on ARVS to the support she gets from this network, revealing that “the big thing is support”. When I asked if she worried about what neighbors said or gossiped and how she dealt with stigma, she said that it did not matter. People will always talk. What matters is that her family and friends are there to love and support her.

Although this woman did not realize it, I truly admired her. She has taken so many brave steps in her young life that others will never manage in a lifetime. I hope that she can be a role model for others to get tested, seek treatment and support, and be open about one’s status. Like the majority of the patients I saw, she looked healthy – not the emaciated, sickly image that many people attribute to victims of HIV. She was still living her life with this rough bump in the road.

Hospital, Half-Marathon, & Happiness

On Friday, I was lucky enough to finally spend some quality time at Galeshewe Day Hospital, the only hospital that serves the township. Sadly, it’s vastly understaffed and deprived of supplies. I have made a few connections with people working in the ARV (antiretroviral) section of the hospital, which is where I hope to spend a lot of time in the coming months. ARVs are the medications that people with HIV take to remain healthy and postpone the onset of AIDS. In this section of the hospital, there are no longer any doctors to help the patients. At one point there were four, but now all people receiving treatment are consulted only by nurses or “sisters” as they are frequently called. The township consists of about 170,000 people. The HIV prevalence rate in South Africa is almost twenty percent and yet, there are only nurses to help HIV positive patients – on a good day. The lack of care is astounding and frustrating. I have befriended the pharmacist, who is doing his mandatory year of volunteer service at the hospital. He hates the work and describes the atmosphere as absolutely depressing. It was hard to hear such a lack of enthusiasm from a key staff member. As soon as his year is up, he plans to return and remain in Cape Town. Although the ARV section is at capacity, he estimates that only about a fourth of the people that need treatment are receiving it. The push to have people learn their HIV status is crucial, but becomes increasingly difficult when it’s impossible for them to receive treatment.

After talking with the pharmacist during a few visits to the hospital, I have become interested in two topics that I want to pursue as research projects this year. First, I would like to determine patients’ adherence to ARVs and factors that influence adherence/nonadherence. After determining this baseline data, I would like to start a project that improves the current down referral system. All staff members that I have spoken with have emphasized the currentfailure of down referral. Down referral is when the hospital begins to refer its patients to local clinics for treatment in order to alleviate their patient burden. The idea is to allow patients who have successfully taken ARVs for at least three months to retrieve their medication and have their adherence tracked locally, rather than at the busy hospital. This move would clear up more space for new patients to seek treatment and eliminate travel for patients. The system sounds great in theory, but in practice, it has failed in Galeshewe. The main problem lies in the fact that the clinics are not adequately prepared to handle the down referrals. Patients recognize that the clinic staff do not know how to adequately counsel or check adherence. Another issue is that the level of anonymity decreases when local clinics are used. Patients are more easily recognized by neighbors and other community members when they travel to the clinic and everyone knows how quickly gossip spreads, especially when it’s related to HIV. Stigma is obviously an enormous barrier to overcome in regards to HIV and many patients may prefer to expend the extra money and energy to transport themselves to the hospital rather than undergo the watchful eyes of suspecting gossipers.

We’re also staying pretty busy with other GRS projects. Lindsay recently started a Skillz Street League for girls. I assist her at the practices that are held twice a week. It’s definitely the highlight of my week. I’ll write more about it soon! I’m also heading a VCT that we’re holding on December 5th in honor of World AIDS Day (Dec. 1st). It combines soccer, GRS games, and HIV testing. More to come about this as well. Immediately following the VCT, we are going to have another weeklong holiday camp. And, in January, we are planning on having a TOC (Training of Coaches) to train about 30 new coaches. So, we have a lot on our plate right now, to say the least. But we’re all happy to be busy and playing such vital roles in the Kimberley site.

In other news, I ran my first half marathon this weekend! I never thought that my longest run would be in Kimberley, South Africa, on rather mundane roads, but I still enjoyed it. About halfway through the race, a 50-year old Afrikaner woman began talking to me. She shared that she has raced an 85km race 14 times now. When asked if I was planning to do it, I just laughed. It takes her 11 hours to run it – way longer than I want to be running. The best part of the race was about the last two miles, when my amazing roommates tracked me down in the car and became my mobile fan club. They danced, cheered, and tried to make me laugh. It was such a great surprise, as they had told me they had absolutely no interest in waking up early on a Saturday morning (the race started at 6am) and I couldn’t blame them. Their ridiculousness made my day.

I thought I would include a picture of our visit to Port Elizabeth, where we reunited with 10 other interns for Halloween. It was my favorite weekend vacation we’ve taken so far. Although it looks like we went surfing, Hooter was really the only successful one. Still, I loved just being in the ocean. I’m definitely jealous of the interns who live there and get to go surfing before work.



Besides the half marathon, we’ve been having a relaxing weekend – tennis, lounging in the garden, reading, going out to brunch. The weather is getting warmer (in the 90s some days) and in the past month, we’ve had some intense thunderstorms. I’m looking forward to the week ahead and making some progress on our many projects. We’re hoping to go back to Lesotho next weekend and spend some time in Semokang. It’s a small village in the mountains that has the longest commercial abseil in the world. Abesiling is like repelling down a mountain face. This one is 206m down a waterfall. I think I’m going to have to get over my fear of heights for this one. It sounds too incredible to pass up.

Zweli

Following our holiday program, I was asked to write a success story to share with Castrol, our sponsor of the event. I chose to write about Zweli, one of our amazing coaches. The story follows:

Delani Mahashi, better known as Zweli, is a lively 20-year-old Skillz Coach from Danielskuil. In late September 2009, he volunteered as a coach in a Skillz Holiday Programme, sponsored by Castrol. With his vibrant personality and contagious energy, Zweli led a group of ten students from Isago Primary School through the Skillz Core curriculum and Skillz Street games during the week-long programme.



Zweli fully adopted the Fair Play mantra of Skillz Street, ensuring that all participants were enjoying their games while simultaneously supporting and encouraging one another. He frequently initiated and became the center of mass celebrations after scored goals, regardless of which team had scored. Most notably, on the final day, when a fellow coach was unable to attend, Zweli stepped in without hesitation to coach the stranded team, in addition to his own. Despite the fields for each team being far apart, Zweli sprinted back and forth between the games to coach both teams. His dedication and enthusiasm were unmatched.

Zweli truly emerged as an extraordinary role model for the participants during the voluntary counseling and testing (VCT) portion of the programme on the final day. Leading up to the VCT, Zweli had encouraged his team to learn their status. As he did this, members of his team began to challenge him unexpectedly. They pushed him to test as well. He recalled one participant in particular, “Tomorrow, Coach, you’re saying to know your status at the VCT. We challenge you to know as well.” Zweli took this challenge to heart. Throughout the week, he struggled with the internal debate of whether or not he would test. Even on the day of the VCT, as he ran between soccer matches to coach both teams, he flip-flopped between deciding he would test and then reneging. But his team held strong with their pressure for him to know his status.



During lunch, a programme coordinator reminded Zweli that now was an opportune time to take interested members from his team to be tested, and if he was willing, to be a role model for them and test as well. In this moment, Zweli met the challenge. As he proclaimed to his team that he was going to be tested, a horde of participants, including members of other teams, enthusiastically marched over with him and overwhelmed the testing tent. The inspiration he gave to these children, who had previously been completely uninterested in testing, was truly incredible. The minimum age to test with New Start was fourteen and suddenly participants were so eager to be tested that they attempted to convince coaches that they were of an older age, despite their records proving they were too young. Zweli went on to test with multiple children during lunch. They attended pre-counseling together and after he had been tested, he waited for each child to exit and ensured that he or she was okay. Zweli later recounted that it was the inspiration from his team that empowered him to learn his status. He was proud of their courage to test, but also of their ability to instill courage within him as well.

Immediately following his testing, Zweli ran to the championship field, where his team was about to begin their competition. The game had been put on hold until Zweli finished at the testing tent. He joined his team and without faltering, jumped back into coaching. Despite losing the final game, he and his team celebrated grandly, demonstrating the true meaning of sportsmanship and Fair Play embodied by Skillz. Zweli is a genuine inspiration to all and his power as a Skillz coach came to life in the Castrol Skillz Holiday Programme.