The Peer Counsellor Programme in South Africa
Loraine Hamm
Gauteng, South Africa
From: LEAVEN, Vol. 37 No. 3, June-July 2001, p. 66-68
South Africa is geographically
divided into nine provinces and Peer Counsellor Programme training has
been initiated in five of them. The programme began there in 1992 in
Kwa-Zulu Natal. Jane Maasdorp, LLL Leaddr and present Area Coordinator
of Leaders in South Africa, ran the first Peer Counsellor Programme
(PCP) training course. The women who were trained were recommended for
the course by The Valley Trust, a socio-medical project in the Valley
of a Thousand Hills, a rural area on the urban periphery of the city.
During the training, Jane realized that she had already met the women
during previous trips and visits with the community nutritionist. Such
community work by Jane and other LLL Leaders laid the foundation for
the formal PCP training courses that would follow, just as it does in
other areas.
The first course was presented
to 21 active lay community health workers ("onompilo") who
had already proved themselves to be highly motivated in helping others,
had a good basic knowledge of nutrition, and understood the importance
of breastfeeding within the context of the UNICEF/WHO Child Survival
Strategy. They had each breastfed at least one child for at least six
months, although most had nursed several children for periods of up
to two years and more. The course was conducted over 13 weeks, one full
morning per week, in a vibrant and successful mixture of English and
Zulu.
In a report at the time,
Jane wrote: "It soon became clear that, in spite of their previous
training, the women had a lot to learn about breastfeeding, and this
they did with great enthusiasm. There were many lively sessions; traditional
beliefs were examined and debated; new ideas and facts were queried,
puzzled over, discussed very seriously, and generally found to be good;
and, most importantly, ways of communicating with and relating to people
with whom they will share their knowledge were readily accepted."
Jane perceived the teaching of communication skills during the course
as "the most exciting aspect of the training." The women were
all skilled at delivering messages about the health benefits of breastfeeding.
They could sing songs, make up poems, and put on highly entertaining
role-plays, and they acquired skills and information to give support
to mothers.
On 12 July 1992, nineteen
of these women became the first Peer Counsellors in South Africa to
receive certificates from LLLI. Nan Jolly, LLL Leader, HRE Instructor,
and now a member of the LLLI Board of Directors, also attended the moving
graduation ceremony that took place soon after the 1992 LLL Conference
in Kwa-Zulu Natal. "We were all in tears," she remembers.
Western Cape
The programme has taken root
best in the Western Cape, with Cape Town as capital. With 13 experienced
Leaders, some of whom had been involved in the Leader Accreditation
Department in the area, the Western Cape has the womanpower to tackle
the programme. The Leaders have all been networking in the area for
several years, so the contacts they have developed are helpful. They
have also put their hearts and souls into developing the programme.
One of those Leaders, Elaine Dawson, was trained in the PC Programme
at the LLLI Conference in Miami in 1991. When she returned home, her
enthusiasm for and information about the programme helped encourage
other Leaders to become involved.
The first course in the
Western Cape was run at St. Monica's Hospital in 1993 by Elizabeth Robinson.
St. Monica's later became the first hospital in the Western Cape to
earn the Baby Friendly Hospital designation.
Rosemary Gauld, LLL Leader
and retiring PCP coordinator, ran a course at Mitchells Plain, starting
in March of 1994. Rosemary has an impressive record of running PCP courses
in the Western Cape, at times even running two courses concurrently.
After Mitchells Plain, 10 more courses followed at many different localities,
yielding approximately 148 Peer Counsellors.
Elizabeth Robinson, who
trained two groups at St. Monica's, comments that a tremendous demand
for PC training has developed. Medical and nursing staff have seen the
need for training and several professional people have completed the
course. There has also been a demand from members of the community-people
already involved in voluntary work through churches, and interested
women identified by hospitals. There are now nearly 300 Peer Counsellors
in the Cape Town area alone.
In Port Elizabeth, a nursing
sister (nurse) in a maternity ward of a private hospital approached
Marianne Brophy, LLL Leader, to get material for teaching her staff
about breastfeeding. Marianne was asked to do PC training for the staff.
The first Peer Counsellors graduated in 1994. The training in the hospital
continued for a few years before the word spread beyond that hospital.
The PC Programmes in Gauteng
and the Northern Provice are smaller in comparison to other provinces.
The growing pains they have experienced make those of us, involved all
the more aware of the tremendous effort that went into developing the
programme to its present size in other provinces. Three LLL Leaders
made a start in 1996 by running a course in Gauteng from which five
Peer Counsellors graduated. In the Northern Province, which is a vast,
mostly rural area, 27 health care workers attended a three-day course
presented by two Gauteng LLL Leaders in 1999.
Funding
LLL South Africa received
funding from Mobil's Energos Foundation that has kept the programme
afloat for several years. The Leaders involved do not receive any fees;
they may, however, be reimbursed for expenses. Some courses were funded
by the Department of Health or by other institutions that requested
training. The Provincial Administration of the Western Cape has provided
funding for two PCP courses. Travel expenses and LLL membership for
Peer Counsellors in training used up most of the funds, but Leaders
are pleased to see that there is recognition of the impact of the programme
and willingness to provide funding.
The PC Programme in South
Africa has also generated funds from within. Lingoma Zokuncancisa-South
African Peer Counsellor Songs--were recorded by the Cape provincial
education department for use in training programs. The idea was sparked
by a remark Marian Tompson, LLL co-Founder, made when she was in South
Africa with a People-to-People Delegation in 1998. On the day of the
recording each of the three PCP choirs, dressed in their traditional
outfits, sang their own songs. A group presentation was also recorded.
The audio and video recordings are selling extremely well. Many were
sold at the LLLI Conference in 1999, and a part of the video recording
was played during one of the LLLI Conference luncheons.
Curriculum and Culture
Jean Ridler, Leader from the
Western Cape who is involved in PC training, led a session at the 1998
South Africa Area Conference about the Peer Counsellor Programme. She
describes the development of the curriculum:
"We have had to learn
about adult education, how to develop an appropriate cumculum, and how
to work with different cultures. For some of us, it was really the first
experience we had in dealing with truly diverse groups with different
languages, educational backgrounds, and cultures."
"In the beginning,
in Cape Town, we used the LLLI Peer Counsellor Curriculum with some
changes to reflect local conditions and culture, with each Leader using
different approaches with different groups. In 1996, we learned about
the Training Curriculum for Community-Based Breastfeeding Support from
Wellstart International. This curriculum and the teaching methods used
seemed more suited to the training of Xhosa-speaking Community Health
Workers (CHWS) with whom we were busy working at the time. The Wellstart
Programme was adapted and found to work extremely well in practice.
It is very interactive and draws strongly on the knowledge of the CHWs
regarding child health problems experienced in their communities and
links this to breastfeeding. This has now also been used successfully
in different cultural groups. A curriculum is not a static concept.
Rather it is a growing, dynamic creation that will need constant modification
in the light of evaluation and new ideas and is thus never finished."
Discussing culture, Jean
remarked: "It is within the cultural context that solutions to
underlying infant feeding problems must ultimately emerge. Changes,
if they are to last, need to originate from within a culture, not be
imposed from without."
Different Groups, Different
Challenges!
In planning the training,
the PC Administrator needs lots of flexibility to adjust the curriculum
to the needs of the group. The chversity of groups comes across in the
experience of these Leaders.
Jane Maasdorp writes of
her with two groups of trainees in Kwa-Zulu Natal: "Regarding cultural
beliefs about breastfeeding, in both the above groups I have found no
uniformity about some of the practices sometimes assumed to be pervasive
in Kwa-Zulu Natal. For example, some mothers may discard their colostrum
but many do not; a few believe that nursing the baby beyond the age
of two will make him 'stupid,' but many do not; some people believe
that a woman should not make love while breastfeeding, but many do not.
The belief that plenty of helpings of a thin porridge will enhance the
milk supply is found farther south, but some migrants have introduced
the practice here, too. And whilst it may be believed that Zulu-speaking
women are uninhibited about displaying their breasts in public, a young
mother was not supposed to allow her breasts to be seen by her father-in-law
(it would have been disrespectful), and this is still true now for many."
One Leader shared her frustration
about the authoritarian attitudes of some of the people being trained,
which persisted even after repeated efforts at teaching empathetic communication
skills: offering suggestions, specific praise, and many, many practice
role-plays. Another Leader says, "I guess I had the easiest bunch,
with the Peer Counsellors communicating so well with the mothers. Very
little time was formally spent on 'counselling skills' as these were
demonstrated so well in the role-plays that they enjoyed so much."
Materials
Handouts are kept to minimum
because of costs, language, and literacy concerns. All participants
receive a copy of Felicity Savage King's Helping Mothers to Breastfeed.
Trainers refer to this often to help the participants become familiar
with it and to suggest ways of using the diagrams when talking to mothers.
Presentations are as visual as possible, using various models, many
slides, and videos.
A Day in the Life of a Peer
Counsellor
A Peer Counsellor may use her
skills in several ways. Some may be more active than others, depending
on personal circumstances. Even if she decides to limit her help to her
own family and friends, she is still a valuable asset for her community.
Shaheeda Abrahams, from
Port Elizabeth, is passionate about her work as a PC. She took the initiative
to approach the staff of a large acadenuc hospital in the city. Shaheeda
arranged regular visits to the hospital during which she gives talks
to women at their initial antenatal clinic visit. During her ten-minute
talk she covers the most important advantages of breastfeedmg and the
most common problenls. After her talks, she visits the postnatal wards
and admires babies and gives tips to new mothers. Shaheeda was one of
the copresenters of a special session for PCs at the LLL Conference
in Port Elizabeth.
Peer Counsellors are not
always women. Patrick Jelele is a PC from Philippi in the Western Cape.
Patrick is very happy to make a contribution in his community by helping
mothers to breastfeed. He attended the LLL Conference in Gauteng in
1998 and poured out his enthusiasm for breastfeeding in a poem he especially
wrote for the occasion.
Ongoing Support and Education
Training does not end at
graduation! Communicating regularly with the Peer Counsellors is very
important, but can also be very challenging as many people do not have
access to a phone. We cannot schedule frequent meetings as time, distance,
and cost do not allow them. In 1997, a system of links was established.
Those in each geographical area identified "link persons"
-someone to form a link in the communication chain. Bimonthly meetings
are held with people who act as links where we can address many issues.
In Cape Town, follow-up
meetings are organized two or three times a year. Up to 60 counsellors
may attend. They have an opportunity to ask questions, raise problems,
and enjoy group activities. One get-together was spent making posters
with messages relevant to breastfeeding problems experienced in each
community. Another focused on the theme and ideas for World Breastfeeding
Week. Leaders' feelings about the follow-up meetings range from "These
are proving to be a real headache ... just too few of us with too much
to do!" to "Follow-up sessions are inspiring - we hear about
such wonderful work and good outcomes." All agree that these sessions
are essential to find out what is going on and keep knowledge and skills
on track.
Keeping in Touch
Elizabeth Robinson edits "Peer-to-Peer,"
a twice-yearly one-page newsletter which is published in English. It is
sent it to all Leaders involved in training and they copy and distribute
it in their areas. In the Cape Town area, 150 copies are distributed at
workshops and by link people.
"Peer to Peer"
provides another avenue for ongoing support and education. For example,
not all Peer Counsellors were reporting on a regular basis so an article
appeared in the newsletter that encouraged reporting of activities.
The feedback from these reports can be a valuable source of information.
Elizabeth writes: "We picked up from these forms that counsellors
often recommend Vaseline for sore nipples and were able to put an article
in "Peer to Peer" explaining why Vaseline is not such a good
idea."
Success stories from the
reports also make inspiring reading matter for "Peer to Peer."
The editor often feels discouraged by lack of contributions from Peer
Counsellors, but the Leaders find it valuable.
A Leader comments: "The
women I work with love 'Peer to Peer.' We make a point of reading it
together in the group and translating it. They really do identify with
the local content. Even back issues are popular reading matter."
PCP Training on Board the
SS Anastasis
The SS Anastasis is a mercy
ship that goes from port to port. The crew of the SS Anastasis are volunteers
who pay or are sponsored to take part in the voyage. Volunteers give
medical treatment to people who live in countries where services are
poor or nonexistent, including surgical operations and quite sophisticated
treatment. Those who participate come from USA, England, Switzerland,
Australia, Holland, Gemiany, and South Africa. Since they were to call
at ports along the African coastline during this voyage, Leaders adapted
the PC training for the countries they would visit. When the steamship
docked in Cape Town harbor around the millennium celebrations, Rosemary
Gauld and Jean Ridler trained 19 of the ship's medical staff to become
Peer Counsellors. They used LLLI books, along with videos, tapes, and
slides. They based their presentation on the Breastfeeding Five Prime
Messages taken from [i]Facts for Life[/i] (UNICEF, WHO, UNESCO). Participants
who completed the course became members of LLLI. This project was sponsored
with funds donated to LLLI by Medela, Inc.
From Peer Counsellor to
Leader
We have been fortunate to
see two LLL Leaders coming from among the Peer Counsellors. Dilshaad
Sungay attended a PCP course at Grootte Schuur hospital soon after the
birth of her second child in 1996. Dilshaad says that doing the course
changed her whole life and she started looking at breastfeeding and
mothering in a completely different way. She began attending LLL Series
Meetings after becoming a Peer Counsellor and read many books from the
Group's Library. It helped her as a mother and she enjoyed the fact
that her children were always welcome at the meetings. Ditshaad's passion
for breastfeeding culminated in her becoming a La Leche League Leader.
She is co-Leading an LLL Group and is very proud of the steady growth
this Group has experienced.
Sophia Blows was recruited
from a community support group and after completion of the training
course, she became interested and involved in other LLL activities.
Sophia is also involved in the Breastfeeding Liaison Group and Baby-Friendly
Hospital Initiative in her area.
As LLL and the Peer Counsellor
Programme grows in South Africa, Leaders and Peer Counsellors alike
will continue to expand the community of breastfeeding support for all
mothers who are interested in the art of breastfeeding.
Breastfeeding Week in Port
Elizabeth
- Dora helped the mother of
a two-month-old underweight baby to relactate.
- Sylvia held fruitful discussions
with mothers.
- Suraya organized practical
demonstrations where mothers at the clinic showed mothers how to breastfeed.
They concentrated on latching the baby on correctly. The working mothers
were met by giving information on cup feeding and storing milk.
- Stalls (booths or tables)
were set up at Hypervalue Stores enabling mothers to come and talk about
breastfeeding.
- An engorgement problem was
sorted out by using ice-cups, warm compresses, breast massage, and follow-up
help and encouragement. The mother concerned was grateful to the clinic
staff for their support and interest. Her mother-in-law and husband
were also encouraged to give her support.
Reprinted from "Peer
to Peer" No 2, Nov CE97
Breastfeeding Song
by Thandie Manona of Guguletu
Botile sukl endleleni
Awuboni
siyancancisa Siza kulithengelwa
ngubani na.
(Bottle stand out of the way; Can't you see that we are breastfeeding?
If not, who is going to buy milk for us?)
Reprinted from "Peer to Peer" No 2, Nov CE97
Page last edited Sun Oct 14 09:31:21 UTC 2007.
