Interview with Dr Elizabeth Musaba founder of Empilisweni Woodslands Centre for AIDS Prevention on 17 June 2002

Interviewed by John Kiwanuka Ssemakula , July 4th 2002

Dr. Elizabeth Musaba- Mphele is the Founder and Executive Director of the Empilisweni Woodlands Center for AIDS Prevention King William’s Town, in the Eastern Cape Province of South Africa which was created in 1999. An award-winning facility for its work in HIV/AIDS prevention and treatment in communities and prisons, the Center serves 21 villages in the surrounding area. Prior to setting up the Center Dr. Musaba worked as Clinical Manager of the Masimanyane Women Support Center in East London, South Africa (1997-1998).

Dr. Musaba combines her skills and career experiences of doctor, activist, educator, and researcher in her work against HIV/AIDS. Throughout her work in the healthcare arena she has been a strong human rights advocate, especially with issues pertaining to women’s rights. She is a member of numerous national and international organizations that deal with HIV/AIDS and violence against women. Dr. Musaba is a board member for a variety of organizations including Catholic Care Ministry of the Diocese of Port Elizabeth, The Steering Committee of the South African Gender-Based Violence and Health Initiative at the Medical Research Council, and she sits on the Advisory Committee of the Desmond Tutu Leadership Academy International.

Medilinks:              Dr Musaba thank you very much for giving your time to talk to us. What does Empilisweni mean and how did it come about?

Dr Musaba:           Empilisweni means the healing place. The project came about following a needs assessment exercise we had done in the area that showed that AIDS was quite a problem in the area, and that there was not much being done about it. We decided the best course of action would be to setup a clinic that could be sued for educating the community as well as providing health services. Before setting up the clinic we decided to go into the community find out their views and knowledge and conduct a series of interviews about what their priorities were.  And we got quite a surprise.

Medilinks:              What was so surprising?

Dr Musaba:           We had gone in armed with the knowledge that we knew what was best for the people in the community. But when we questioned the people we found that AIDS was nowhere near the top of their priorities. It was about 13th on the list. Their main problems were poverty, hunger and unemployment. In fact very few people knew about AIDS to call it that. They knew there was a new disease, and from their descriptions we were able to deduce that people were suffering from TB and other AIDS related diseases.

We decided that if there were to be any chance of success with our programme we would need to change our approach and at least meet the community halfway in their needs. We decided to center our project around women and gender empowerment because women are bearing the brunt of HIV/AIDS.  Income generating projects seemed to be the best way forward. But to do this we needed funding and we had to look around. We were fortunate to be put in touch with the Catholic Medical Board, which has a long history of funding development projects in the developing world.

Medilinks: So what happened next?

Dr Musaba - Initially we started with 20 women for our income generation projects, now there are over 400. Theincome generation projects include, sewing, gardening, poultry farming and beadwork. These income generation projects have proved very successful. In order to be eligible women must attend the center at least once a week. We tend to run sessions on Tuesdays. The aim of the project was education on HIV/AIDS, home-based care and counseling. But is mo much more than that. At the centre they are taught basic health education, nutrition, prevention, about STD's and HIV/AIDS, counseling, and  reproductive health. Really its an all round education. We are now also extending the program into schools.

Medilinks: Did you encounter any problems trying to implement the project?

Dr Musaba:  Yes we did. The first and main problem was with the men. They saw us as trying to usurp them. We had to be very careful about how we handled this. We needed to handle this sensitively and carefully to avoid cultural clashes. We also started education classes for the men with the help of one of our colleagues in order to include them in the project activities and so they wouldn't be left out. This proved very successful, so much so, that the men started demanding their own income generation projects.

Medilinks: Were there any other issues?

Dr Musaba: Another issue we encountered was the one of where you are trying to educate people who do not have a lot of knowledge about Western medicine. We were guilt of assuming they knew nothing. When we first went into the community we ignored their "local knowledge" instead thinking ours is enough. But to be able to help educate them effectively, we the doctors and nurses had to first educate ourselves about what they knew and thought about health related issues. For example in the case of vaginal discharge, it wasn't that the women didn't know about it, but most regarded it as part of the price to be paid for being a woman! Knowing this, we were able to explain to them how to prevent the condition.

Medilinks: What other achievements has Empilisweni had?

Dr Musaba: The Empilisweni program has proved extremely successful. One of our most successful endeavours was taking the project into the prisons in King Williams Towns. There we launched AIDS awareness campaigns with the prisoners. Long-term prisoners were given lay training as peer counselors for their fellow inmates. They were trained and educated to become self sufficient in all aspects of HIV/AIDS prevention. These long-term prisoners in turn educate prisoners who were there on shorter sentences. This is very important, because these shorter-term prisoners are going to be released into the population, and it would be a tragedy for them to spread AIDS on their release. This has proved so successful, the Governor of Prisons in the Eastern Cape has asked that the program be taken to all the other prisons in the province.

Medilinks: Do you do any other programs for example outreach in the rural communities?

Dr Musaba: No, most of the activities take place at the center. We do have a psychiatrist who will make home visits and give counseling.

Medilinks: Have you encountered any problems with this being an AIDS Clinic?

Dr Musaba: We have been very careful not to associate the center with AIDS alone, because of the stigma associated with the disease in society. If people thought of it as an AIDS clinic they would not come. It's more of a women's support center providing counseling and health education.

Medilinks: Do you provide any treatment for at the center for people who come in with problems?

Dr Musaba: No we do not. As I said this is mainly a support center. One of the things we emphasize to our participants is the need for good nutrition, because a hungry body is a weak one, and will not be able to fight disease. So we provide them with access to better nutrition, and knowledge of how to prepare food in the most nutritious way. But we do have a network of church hospitals and private clinics to which we can refer people who have health problems. The advantage of this is that people can keep their privacy if they have any problems related to AIDS.

Medilinks: What are your views on the way AIDS is viewed in South Africa?

Dr Musaba: In some ways it is really disheartening. The stigma is so strong no one talks about it. Not enough is being done to break down the stigma associated with AIDS. For example church and other religious leaders have really not played a part, but have kept quiet, unlike in other countries such as Uganda. The stigma is so great, that it is now like the way people used to treat cancer. I can remember 15-20 years ago, cancer had such strong stigma attached to it, no one would admit they had it and only talked about it in whispers. Today people would prefer to say they have cancer rather than admit to having AIDS!

Medilinks: Do you have any plans for expanding the programme to provide for example micro-credit or micro-finance lending for women who have absolutely nothing to start with?

Dr Musaba: We would very much like to be able to do this. We are a very young programme, only two years old and we are just getting established. But our successes have greatly encouraged us. This is one of the many things we would like to do, but it is a question of getting funding, of finding donors who would partner with us so we can expand our activities.

Medilinks: What is the one most important thin g you would like to see in the fight against AIDS?

Dr Musaba: Two things, not just one. First the need for global programmes to help poor people break free from poverty. We need to eradicate poverty and free people from the exploitation and suffering of poverty. Secondly empowerment of women is very important. Women need to be educated and helped to protect themselves from getting infected with HIV. Every year, 500,000 women in Africa die from childbirth related problems. 805 of the women infected with AIDS got it within a monogamous relationship. Women need empowerment to protect themselves and stay alive, so they can help keep their families together, prevent the creation of orphans and ultimately help communities together.

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