Family study reflections

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Eric Chisupa
Principal Lecturer
Pediatric and Child health Nursing Program
Lusaka College of Nursing
FAMILY STUDY REFLECTION
First Study day one 23th April 2016 (Saturday)
Objective: knowing the family and the environment
What did I do with the family today? What did I think or feel about it
The first day am meeting the family. I took a long time planning this visit. I was told by others
that it was dangerous to go to Kheyelitsa Makhaza. I had earlier asked my friends who are in class
and have families in Kheyelitsa to have to give me a lift. Unfortunately their schedule could not
meet up mine. I had no idea where Kheyelitsa was.
Like always I googled up the place. The image google painted was of “a community at war” with
itself. The image of violence, theft, disorder and lawlessness in the area. I got to realize that it was
a location probably the biggest location in Cape Town and crime escalating at a very fast rate.
At some point I almost gave up this family to look for another family who probably live in a
different location. But somehow I dropped that idea. I was never going to drop the family on
account of fear of the place. Am not the type that does that. My curiosity got the better of me. I
called up the family and they told me I could get a taxi and drop at some location and then get
another taxi to Makhaza. But I was warned to not ask anyone for direction for it was not safe to do
that. She told me that when I reached at shoprite in Makhaza I should call her and she will arrange
for me to be picked from there
So I dropped the idea of getting a taxi from that warning. I decided to get a private cab. The first
can driver told me that he will charge me R500 to go and come from Makhaza for it is very far. I

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thought that was too expensive by any standards except the exploitation standard. I tried to
negotiate some more, the more I talked to him the more I got convinced that it won’t work. He
was making it sound like it’s so far away and that it’s difficult to drive there. His explanation was
not convincing me. I tried to get google involved in the discussion.
I showed the cab driver that google was saying my address was 30 minutes’ drive from the where
I stay. That did not move him and He showed me that he didn’t trust the results from these “gadget”
they don’t give accurate results. “They are meant for places in Europe not here” he attempted to
reason with me. I could quiet hear him and I could also quiet agree to some extent with his
reasoning. But there was a R500 at stake here. So I had to stand my ground if I ever hoped to have
that fare reduced by any chance.
We spent a good 20 minutes discussing. I then realized that it was time to move to another cab
driver. At this point I remembered a cab driver who one of my international friend knew and was
ferrying us to St Joseph for work. So I contacted my colleague to contact that cab driver for me.
They apparently spoke the same home local language (Swahili). I thought I could tap on this
resource. This also meant I had to ask the company of the class mate. This I knew would help in
getting a fair fare.
In my language there is a proverb which says “twende babili te mwenso”, which when translated
would mean when you are on a journey and you ask for company it doesn’t mean you are a coward.
Its shrewdness. So I decided that would be a perfect move to do.
I left all the negotiation to be done in Swahili as I comfortably stood by and waited for them to
conclude and advise me what to pay. I trusted them. They both of course could speak English but
I left them to discuss from the depth of their hearts. I pretended to be a bystander when in the actual
fact I was the owner of the trip. They did not take long, she reported to me that the driver wanted
a R300. I instantly thought it was a cool deal. My earlier deal collapsed at R500 so I agreed that
we go
Alas, I had to wait because the cab driver had to go and drop some people at Claremont. So we
waited for about 15minutes. True to his word he arrived and off we started off. He was anything
but a quiet man. He kept us busy with his narrations and his stories. He appointed himself a tour
guide. He was from Uganda and he says he has been working here in South African for 16years.

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He boasted that he knew almost all the places in Cape Town. I heard very little of what he was
saying. My mind was flirting with the expectation ahead of me. What will I find…will I find blood
all over the street….is this worth it….will we be safe…etc...
He first commented on the politics in his native Uganda. He complained about President Museveni,
that he has held on to power for too long. He is the only president he has known all his life. He
talked about the corruption that a few people are benefiting from the wealth of the country. He did
not like the idea that “everything in Uganda was privatized”. I usually show very little interest in
political debates apart from following the issues just to know what is happening. I have a great
curiosity for details on anything, and I mean just about anything and any subject.
Then he waffled about Christianity. He complained about the many rich men of God who abuse
their flock. He then confessed that he was a Moslem, and he was quick to condemn the extremism
in Isis, and other areas. He called them brain washed Moslems. The true Islam teaches peace and
co-existence and he does not agree with the ideology of the extremists. He wondered how they
wished to go to heaven after killing a fellow man who in most cases would be innocent
His rumbling was only interjected by introduction of places. He would explain this is Langa. This
road goes to Mitchell’s plain. This is N2 you can get to Bellville with N1 not really N2. Have you
see how Langa looks and so on. I had in the meantime engaged in some thinking and at the same
time show some level of interest in his story to keep him motivated to say more. I nodded my head
countless times. This encouraged him. He increased the volume with his crispy voice sounding
like a teacher in a class of damn students who he thinks they will never pass and he is just wasting
his precious time and energy teaching them
He was so consumed in his rumbling and giving us the tour direction that he didn’t even see me
take my phone to call the family. When I started talking on the phone, then he stopped talking, and
reduced the volume on his stereo. As soon as I finished he continued talking like nothing happened.
We passed Kheyelitsa section one, then section two and we turned left and I saw the place. My
fear dawned on me. The fears arose from what I was told about the place than what I was seeing.
I noticed on the left there was a sign post indicating that there is an infantry base in our left hand
side. I wondered how the place this famous for violence can be so near to a military base.

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As soon as we entered the township, we found traffic lights. Then from nowhere a young man with
a wind screen cleaning stick and some fluid on the bottle jump in to the road. It looked pretty much
like a person who makes a place dirty in order to clean it afterwards. Without asking or saying
anything, he poured the fluid on the wind screen, and started cleaning. The driver was protesting
the action. The cleaning guy either he did not hear him or just totally ignored him. He continued
un abated cleaning the wind screen. Then he jumped to the other side. He was so quick that before
the traffic light turned green, he was standing by the door of the driver. While still protesting the
driver pulled a few coins from his dash board coin receiver and dropped them on the open hands
on the cleaning guy. He cared less about the drivers protest about cleaning without asking first. As
soon as he got the coins he was doing the same thing to the car just behind us
I realized this guy has done this for some time. All the drivers were complaining but none could
refuse giving the guy something after the unwelcome job was done. When I looked closed I
realized that there quiet a number of them. Our cab driver told me that if you don’t pay something
these guys can assault you and even grab your car. To some extent I thought the guy was doing an
honest day’s work. The only problem was the compulsion part of things. Because drivers paid out
of intimidation, and not because they appreciated the service. The cleaning guy did not care, so
long as your wind screen is cleaned and you pay him, he was quiet happy with himself. So one
has to pray that you always find the traffic lights at green to escape this, or better still budget for
this wind screen cleaning every time you pass here
We took another turn left and we found the shoprite. I called the family again and they said they
will send somebody to fetch me. We waited in the car. We waited for like 30 minutes then a young
girl appeared. She fetched me and we walked with her. We left the driver at shoprite. The house
was not very far though the walk was rather long because I kept looking through my shoulders just
in case
The external environment of the community looked quiet. It was a Sunday so I thought. We saw
boys who looked half-drunk standing aimless on the street. They were conversing to each other
like they were urging. By my count we found about five such groups. The girl who came to fetch
us did not seem to mind them for we moved like everything was fine.

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We arrived at the house. The outside looked clean. We found the patient playing with some friend
on the skating board by the roadside. There was no adult supervision. They were about five or so
kids. The house is at the junction. The boy just stopped to greet the aunt. And then he looked up
and I think he might have remembered me from the hospital. He looked at me again and continued
playing. I gave him a smile indicating don’t mind me move on.
The yard is fenced with up to the waist line fencing wire. There was a small fenced gate, which
was pushed permanently to the side. When we entered the yard I realized there were two structures
which stood up like houses. The first one was just as you entered. It looked like the master house.
Build with concrete blocks. From outside it looked like a one bedroomed house with a kitchen,
bathroom, and living room. Just behind it stood the structure put up with iron sheets.
The yard was a bit small for the children to play there. It explained to me why I found my patient
playing with his friends outside the fence. It had grass which was growing there. As I suspected
we headed for the structure in the iron sheets. It was a one big room which was divided with a
curtain to create a bed space and a living room. The living room had a set of sofas. On one corner
there were plates and the other corner there was a fridge which did not like it was working, because
it was not connected to any power source in the house.
We found the lady sitting by the sitting space. The curtains to the bed was, was partially lifted.
The bed appeared like it was resting of some high surface, because it looked too high for a home
bed. It looked more like a hospital bed which has been elevated.
We sat in the sitting space. From the look on the mother patient she could not believe us that we
had come that far to see her. The first question she asked was, you have come? Of course we had
come. She assured us that this section of Kheyelitsa was the peaceful side. The other sections were
very violent and rape cases were too numerous to report. There were even incestuous rape cases.
That is a son raping the mother or the sister. No one was safe in the other sections.
While we were talking there about two or three small rats which were apparently crossing the
house and making circles. She acknowledged them by saying these rats have disturbed us a lot.
And I could see on the corner were the old fridge stood there was a mouse trap.

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My objective for this visit was to meet the family and get to understand the environment. She was
happy for me to interview her. She even reminded me that I should take notes and we chat. She is
a single mother with two sons. The first one is 13years and the second is the patient who is almost
4. She was married but the husband left when the child started getting sick. He stated that he could
not stand seeing the child getting sick. She however was quick to state that, the husband used the
child’s sickness as an excuse because, there marriage was not always a happy one. She knew their
marriage could not last because her mother in-law always wanted the husband to live with her in
the Eastern Cape. She claims this is because she is Zulu and the husband was Sotho. She said inter
tribe marriage do not survive here.
She comes from the family of three daughters. She is the first born. The second born sister passed
away when she was young. Their third born sister stays with her since she finished her matric. She
is the one who came to fetch us at shoprite. She apparently has a baby girl, two years old and they
live together. So in that sleeping space lives, two adults, and three children. She pays rent for that
space of R350 and R50 for electricity every month
She has finished her Matric and did a course in secretarial work. She was working as A Personal
Assistant for a foreign firm. The firm relocated to the UK about the time she was in hospital with
the child. She was hence asked to resign so that they can find somebody to prepare the company
for relocation. She has not started work since then
They depend on the child grant for the children. My patient because he is sick he gets a grant of
R1, 500. The first born get R350 and the sister’s daughter also gets R350. In a month they get
about R2, 200 a month
The maternal grandparents to my patient have both died. The grandfather who was living in
Johannesburg dies during the riots against apartheid in 1993. The grandmother died due to the
causes unknown to my patient mother. She was sick and died in hospital in 2000.
The paternal grandparents are both alive in the Free State. The grandfather has an unspecified heart
problem and he is diabetic, whereas the grand mother is a known hypertensive patient.

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They have two aunties to my patient mother who they communicate with regularly. That is all the
family they have. When they need help they call their pastor who is a parental figure in their family
It was such a privilege to do this family study. I feel very privileged that the family gave me an
opportunity to interact with them in their space.
What did I learn from them today? How can I apply the lessons to practice?
Today I learnt the resilient and the troubles they pass through for the family to get where they are.
It is all quiet easy to judge people by your first contact. My patient mother is very hard working
and tries her level best to take care of her family.
I can apply these lessons to practice by being a little bit more patient with families. The diagnosis
of a long term illness does not just impact on the medical history of the patient. It affects all the
family dynamics and how they do things. My family broke down partly due to the illness of the
child. The husband left and they got divorced. She can can not go back to work for now because
she has to take care of the child. She cannot possibly travel out for a long time because the child
need attention almost all the time
Did I meet my objectives for that engagement /visit?
Yes the objectives were met. My objectives were to understand the patient and get the environment
in which the patient live in. I did found that out and I was able to observe all the interaction of the
family members
Which of my strengths did I use today?
I use all the top five strengths
1. Strategic
2. Ideation
3. Developer
4. Achiever
5. Activator

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What can I do next time, or what will make it easier of different when I go again
I will need to discuss the family history more. Next time I need not take too much time for the
family. I must have disturbed the family though they didn’t complain. I started communicating
with them from morning and they were waiting from the morning till when I saw them in the
afternoon.
Now that I know were the house is it will be easy to get it.
Second study 24th April (Sunday)
Objective: family history
This time the going was not at the previous visit. Being a Sunday she told me that she will be at
church in the morning. So I was advised to see her in the afternoon, especially after 14hrs. I had
to go to my meetings in the morning too. About 14hrs I got the private cab and we went straight
to the home. He parked just outside the house. I reached about 15hrs. She was not home yet. The
young sister was home with her daughter. Church was quiet a walking distance from her home. I
won’t mention the name of the church for the sake of confidentiality.
I called her and asked her if I could join her there at church. She was happy to allow me. The
young sister agreed to walk me up to church. I found her standing with her pastor. Apparently the
service had already finished she was just having some moment with the pastor. She introduced me
to the pastor as the Zambian Nurse. The pastor must already have heard about me from the way he
greeted me with some sense of familiarity.
The pastor excused himself stating that he had to go and attend to some other matters. We started
walking back home. She told me on the way that she had taken my patient to the pastor for prayers.
She does that regularly. The prayers are held after the service
I asked if she would mind me lifting the boy which she did not. I lifted the boy. I put him up on
my shoulders. We started walking back home. I asked her to define to me what she considers

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family to be. She said to her family would be those people who would help them in time of need.
She mentioned that they were brought up in the city. She was born and brought up in Johannesburg.
In the city itself. They had very relatives they were connected to
She came to Cape Town when she was 16years old. The other family members she knows are the
two aunties. The sisters to her father. Though she communicate with them sometimes, they are not
involved so much in the care of the child. She knows very little of the family of the husband. They
were married for seven years.
The person they rely on most for social help is the pastor. He provides them with social and
emotional support and not forgetting spiritual support as well. He gives them comfort in time of
distress, but I never saw him any of the days the child was admitted in hospital visiting.
By all standard her family involves the two aunties, the young sister and the two sons. From the
time we met in the ward she has been mentioning that she has two sons. She clarified that actually
the bigger boy was from another man. She only had one son with the husband the patient.
By this time we had reached home. The boy was actually sleeping. She took him straight to bed.
We continued elaborating on her family. She mentioned that they knew a number of people as
family members. But almost all of them disappeared when the father died. She does not really
“need them now”. She feels they can do without them. From what she was saying I concluded that
to her family must mean somebody who should be able to help you in time of need. If you can’t
then there is no point in been family. Her concept of family is based on mutual interest and
availability of each other in time of distress.
She has been divorced for the past two years now. She still is using the husband’s second name.
She still signs on papers as Mrs. I didn’t ask her why that was. I thought that would be too much
going in her private matters. She did mention though that she has not communicated with the
husband for the past two years, not even her phone call. I found that strange.

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Today’s visit was very important to me. It told me that we should take for granted people’s
perception of things. I learnt from the family that sometime even people who are not related to the
person by blood may hold such an influential position in the person’s life. One would have
expected that the aunties who have commanded some position of authority in this family’s life.
But it was not. Instead the pastor was more influential
The importance of spiritual support in chronic patients cannot be over understood. Despite the
many interventions the patient received, there was room for spiritual intervention in the form of
prayers for the baby.
I feel I did meet my set out objective. Though I would have loved to know more about the family.
1. Strategic
2. Ideation
3. Developer
4. Achiever
5. Activator
Next time I hope to get more information on the medical history and the history of the patient

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Third day 27th April 2016 (Wednesday: public holiday)
Objective: medical history
This is my third visit. I hope this to be my last visit. The objective is to go and discuss medical
history for the patient. This time the patient and the mother I was promised that they will be home.
For sure I found her home this time.
She told me that her pregnancy was relatively normal. She was booked and attended antenatal
regularly. This was her third pregnancy. She had one child and one spontaneous abortion.
On the first born she had no problem. She delivered SVD at term. The second pregnancy she lost
it at four months. And this is the third pregnancy. Problems started when she was 7months
pregnancy. She had severe anaemia. She came to the hospital and was admitted for aneamia. When
they did a scan they also noted that she had placental previa as well. She was told she will need a
caesarian section but they could not do it because of her anaemia. She managed to deliver SVD
after two weeks, The baby was born premature with a birth weight of 2600gram. They remained
in hospital for two weeks. After discharge the child was ok, till at nine moths
1. Strategic
2. Ideation
3. Developer
4. Achiever
5. Activator

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