“You are nothing”
I am Nosipho, 19 years old and I was raped by my stepfather for the past four years. My mother is addicted to Tik (methamphetamine) and often threatens to kick me out of the house, “You are nothing” she screams at me when she sees me sitting all day on the couch watching TV.
I had a couple of short-term boyfriends, mostly older men, who come to use drugs in our home. I am pregnant and HIV positive, but I have told no-one. No-one would care.
I went to the maternity clinic and got my first mental health screening. I couldn’t make eye contact with the PMHP counsellor. When I filled in the form, Liesl, the counsellor, was so nice and explained that the questionnaire shows that I could benefit from speaking to her. She promised we would have a quiet, safe space where I could tell my story.
I told her that I will think about it and she gave me a pamphlet with simple information about social and mental health challenges faced by many women and how counselling may help. Liesl also gave me her work cell number and told me that she can book a session when I am coming for my next clinic appointment.
The next few weeks went by in a blur. I had to start my antiretroviral medication for the HIV and it made me nauseous. My step-father found them in my bag and called me a “whore” and all sorts of words. I felt so hopeless, that I didn’t see the point of taking the medication and was thinking of taking them all at the same time to end it all. The night before my next clinic appointment, I was lying in bed after we had finally finished fighting I remembered how nice Liesl was and decided to call her and see if I can meet with her.
The next day, after I saw the midwife, I waited outside Liesl’s office until she was finished with another client. Liesl recognised me and she invited me to her nice room. We just sat there and I started crying. Liesl didn’t seem to be in a rush and just waited and said I can tell her anything I want to.
Since that first day I have seen Liesl four times while I was still pregnant and a couple of more times after I gave birth. She helped me to realise that I was worth something, that nobody has the right to abuse me, with words or with violence. She reminded me of how well I did in business science at school and how my friends asked me for help with their studies and personal problems. Liesl encouraged me to reach out to some of my old friends – I don’t know why I didn’t contact them for the past couple of years.
They were all very supportive and so glad to hear from me again. I felt like I can solve my problems with their help and I had more energy to do things. With Liesl, I learnt to explore my options and started thinking I can change things in my life. I started to enjoy my baby’s movements inside me and to look forward to his birth. I also learnt how to avoid the conflicts at home – and moved out when one of my friends offered me rent-free accommodation in return for help with her start-up business. I am now sharing childcare with another friend who has a baby of a similar age. And I know, if I have a dark moment or feel like nothing again, I can always go back to see Liesl and talk to her.
“After hitting me, he would say sorry.”
Like many people struggling emotionally, Maria has persisting memories of disruptive events during her childhood. She had shared a close bond with her father, and that was a protective factor in her life. But then, things changed.
“When I was nine years old, my mom divorced my dad. Me and my mom moved to another city, and over some years, I lost contact with my father,” she says, recalling the difficulties that lay ahead, “We had no money and life was very tough. Everything was a struggle. Sometimes trying to sleep without food.”
Financially disempowered and eking out an existence, she eventually turned to sex work as a mode of survival. Although this is not an uncommon survival strategy in South Africa – with estimates sitting at 150 000 sex workers – it is an unregulated industry in which workers are vulnerable to many forms of harm and lose much agency over their sexual and reproductive health as a result.
In that context, Maria became pregnant and gave birth to a little boy.
She had also begun using methamphetamine, known on the streets as ‘tik’. Although the multiple negative effects of ‘tik’ are well documented, it remains the second most common primary drug in the Western Cape, the province where Maria lives, because it is readily available, is relatively cheap, provides an instant escape from reality, and is highly addictive.
But, like all other users, Maria experienced the full price at which the sudden rush of ‘happiness’ comes: an ongoing desperation for another hit, nervousness, an ability to sleep, weight loss, and many others.
“I stayed that way for four years,” she says, “and then I stopped, but I was always worried I would start using it again.”
Longing for a calmer life, she thought her fate had changed after meeting ‘that someone special’.
“I met a man and after just one month together, we got married. He seemed like a stable guy and that’s what I needed, you know” she says.
However, after only three months, things began to change.
“He became a different person. He would speak to me very badly and make me feel so useless,” she recalls, “Then he also started hurting my body, doing things like hitting me and sometimes pushing me.”
Their marriage was falling apart.
“The thing is, after hitting me, he would say sorry. Then, for a few weeks he would be ‘good’,” she says, and like many survivors of abuse, she placed the blame on herself.
“He was always nice to my son so I thought maybe it’s my own fault. I was thinking, thinking all the time: maybe I am not good enough for him. My friends were telling me I deserved better than this man. I became stronger and wanted to leave him. I was planning on that,” she says.
On the brink of escaping from her abusive partner, Maria then discovered she was pregnant and thus made the painful choice of staying with her husband to spare her children the anguish of growing up without two parents.
“When I found out I was pregnant. I was scared,” she says, “and so when I was going to the clinic, I got help at the PMHP. I got counselling, and that helped me to be safe.”
The counselling process equipped Maria with new skills to anticipate a potentially violent situation, and to negotiate conflict.
“I could see if things were going to be violent, and I found ways to change that. From the counselling, I got the skills to deal with the situation and so then, he stopped hurting me, I mean physically,” she says.
The emotional abuse, however, has persisted, and as Maria wishes to stay in the marriage for the sake of her children, she needs ongoing support.
She says, “I feel like I can’t be happy like this, but it doesn’t matter because at least my children will be in a house where the parents are together. If I leave my husband, my kids could go the wrong way and it will be my own fault.”
Maria is aware of the challenges of her decision to stay with her husband, but has given herself more agency over how to handle the situation by reaching out for help.
“It is a very hard situation, so I carry on seeing the counsellor to help me through this. It is very difficult and I need the support,” she says.
“The atmosphere in the house was tense”
My name is Johanna. When Sr Matsha examined me at the clinic, she noticed that I was very quiet during the examination. Although everything was fine with my pregnancy, Sr Matsha knew that something was wrong with me. I had filled in a mental health screening questionnaire, which is routinely offered in the clinic. I had a high score but didn’t understand what it meant. When Sr Matsha approached me to offer a referral to the PMHP counsellor, I started crying and couldn’t talk. Sr Matsha arranged for me to see the PMHP counsellor right away because she did not feel comfortable sending me home in such a state. The counsellor saw me immediately.
I had woken that morning with a feeling of dread. My partner had come home in a bad mood from work the night before and the atmosphere in my house was tense.
Before I left for my appointment at the clinic, I needed to prepare breakfast, get my 7-year-old ready for school, and arrange for my 3-year-old to stay with a neighbour. My partner was not satisfied with the porridge I had made for him and started yelling at me. I kept quiet and continued getting the children ready. After I had taken my younger child next door, my partner asked me if I had gossiped about him to the neighbour. I said no, and started walking out my house with my older child. He began hitting me on the arms and face, pushing me against the wall and calling me a liar. My child ran away, crying.
While I was telling my story to the counsellor, I already started feeling better. Over the next few sessions, the counsellor focused on the ongoing cyclical nature of abuse in my home. Eventually, I felt empowered to leave my partner. When he would not accept my decision and threatened to kill me, the counsellor assisted me in taking out a police protection order against him. I ensured my family’s safety by arranging to stay with my cousin, who had experienced a similar situation and was supportive. With the help of the counsellor, I was able to cope with this situation and have a healthy pregnancy.
“I seldom had space just to think about myself “
I felt like all eyes in the clinic were on me, with probably many wondering why a forty-year-old woman was pregnant. I felt embarrassed, ashamed and my heart felt heavy. The heavy feeling was not new to me – since I had my first daughter 22 years ago and had been through many periods of feeling weighed down with body pains, fatigue and a foggy mind. I had also been preoccupied with the responsibilities of trying to provide for my family, as my husband was disabled, and my brothers constantly brought drama into my life due to their drug habits and criminal activities.
At the clinic, I was asked to answer some questions about how I was feeling. The counsellor spoke about counselling, which was something that I had vaguely heard about, but it was not familiar to me. Once I had answered the questions about how I was feeling, the counsellor asked me if I would like to make an appointment with her to talk about these feelings. I felt apprehensive, but she looked kind and seemed very caring as she went about her duties in the clinic.
Over the next few months, until my baby was born, I spent time with the counsellor when coming for antenatal appointments. Together we realized that through all the years of caring for children and dealing with my family problems, I seldom had space just to think about myself and also nobody to talk to about my deepest worries. I learned that I had been depressed for months at a time, which had affected the way I functioned at home. I was also taught not to share my family problems with anybody, and had always tried to be the ‘coper’, and the person to whom others came to for help. The counsellor encouraged me to step back from needing to solve my brother’s problems. She also helped me to think about what I needed in order to feel better, and how to start becoming more assertive about this. When I felt the weight on my mind lifting, I found myself thinking about the innocent baby I was carrying, unplanned, but who deserved to feel loved. I started talking and singing to my baby, and connecting with some of the mothers at the clinic.
I knew that I would always be faced with problems in my family, but with the relationship that I had developed with the counsellor, and her words which echoed in my mind all helped me to feel less alone. This gave me new ideas about coping differently, so when my son was born I was able to welcome him into the world and felt I had something to give him.
“I had to leave without my children”
My name is Maria. I can still hear the sound of the gunfire and smell the smoke, feel myself running, desperate to find my children, soldiers shouting, too much screaming…
I had to leave without them, I couldn’t find them. Maybe my sister took them to safety. My chest feels like stone. I am numb.
At the border, I realise in my foggy mind that I don’t have my documents. I won’t be allowed to cross the border, leave this horrifying place. I feel the panic rising. I have to get across, I will do anything to get away from this place.
His hands are rough as they push me away – he swears at me and tells me I can go, now that he has got what he wants. Another uniform, another nightmare, I run to freedom.
I come across Lia, an older woman who lived in our village. She has a contact in a township in Cape Town, and we stay in an overcrowded room. At night I hear the rats in the kitchen. It’s hard to get work with no papers, and I struggle with the language. The refugee centre is trying to help, but it takes time.
I am dimly aware of the fact that I am pregnant from my rapist. My numbness protects my feelings as I go about surviving from day to day. I can’t go for a termination of pregnancy without legal documents. I feel trapped, powerless and alone. By the time I get my papers, it is too late to abort this baby. I am already 24 weeks pregnant, and I see the disapproval and judgement in the midwife’s eyes when she is booking me at my first antenatal visit. “Why are you here?” she accuses. “When are you going back to your country”? I feel useless, unwanted.
She asks who the father of my baby is and if I’m married. I lie to protect myself from her intrusive stare. There is a counsellor at the clinic and she invites me to talk to her. She is kind and warm. I feel I can let my guard down and the pieces of my story fall from my lips. I can see she grasps the darkness I am living in. My past intruding on my present – flashbacks, nightmares, fear of uniforms, feeling hopeless and helpless. The counsellor offers me support and I start to allow the baby into my mind. The start of a connection. These conversations are the beginning of my healing.
“I wanted to die”
Why did I drink that stuff? Because I didn’t know what to do, I wanted to die. My boyfriend and I broke up before I knew I was pregnant, and when I told my mother about the baby, she said I should abort as she didn’t have the money to support me. When I refused, she kicked me out and I had to stay with a cousin, which wasn’t easy.
I really tried, I got a casual job, but when I went to the clinic they told me I was HIV positive. It felt like the end of my world – I felt broken, ashamed, I couldn’t believe it. How could I bring a child into the world without a father, in this mess?” Liesl, our Hanover Park counsellor, gathered the broken bits of my story and held them in the space between us over the counselling sessions that followed. She listened to my feelings spill out and we named them together, including thoughts and assumptions which I needed to look at carefully and gently challenge. It was hard to find the positives in my situation, but once the pressure of the many unprocessed feelings were off my mind, I was able to see some different ways of looking at things; some options, some hope.
I was also able to be reassured around some aspects of my HIV diagnosis, even though my emotional state had prevented me from receiving useful information which could help me to feel better and more empowered. I was encouraged to think about contacting an aunt with whom I had a good relationship, this also enabled me to reconnect with my mother, and the three of us devised a plan how to manage caring for my baby once it was born.
After the birth, I started feeling more hopeful and my mood improved. This together with more support and by having a plan in place, allowed me to start bonding with my baby and to work better at my job. Where I had feared losing my position, I was now recommended for a promotion. I was also able to buy some items for my baby, and my pride as a mother grew. When my baby was two months old, I came back to see Liesl who was very happy to report that my baby was HIV negative. Although I was feeling guilty about going back to work and leaving him with my cousin, Liesl helped me to think about how I could help my baby adjust to the new carer. I continued expressing breast milk for him, and this helped me bond during our time spent together.
“I was struggling to accept the divorce”
My name is Annie, and I was screened early in my pregnancy but declined the offer of counselling when it was offered to me. A few months later, after I found out my husband was abusing drugs, I was back at the clinic complaining of abdominal pains. The midwife said it was stress-related and I was referred to the PMHP counsellor once again.
I felt better after the first counselling session. When the counsellor contacted me a few months later for a follow-up, I declined her offer for another session. I was divorced from my husband and I felt fine, happy even. I was working from home, which meant I could spend time with my baby. I struggled a bit with my two older children but my family tried to be very supportive which helped for a while.
I always remembered how good I felt after that first session with the counsellor and when I started feeling my mood change, I contacted the counsellor to make another appointment. After a few months of being single and raising the children on my own, I was struggling to accept the divorce and was angry at my ex-husband for being absent in our children’s lives.
The counsellor worked with me for six sessions and referred me to a community organisation for help with single parenting. They also gave me advice on mediation with my ex-husband and supported me when my 6-year-old started experiencing psychological problems.
The counselling helped me to cope during a difficult time and gave me access to some great resources to help me with my family problems.
“Adjusting to my HIV diagnosis”
A few weeks ago, my boyfriend lost his job. He disappeared for long periods and I thought he was out looking for a new job. But then I noticed him coming home drunk more and more. I was angry and we were fighting a lot. After a while, we had to move in with my mother. She was very supportive but I could tell that all the fighting with my boyfriend was stressing her out.
With all of these problems at home, I did not expect my first visit to the antenatal clinic to go so badly. Not only did I find out that I was pregnant, but I also found out I was HIV positive. For a while, I think I was in shock, not really knowing what to think or how to feel. The midwife offered me a mental health screening and I was immediately referred to the PMHP counsellor.
At first, I felt embarrassed that I was speaking to a complete stranger about my problems, but for some reason, I could not stop talking and crying. The counsellor listened and together we agreed that my and my baby’s safety was a priority. Over the next few sessions, I was able to come to terms with my HIV diagnoses and the counsellor and I spoke about ways that I could tackle the conflict with my boyfriend. I was able to see things from my boyfriend’s point of view and was able to talk to him without becoming angry.
Before my baby was born, my relationship with my boyfriend improved. My mother was also less stressed, and I was able to disclose my HIV status to her and talk to her about my treatment. She was worried about me infecting the baby but we spoke about all the feeding options the counsellor told me about.
My baby was born healthy and HIV negative. Despite ongoing challenges in my life, I was able to bond with my baby because I had healthy ways to approach my problems. I saw the counsellor a few times after my baby was born until I felt confident in my adjustment to motherhood. It was reassuring to know that I could go back to the counsellor if I felt I was not managing.
“I started spending days in bed”
My name is Aziza and I have just given birth to my second child. My first pregnancy was very tough as we were struggling financially and I felt unwell – I started spending days in bed and neglected the housework. Jacob got a casual job just before I went into labour, and he could not come with me to the hospital. The nurses were impatient and angry at me because I had missed a few clinic visits. I was alone and felt scared. I felt weak and ashamed, and like a bad mother.
For the first few months of my baby’s life, I continued to feel tired, unhappy and unmotivated. Jacob didn’t understand what was happening, and our relationship went through a bad patch.
In my second pregnancy, the nurses were so gentle and they referred me to the PMHP counsellor at the clinic, who was able to settle my nerves and reassure me that many women feel anxious in pregnancy. The counsellor told me about depression and anxiety, describing some of the exact feelings I had experienced. I felt supported and understood. The counsellor helped me think about how I could talk to Jacob about what I was feeling, and our relationship really improved. It helped him to know that I was not being lazy or difficult. I felt more open after speaking with the counsellor, and I made a friend with another mother at the clinic.
The counsellor called when my baby was eight weeks old. She checked up on how I was feeling, and how things were going with my baby. I felt I was managing even though looking after two children is very challenging. She reminded me that if something changed, and I did not feel okay, I could come back to talk to her. It really helped knowing she was there.
“I talk about this depression with everyone”
“When I first became a mother, I didn’t know about depression. Now I would like to let everyone know about this problem so that people can stand up and do something about it.” Ntombomzi*, former PMHP client – pictured with her daughter Liphiwe.
I was born, one of twins. My parents divorced when I was only two months old. Because my mother was alone she couldn’t do what she was supposed to do as a mother and I grew up with her family. There was really no one to talk to or to discipline us and I became pregnant at the age of 14. I have suffered depression since then.
Having a baby at such an early age was really hard. I had to leave school and was forced to work as a domestic worker, which I couldn’t really do because I was so young. I tried very hard, but I just couldn’t do it. So, I decided to go back to school when my baby was three years old. I passed my standard nine [penultimate year of high school] but didn’t have enough money to register for my final year. I was forced again to go back to work as a domestic worker; which I am still doing to this day.
When I was twenty-one years old, I got married to my husband. He is not the father of my first child. A couple years after being married, we had a child together. I again suffered very much from postnatal depression, although I did not know what it was called at the time. The clinic I went to in the township did not know anything about depression. So, I was unable to get help from them. Luckily, my husband was always there for me and supportive throughout my depression, even though he didn’t always understand what I was going through.
Since then, I suffered from depression until I was able to get help from the Perinatal Mental Health Project in 2004. This was the first time I heard about perinatal or postnatal depression. I had suffered from depression all these years, but I didn’t really know what it was. Finally, I was able to get help.When I was pregnant with my last baby, I was working for Linda, a psychologist. I was not at all happy to be pregnant. I was just very stressed and worried about telling her. I knew it was not the right time for me to become pregnant and I was very concerned about my job and all the things that I needed money for. But I realised that I needed to tell Linda, not only because she was my employer, but because I needed help. Everything was very hectic for me and nothing that I was experiencing seemed to be good. I knew that I was becoming more and more depressed.
I finally told Linda when I was 5 months pregnant. It turns out that she specialises in women who have perinatal and postnatal depression and when she heard my history she thought I was suffering from it. She decided to take the step to get help for me by sending me to the Mowbray Maternity Hospital which provides the Perinatal Mental Health Project.
At Mowbray, I met with a counsellor. It was very good to speak to her about how I was feeling and to just talk out about everything. That was what was killing me, having to keep all my feelings inside of me for a long time. I was so lonely and there were so many things that I needed someone to listen to. I needed to express my feelings and to be heard when I was saying something. I needed someone who could understand and who could listen when I was talking. Meeting with this counsellor gave me that chance to finally speak out, which helped so much. They also sent me to a psychiatrist to get medication for my depression. Now I am doing just fine and coping very well with motherhood. Dealing with perinatal and postnatal depression is a very difficult thing.
When you are depressed there are so many things that are affecting you. You may not be able to tell exactly what it is that is making you feel so bad, but just that you can’t get out of the fog you are in. Everything can feel like it is just falling apart, that nothing is happening right or according to plans. You may not know to take it seriously when you are first suffering from it, but it is very important to address it and to find a way out. There are so many women who are dying inside from this thing. They don’t know how to deal with it or how to cope. Everything in their lives is turning upside down. And they need someone who will understand and not judge them.
That is why I talk about this depression with everyone. I even talk to mothers I see on the bus. I want everyone to know about this problem. I want the mothers to listen. If I could have my way, each and every one of the hospitals would have these kinds of counsellors, especially the government hospitals which are for everybody. That way everyone, including women who really don’t know anything about this depression, could get help. Until that happens, I hope that all the mothers out there, who are suffering from perinatal and postnatal depression, will take care of themselves and find support. You only live once, and it does not have to be a life filled with depression!”
* Ntombombzi has given consent to tell her story and use her photo, pictured together with her daughter Liphiwe
“I was not as excited as I had anticipated”
My name is Samantha* and my story begins in 2004 when I was told that I was pregnant with my first child. After extensive consideration, my husband and I decided that we would use the public healthcare facility, a Maternity Hospital, closest to our home, as private users. This facility happened to be the site of the Perinatal Mental Health Project (PMHP). Although my pregnancy was planned, and eagerly awaited, I noticed that I was not as excited and happy as I had previously anticipated. Not knowing what to expect, however, I kept these feelings to myself.
During a routine antenatal visit, I was asked to complete a questionnaire that screened for symptoms of depression. This part of the service was initiated and run by the PMHP. A high score on this questionnaire, led to a suggestion from the midwife, that I consult the PMHP counsellor, which I agreed to do. My visits to the counsellor, thereafter, coincided with my antenatal follow-up visits. During the first and follow-up session with the counsellor, I was provided with an opportunity to speak freely to someone who seemed to understand my experience, without judgement, which allowed me to process and understand my negative and anxious response to my pregnancy. My experience of not feeling the joy others were expressing for our baby, intense emotionality, and a reluctance to leave familiar spaces, suddenly made sense, and I felt less lonely.
The level of antenatal care, including, the routine screening for a common mental health problem, depression, was excellent. Similarly, the sessions with the counsellor, which coincided with my routine antenatal visits, also worked well. During one such routine antenatal visit, I was admitted after raised blood pressure and the presence of protein was detected. I started receiving medication for this as well as being monitored closely for any changes. It was decided to induce my labour after a few days. I was still being treated for hypertension, and I was given instructions to lie still and not move, through labour and birth and finally gave birth to a healthy baby girl.
After this experience of labour, I was left feeling traumatised and powerless. I had to stay in the hospital for several more days for my condition to be deemed stable. I was, however, able to see the counsellor again. Through the provision of information, empathy, understanding, respect and dignity, she was able to assist me in processing and understanding my traumatic experience. This assisted my healing and recovery emotionally.Psychosocial support can often be seen as a “nice-to-have”, add-on service. Through my traumatic experience, however, I was able to see how necessary psychosocial support is, and what a huge impact it can have on the quality of care provided to healthcare users.I would like to advocate that psychosocial support form an integral part of basic healthcare services so that health-care users receive holistic care. More importantly, however, as my story indicates, healthcare workers are in an ideal position to influence a patient’s experience of care. Healthcare workers need to understand that patients are more than just their illness, and “work” for them. Medical procedures that seem standard and routine to healthcare workers are often new and extremely anxiety-provoking for patients. Physical needs and wellness cannot be separated from emotional and psychological needs and well-being. Psychosocial support should not be a specialised service running alongside healthcare services. Instead, it should be integrated into the routine treatment of patients.
This example describes how the Perinatal Mental Health Project was able to implement just such a service and it made such a difference to my experience. In caring for women who are pregnant and are about to embark on the journey of labour and supporting a new life, this is especially necessary. Growing a life inside your body is a life-changing experience each and every time. A mother typically will visit a health facility often during this time and receives screening and treatment for all types of preventative and pregnancy-related medical treatment. This would also, as in my experience, be an ideal opportunity to intervene with emotional as well and psychological interventions to support mothers. Mental health concerns at this time can have serious consequences to both mother and baby for the rest of both their lives. I was screened for depression and given treatment and support during this time. This enabled me to support my baby during the first few months of her life. I was also made aware of my own needs and could receive the help I needed. Without the treatment and support, I was given, this would have been a far more painful time for me.As a result of my experience of having had support during a difficult time, I have a good understanding of the emotional support women need during pregnancy and birth. This understanding led to me continuing my studies and choosing to qualify as a counselling psychologist. When the opportunity came to work for an organisation focusing on pregnant women and children affected and infected by HIV, I took it. This organisation works closely with the Department of Health, which allows me to work with staff at primary health facilities and raise awareness of the importance of psychosocial support in the area of HIV, specifically for pregnant women, their children and families.
* Samantha has given consent to tell her story and use her photo.
“I found out I was HIV positive”
My name is Phumza and my baby’s father abandoned me when I became pregnant. It was hard because it was also the time that I found out that I was HIV positive. I was scared that my baby might also be affected by the virus. At my first antenatal visit, I was offered the PMHP mental health screening and was referred for counselling. I attended a few sessions with the PMHP counsellor.
After my baby was born I lost my job because my employer would not allow me to take time off work when my baby was sick. I also had to take care of my older son, who was 6-years-old at the time.
I thought to myself: “I don’t know what is wrong with me. My memory is very poor. On Monday I lost money in the taxi. Yesterday, I lost my jacket. I don’t know what I’m doing these days. And I’m sad. Maybe this virus works in my mind, and I’m suffering. I’m always thinking about my future and my children. What if I can’t take care of them?”
I grew more desperate about my financial situation. I was unemployed and received no support from my baby’s father. I felt hopeless about my future and I could no longer afford transport costs to attend counselling sessions at the clinic. I sent a text message to the PMHP counsellor: “I just want it all to end.”
The counsellor began providing sessions telephonically and arranged for me to receive medication for my depression. She also referred me to the community clinic which was within walking distance from my house for on-going psychiatric care. The counsellor also helped me to connect with a community project for assistance with food and child grants.
It wasn’t a lot, but it helped improve my situation. I stayed in touch with the counsellor and called to share the good news that my baby was HIV-negative. Although there are still many challenges for me, I feel that I am cared for and supported. Today, I feel better able to cope.
“I finished my job application today. I want to say thanks for everything you did for me. You must continue to help other people, other people who are suffering, just like I was.” SMS from Phumza to the PMHP counsellor
“I knew very little about my husband”
My name is Jeanette and I came from CAR (Central African Republic) to live in peace away from my village torn apart by war and atrocities. I am a teacher by profession and the breadwinner of my family. My parents gave me away in marriage to a man originally from my region, who lived in South Africa.
As in many arranged marriages, I knew very little about my husband. Soon after arriving in Cape Town my world turned upside down. My husband was physically and emotionally abusive and incapable of supporting me. After a short while, I became pregnant and all my hopes faded. Desperate, lonely and confused, I became very anxious. The language barrier I faced in my neighbourhood, the lack of resources and social isolation fuelled my anxiety.
At the antenatal clinic, I attended three PMHP counselling sessions with a French-speaking counsellor during my pregnancy and two sessions after my baby was born. My anxiety was acknowledged and contained. By looking at my history, the counsellor was able to point out examples of my natural resilience and I came to feel supported and empowered.
I reconnected with my family from whom I had withdrawn in shame, I started learning English and got to know my environment better. I made friends with a neighbour who had a toddler and in whom I found both practical and emotional support. In the counselling session, I was able to disclose the abuse I was experiencing. The counsellor provided me with information to protect myself and I become more assertive. After my baby was born, I felt more hopeful about being able to care for her. I now feel happy as a mother.
“I started using alcohol heavily”
I am Annie and I grew up with a mother who verbally and emotionally abused me and my siblings. We were constantly moving from home to home. When I was 14, one of my many step-fathers sexually abused me. After that, I went to live with my aunt, dropped out of school and found a job in a factory. I started using alcohol heavily two or three nights a week. At the age of 18 I was pregnant. It was unplanned and I had no partner to help me.
At 3 months, I booked at a Midwife Obstetric Unit and was screened for mental ill-health by one of the clinic staff. I was referred to see the PMHP counsellor as my scores indicated that I had symptoms of depression and anxiety. I was initially suspicious that I would be judged by the counsellor and that my baby would be taken away from me at birth. I arrived at the first appointment sad and reluctant to talk.
The counsellor gently developed a rapport with me, treating me with dignity and care. I was not used to this type of relationship. I broke down and was able to tell much of my life story in the first session. The counsellor was able to acknowledge and contain my anger at my mother. We spoke about my fear of abandonment and my overwhelming anxiety that I would not be able to care for my baby without damaging him the way I felt I was damaged.
The counsellor was also able to identify where I had shown evidence of resilience and good decision making in my life. Over the next few sessions, together with the counsellor, I was able to identify a work colleague, an old school friend and my aunt as people with whom I could link more closely to be a support for me. My self-esteem improved and I developed a sense of agency. The counsellor was also able to work with me to address my drinking problem. When I gave birth, I had been sober for 4 months. My aunt was present throughout my labour.
During the first few months of my son’s life, I made a few appointments with the counsellor to work through some of the challenges of being a mother. I feel cared for and confident in my ability to care for my baby.
“I felt so ashamed”
My name is Bongi and I was raped by a “friend” who offered to help me with my schoolwork. After my mother died when I was 8, my aunt raised me. She did not teach me anything about sex and I didn’t know I was pregnant for several months.
After attending the antenatal clinic for my first check up, I was referred to a PMHP counsellor who helped me contain my desperation and anger.
I told the counsellor: “I can’t get the pictures out of my mind. I wake up in a sweat with my heart beating really fast. I keep seeing his face, laughing. I hate him, and I’m so scared the baby will look like him. I wish my mother were still alive. Then I’d be okay. But right now I just want to die or kill him.”
The next thing I had to face was telling my aunt. I felt so ashamed. And I thought she wouldn’t believe me anyway because I was always going his house. At first my aunt didn’t believe me. She said I was asking for it. She said she would send me back to the Eastern Cape to live with my good-for-nothing father. I didn’t know what kind of person he really was and when I explained this to her, she understood.
After I gave birth to my baby girl, I continued to attend my sessions with the PMHP counsellor. My confidence and parenting expertise grew and I began to plan for the completion of my schooling.
“I felt useless as a mother”
My name is Christine and I arrived in South Africa from the Democratic Republic of Congo four years ago. I struggled to get work and stay employed due to language difficulties. When I became pregnant for the second time, my partner did not want the child. He became verbally and emotionally abusive and was controlling with finances. I was forced to live on his meagre handouts. Eight hours after giving birth to my second daughter, I was discharged from hospital and returned home. Despite my pain and exhaustion, I had to continue, alone, with my domestic obligations – washing clothes, cleaning the house, and cooking for my partner and children.
I continually thought: “Maybe it wasn’t a wise decision to bring this child into the world. I am a failure. How am I going to take care of this baby?”
My relationship with my partner deteriorated, and without any friends or family to support me, I felt completely alone. I became increasingly sad and stressed. Feeling despondent, isolated and helpless, I found it difficult to bond with my new baby and had no energy to meet the demands of my 2-year-old daughter. I wanted to ‘run away from it all’, but then was consumed with guilt for having such thoughts.
The baby didn’t stop crying. I couldn’t do anything to make her feel better. I felt useless as a mother and thought that it may be better if I ended my life.
The norms of my culture also added to my desperation. At the time of my pregnancy, my partner’s parents had not yet paid lobola (dowry) for me. I was therefore not recognised as being married and my baby could not be named, making it more difficult to bond. My stress and depression caused my breast milk to dry up. I was then referred to Charlotte, the PMHP’s French-speaking counsellor. At the time, I was 31 years old and unemployed. My daughters were 2 years and 2 months old.
At first, help was like a slap in my face. But with counselling I recognised that I had a problem and that it was not my fault. Charlotte worked with me on acknowledging my feelings and building a sense of my own self-worth and capabilities. I started to develop solutions to some of my problems and felt empowered to negotiate a healthier way to communicate with my partner. I also accepted the help of a breastfeeding advisor.
I now have time with my children and the milk is flowing. The heavy cloud over my head has been swept away. I now take things one step at a time. Today, I love being a mother. I am more able to manage stress effectively and to care for my own and my children’s physical and emotional needs.
“What if I get sick?”
My name is Zukiswa and my score on the mental health screening questionnaire suggested that I was very distressed: I had not been able to get hold of my boyfriend since I found out I was pregnant and I had just learnt that I was HIV positive.
My boyfriend won’t take my calls. And his friends say he has gone to Joburg where the mother of his other two children is living. Worst of all, was finding out about my HIV status. I’ve been going through hell. I am so worried about my baby. I am afraid the baby will get the virus. And what if I get sick? Who will support this child? I’m afraid to ask my mother because she never liked my boyfriend – said he was too old for me. I regret ever meeting him and trusting him and not using condoms.
I was referred to the PMHP counsellor. The first few sessions focused on containing my emotions, through active listening, reflection and empathy. After a few sessions, my mood started to change. I no longer felt as depressed and anxious. With the counsellor, I worked on solutions to my problems. I identified the resources I had around me and thought of ways to use these in the best way. The counsellor also referred me to the HIV peer advocates at the clinic. Through the weeks of my pregnancy, I learned about HIV, feeding options for my baby and how to protect my own and my baby’s health.
Eventually, I felt ready to disclose my status to my mother. This helped me to get more support and understanding at home, which gave me the strength to cope with my status, my pregnancy and my plans for the future.
The PMHP is committed to client confidentiality in keeping with the ethical requirements of professional mental health practice. The client stories reflect common scenarios or sets of circumstances faced by many of our clients. Pseudonyms are used and details are changed. The stories are not based on any one particular woman's experience, unless an individual explicitly chooses to share her story with or without her name attached.