LGBT and Healthcare: The Culture in South Africa

Showing some NU pride at the top of Lion’s Head Mountain

The Global Health Portal recently spoke with Emily Smith (Biological Sciences, Gender Studies and Global Health, WCAS 2014), who spent her summer in South Africa researching lesbian and bisexual women’s access to healthcare in Cape Town. Here’s what she had to say about her research, her time abroad, and how it reinforced her desire to pursue a career in medicine.

Tell us about your project. What inspired your work?

My project is a qualitative study looking at lesbian and bisexual (LB) women’s healthcare experiences in Cape Town, South Africa. I’m studying gender studies in addition to global health and have researched the health of LGBT youth in Chicago, so in planning my project I knew I was interested in researching something related to LGBT health. Although South Africa has one of the world’s most progressive constitutions and LGBT people are legally protected from discrimination, my background research found that LGBT South Africans still face discrimination and homophobia in many different areas. I also found that little was known about LB women’s health, and some people feared that LB women might face unique challenges in healthcare due to their double marginalization as women and sexual minorities. This is what inspired my project and I hope that by understanding the difficulties LB women face when getting healthcare, ‘coming out’ to healthcare providers, and accessing sexual health information, public health efforts will be better equipped to provide meaningful and affirming healthcare for LB women.

A quote on display at the Nelson Mandela Exhibition (one of many events to honor Mandela on his 95th Birthday) in downtown Cape Town

How did your experience on the ground vary from your expectations?

I found that it was much more difficult to meet people and recruit participants than I expected. I was initially hoping to interview at least 30 lesbian or bisexual women involved with either LGBT student groups or a local non-profit. However, I faced a lot of challenges recruiting participants from these spaces because, for example, the student groups were mostly comprised of gay men. For participants recruited through the NGO, the language barrier posed a significant challenge and I found that a lot of women did not want to do an interview because it would be in English.  I ended up getting 22 interviews, but it was still pretty difficult and caused a lot of anxiety throughout the experience.

What was your most meaningful experience abroad, and what did it teach you?

While doing my research I was also volunteering with Triangle Project, an NGO that works with the LGBT community in Cape Town. Triangle has ‘safe space’ groups in nearby townships, which are impoverished areas where hate crimes against LGBT persons are highly prevalent, especially the so-called “corrective” rape of lesbians. One weekend, one of the safe space groups was hosting a women’s health event that I attended with people from Triangle. After the event, a group of about 20 lesbians was hanging out outside while I was waiting for my ride home. Standing in one of the most dangerous townships in South Africa and seeing these women bravely holding hands and showing that they are proud of who they are was incredibly moving. In addition, although everyone else was speaking isiXhosa, one of the women came to talk to me and invited me to hang out with the group. I couldn’t understand everything that was going on, but different people helped translate and I had a lot of fun meeting and talking to everyone. It was a really great experience because even though we came from incredibly different cultures and backgrounds, we were able to communicate and interact in a meaningful way.

Upper Campus of the University of Cape Town nestled at the foot of Table Mountain

What was your most challenging moment, and how did you cope?

My most challenging moment was actually an ongoing struggle with learning how to adjust to living on my own in a vastly different culture and community. Prior to my research, I was living in Stellenbosch (about an hour from Cape Town) participating in IPD’s Public Health and Development study abroad program. Studying abroad, I was constantly with friends and other NU students, so it was really difficult to go from that to living by myself.

In that context, the most challenging part was probably my first night in Cape Town. Saying goodbye to all of my NU friends and moving into a single apartment that didn’t have Internet or TV was really hard, and on top of that, it happened to be my 21st birthday. I thought I was completely in over my head and, if I’d had Internet, I probably would have tried to buy a flight home the next morning. I knew I would get used to it though and I made an effort to keep myself busy and take advantage of being in such an incredible city. I spent a few days walking around near my apartment so that the area felt less foreign, started volunteering at an NGO as a way to meet people and keep myself busy during the day, and figured out how to get enough internet in my apartment to at least check my email every day. For safety reasons I couldn’t really go out after dark, but I got used to quiet nights reading or working on my research in my apartment. Although it was really challenging in a lot of different ways, I know the experience taught me a lot about myself and helped me become more independent.

Did you encounter any cultural differences that required getting used to?

Cape Town was culturally very different from anything I’ve experienced before, so it’s hard to think of specific things that required getting used to. That said, the thing that was probably the most difficult to adjust to was the amount of gender based violence. As a young woman living on my own in the city, I had to be very careful about where and when I went out. The city is also very “in your face” – for example, the minibus taxi drivers always honk and yell at pedestrians – which can be quite disconcerting if you’re not used to it.

A view of Devils Peak, Table Mountain, and Lion’s Head from a sailboat on the Atlantic just before sunset

Has your summer experience impacted your future goals and interests at Northwestern?

My experiences this summer have reinforced my desire to pursue an MD/MPH after graduation. I’ve always been interested in a career in medicine, but seeing how research can be used from an advocacy perspective to hopefully improve patients’ clinical experiences has motivated me to pursue an MPH as well. I think that the dual degree will help me combine the clinical skills of medicine with a broader public health perspective, which is critical for providing meaningful care and reducing health disparities.

Do you have any advice for students wishing to conduct research in an unfamiliar location?

My advice for students wishing to do research abroad is to establish as many connections as possible before you go. I thought it was really helpful to work with an NGO, not only in terms of my research and getting access to participants, but also because it helped me meet people and get more involved with the community. I also reached out to student groups at nearby universities, which helped me meet other people my age.

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