Journal of Social Development in Africa (1997), 13,1,59-66 
The Elim Care Group: Conflict in 
Community Development Styles 
MOKGADI TLAKULA* 
The Elim Care Group Project 
The Elim Care Group Project is a health-based rural women's organisation which 
is found in most parts of the Northern Province, South Africa. The main thrust of 
the project is preventive health care, exchange of knowledge and skills and 
emancipation of rural women through empowerment. 
The Project started in 1976 as an intervention against trachoma, a blinding but 
preventable eye disease which had reached epidemic proportions along the 
Trachoma Belt in the Northern Province. A resident ophthalmologist, Dr Erika 
Sutler, used to treat patients who were afflicted with the disease but on discharge 
from the hospital the people went home to the conditions that had caused the 
trachoma in the first place. Repeated attacks of the disease causes scarring of the 
cornea which later causes blindness. This created a vicious circle which Dr Sutter 
decided could only be broken by community intervention. Rivoni ('Light') Society 
for The Blind was established during this period by the same doctor as many people 
lost their sight because of this scarring of the cornea. Today there is a workshop for 
the blind and disabled at Elim created by the Rivoni Society. 
Three pilot villages were chosen to initiate the community intervention programme. 
The community leaders, usually the Chief or the Induna, were requested 
to call a meeting of all the villagers. The problem which was obvious to everybody 
(leaky red eyes) was discussed. Those who were willing to help eradicate the 
menace came back for the next meeting. Most people stayed away when they learnt 
that there would be no pay for the work done. The people who volunteered were 
mainly women and only a few men became Care Group members. 
At the next meetings, discussions about the disease took place wherein people 
learnt about the causes of trachoma, how to diagnose it, how to cure it and how to 
prevent it. People learnt how to invert the eyelid to diagnose the condition and how 
to administer the eye ointment. Songs were composed about the whole process and 
the people elected to work in groups. Because the measures were introduced in a 
non-threatening manner, the groups came to a stage where they owned the process 
and decided on the most appropriate ways of tackling the attitude change process. 
* Contact address: Elim Care Group, c/o Mokgadi Tlakula, Social Welfare, Northern 
Province, Private Bag X628, Giyani, 0826, South Africa.
60 Mokgadi Tlakula 
The intervention in the pilot villages was such a success that neighbouring 
villages inundated the Care Group office with requests that the programme be 
started in their villages as well. The programme spread fast and the Care Group 
movement soon spread to other health wards and over the whole of the Northern 
Province. The Elim office became the Training Centre because people came from 
other hospitals to learn even from other Homelands and Provinces. 
Care Group Motivators 
The lifeblood of the movement was a cadre of Community Health Workers referred 
to as Care Group Motivators. They were trained as Assistant Nurses. They 
travelled from village to village helping the Care Mothers to learn and monitor the 
disease. A lot of training was invested in this group of Community Health Workers 
and they in turn passed on the knowledge to the Care Groups. The Care Groups 
shared the information with their communities. In this fashion the information 
quickly spread throughout communities and that is perhaps why the menace was 
so easily controlled. Also, because the people owned the information, they devised 
appropriate methods of making it work for them and their communities. 
When trachoma disappeared, the groups remained. Because of the participatory 
nature of the management style in the movement, the group dynamics were strong. 
The Care members requested to be informed about other diseases that plagued rural 
communities. Their motto was to prevent all preventable diseases and to fight all 
poverty as an effort in self-help. When asked why they stuck to the movement 
which did not pay them, the rejoinder was always that the movement helped them 
to help themselves. They improved their food production methods by establishing 
communal gardens and trenching their home gardens so as to preserve moisture 
because water was scarce. They learnt about the causes of kwashiokor and fought 
malnutrition. They learnt how to mix the Oral Rehydration Fluid and how to 
administer it effectively to prevent death from dehydration. They learnt what 
caused diarrhoea and vomiting and dug refuse pits in their yards and built pit 
latrines. This had theeffect of motivating their neighbours so there was a multiplier 
effect. 
They also learnt how to prepare the weaning diet of maize meal mixed with 
peanut meal, bean powder or mopani worm, a protein-rich worm, for variety. 
Incidentally some people remember that these dishes were prepared by their 
grandmothers long ago but had fallen into disuse as people became displaced and 
food became scarce. 
The learning continued into other areas like sewing and mending of clothes, 
building of mud stoves to prevent burns in winter, communal gardens, starting day-
The Elim Care Group: Conflict in Community Development Styles 61 
care centres for under-fives, starting literacy groups, re-learning how to prepare 
some of the indigenous dishes and making peanut delicacies WkcXigugu -a peanut 
delicacy made from baked maize meal, baked peanuts and some sugar and salt - 
it is like a sweet and gives energy. 
They addressed diseases of poverty: tuberculosis, diarrhoea and vomiting and 
kwashiokor, because of lessons learnt though fighting trachoma. One other thing 
they learnt was that disease has no boundaries and they traversed the homeland 
boundaries because they were artificial. Care Group Mothers soon became 
resource people in their communities, often being called upon to mix the Oral 
Rehydration Fluid, dress burns and prescribe an energy diet for a weak baby. 
The movement is accessible to anybody as membership is free. Members only 
have to agree to do voluntary service. At one stage the movement boasted 8,000 
known voluntary workers. The short-term objective of the movement is to prevent 
all preventable diseases, the medium-term objective is to share skills through 
networking with other groups and the community, the long-term objective is to 
emancipate the rural women through empowerment and knowledge because 
knowledge is power. 
The Care Group members have a strict code of conduct A full member has to 
attend group meetings and learn, be examined and pass, then attend a Graduation 
Ceremony where she receives a pin and a head scarf. 'Grad day' is a big event 
usually prepared for over a period of months. A panel of examiners is selected to 
examine the incumbents before they graduate - the panel is usually made up of 
people from different villages to obviate favouritism. The following are some of 
the criteria on which the examinations are based: 
- individual face-cloths for each member of the family; 
- immunisation cards for all the children under five years; 
- a clean and orderly household; 
- a refuse pit; 
- a pit latrine; 
- a mud stove to prevent burns in winter; 
- a home garden for green leafy vegetables; 
- a notebook where sharing these ideas with 10 other families is recorded; and 
- a knowledge of basic causes of disease and how to prevent these causes. 
These measures were to be observed by a Care Group Member before she could tell 
other people about them. In other words, members had to lead by example. 
Now with the HIV/AIDS virus spreading so fast in the Northern Province, the 
Care Mothers feel they should address the problem in the way that they know how 
- through appropriate awareness programmes and through the creation of self-help 
projects to help rural communities go through attitude change which will help them 
disengage from unsafe sexual practices. The rate of unemployment is high and
62 Mokgadi Tlakula 
many more households do not have enough food to eat. (The correlation of the two 
phenomena did not escape the Top Executive Committee of the Care Groups when 
they met to discuss the issue. The Top Executive is the overhead governing council 
which is elected by the groups themselves. They see the correlation of unsafe sex 
with poverty when people engage in sex for money or other rewards.) 
When the new dispensation in South Africa arrived, it reiterated what the 
movement had been saying all along - that people should leam to do things for 
themselves and get knowledge because knowledge empowers people. Many of the 
Care Mothers had been somewhat marginalised by the old dispensation, as they 
were branded activists. The Civic Associations, on the other hand, composed of 
young and inexperienced people, also regarded these elderly matrons as relics of 
the past regime. The fact that they had been in community development for 20 years 
also made them a threat to the newcomers. Because Care Groups had adopted a low 
profile, yet had achieved so much, they are an enigma and this is why they had to 
face up to a number of different challenges. Two of the difficult situations which 
had to be resolved are described in the words of the qualified Care Mothers below. 
They are both Chairpersons of their local Care Groups. 
Manana (Mrs) Khaurisa Mabunda's Story 
I am the Chairperson of the Care Group in Mageva, a village under the 
Dzumeri Traditional Authority in the Northern Province. I have been 
requested to speak about how I deal with conflict in community development 
and how I manage to bring about peace. 
When a person initiates a thing in the community, that person always 
meets stumbling blocks. I have had to overcome many obstacles in my 
work. I am a voluntary worker, I have received a certificate that attests that 
I know about preventing disease, that I know how to run a household and 
that I know how to go about bringing development to communities. When 
a person is part of a development programme, that person also gets to be 
developed because one learns a lot from the different interactions that one 
goes through. 
There are 32 women who belong to this organisation in my village. 
Twelve of these members, including myself, are engaged in running a daycare 
centre for children who are under five years of age. The creche building 
was put up in this manner: we formed mud bricks and fired them. We 
worked very hard during that time, starting work early and and knockingoff 
late from 7 to 7. When the bricks were ready, we got a builder to help 
us put up the building. We worked as dagga boys (builder's hands) mixing 
jhe dagga and handing him the bricks until the building was complete. We 
had a register and time-sheets where we recorded the hours of work.
The Elim Care Group: Conflict in Community Development Styles 63 
During that period, Care Groups received window and door frames and 
cement from the Independent Development Trust. This was during the 
drought and we received food from the National Nutritional and Social 
Development Programme. We had 60 children receiving meals at a makeshift 
play centre, a house offered by one of our members for use as a creche. 
When the funding stopped, we went through very hard times. 
We had to build our facility quickly so that we could move away from the 
borrowed house. The children were very thin because food was scarce and 
the meals were very welcome. We added peanut meal to the porridge and 
the children soon looked better after a few months. 
While we were building the creche, someone came in the night and stole 
our window frames by ripping them from the walls. We reported the matter 
to the Chief and the police but the thief was not arrested, instead the police 
asked us to tell them who we thought had stolen the things. All this time the 
people from the village were passing remarks and sometimes ridiculed us 
saying they were yet to see a creche that could be built by illiterate women 
in traditional clothes (Xibhelana). 
We did not despair despite the disempowering remarks that went around 
about our illiteracy and our rural ignorance. When it seemed as if all had 
come to naught, we receive some funding from the Community Development 
Section and bought roofing for our structure and completed our creche 
building. 
When the Civic Association was elected, composed mainly of young 
teachers and young people, they said that our committee should disband as 
they were going to form a new committee for the creche. They said they 
would only allow me, from the old committee, to join them. I refused 
because I could not abandon my co-workers. We fell into disfavour but told 
them that under no circumstances were we going to allow them to take over 
our creche. 
There was a lot of misunderstanding and when we held a meeting of the 
Top Executive of the Care Groups I mentioned this problem that existed in 
my village. The Top Executive decided that the next meeting be held at 
Tiyiselani Mageva Creche where the Induna, the chief and the Chairman of 
the Civic Association should be invited. We also invited the Care Group 
Motivators and the Community Development Section officers. The story 
of the Care Groups was told at the function and the story of the creche
64 Mokgadi Tlakula 
building also came up. The remarks that were made by some of the leaders 
in the community were repeated. Some people blushed and felt ashamed. 
The chainnan of the Civic and his chance to speak and all he said was that 
he was sorry that they had treated us in the way they had done and that from 
now on because he understood where we came from, we would work 
harmoniously together. 
Usually people create confl ict if they do not know; if people do not know 
and do not understand what is taking place, give them time to learn and 
understand. After giving them time and being patient with them, they learn. 
The one who makes the most noise will be the most watered down in the end. 
Ignorance and jealousy are usually the cause of conflict People look at you 
and say who is this one who is initiating this project. I usually advise people 
not to judge a person by how they look and whether they are educated or not, 
but to look at what the advantage of the project is to the community. 
If there is conflict, the best thing is to make the 'howler' the leader, put 
him in the driving seat and you will see a change because he will have had 
achance to learn. When you want to do a thing you have to persevere. When 
a person reacts in a loud and high-handed manner, be calm and he will come 
down. If you know that what you are doing is right, keep on doing it, do not 
be derailed and do not give up - finally you will see you will complete your 
mission. Many Care Groups discontinued their efforts because they got 
scared of the Civic Associations and the people who took over the projects 
they had been working on for more than ten years. 
After building our creche, we approached the Social Worker for the 
registration of our creche. I tell you she was not easy with us. For instance 
she told us to go to the hospital dietitian to get a menu for the creche feeding. 
We did not even know what a menu meant. We did that despite the fact that 
we had been feeding our children at the creche for the last seven years. 
Because we did what she wanted, our creche is about to be registered and 
we might receive a government subsidy. 
It has not been an easy road. It was fraught with a lot of hurdles but in the 
end we succeeded. I am now at the Health Desk of our Civic Association 
and am charged with Social Security.
The Elim Care Group: Conflict in Community Development Styles 65 
Manana Violet Ritshuri's Story 
I am the Chairperson of the Care Group in Makhuva Village which is 
situated 50km north-east of Giyani Town. In the last eight years I have been 
involved in a feeding programme for Mozambican refugees, the National 
Nutrition and Social Development Programme Feeding Scheme for the 
poorest of the poor, and the establishment of Makhuva Creche. The feeding 
scheme money comes with a development component where sewing 
machines, brick-making machines or fence-making machines can be purchased 
so that people can learn how to sew or make bricks. We at Makhuva 
bought sewing machines and a lot of sewing has taken place and articles 
have been sold. I want to describe the conflict I had with the Civic 
Association in my village. 
When we started our creche in 1990 we called a meeting of the community 
through the Chief who was requested to call a General Meeting. We 
announced our intention to start a creche as many children were going 
hungry and had nobody to look after them when their parents had gone to 
work. We also requested the community to allow us to use the church 
building for our creche until we could build our own structure. Both the 
community and the Chief agreed to our requests and we started with more 
than 100 children under five years of age, 5 teachers and 2 general 
assistants. 
We are a large Care Group with 30 members who have graduated and 36 
who have not graduated yet. The feeding programme has 150 recipients of 
food. The Care Group members and the recipients of food have duties 
assigned to them like cleaning the Tribal Office grounds, keeping the Clinic 
yard clean, and sweeping the church and the church yard before the children 
arrive each morning. These activities take place in the morning and in the 
afternoons the sewing takes place. We also learn how to cook and bake. 
When the Civic was selected in 1995, the Care Group had already done 
a lot of work. The Civic came to the creche and said that we will have to 
discontinue the creche because they would start one. We told them that we 
would not stop our activities because we were given permission by the 
General Community meeting. I was direct and asked one of the Civic 
members who was at that general meeting whether this was not the case - 
he answered in the affirmative. At the time we had started firing our bricks
66 Mokgadi Tlakula 
and were ready to start building. The Civic told us that if we went on with 
the building activity they would petrol-bomb our structure. Some Care 
Group members became scared and left the organisation but others stayed 
on to see what would happen. 
Feelings had run so high in the community that we had to call the Care 
Group Motivators to come and help us. At the meeting it was explained to 
the Civic what Care Groups stood for. They demanded to see our constitution 
and this was given to them. This watered them down because I think 
they wanted to say that we were not a properly constituted organisation. 
They told us that each time we received money we should bring it to them 
so that they could administer it. I told them that that would not happen. 
They went further to say when the feeding scheme money arrived we 
should bring the cheque to them. We told them that this would also not 
happen, as once we have shown the cheque to the community we buy food 
and goon with our work. They said many nasty things to me but I stood firm 
because I knew I was doing the right thing. 
After a while, on their own, they decided that they had to invite me to be 
one of their members. They had decided that they had a need to work with 
somebody who had the experience that I had and who could stand by her 
convictions. They told me afterwards that they had a problem of how they 
would approach me after so much verbal abuse. One of them became brave 
and came to invite me to their meeting. 
If there is a conflict, people should not hold on to it afterwards, but should 
be willing to make peace - once there is a will on both sides to bury the 
hatchet, peace is achieved very easily. Not being afraid to stand by your 
convictions is a good weapon to end conflict.