For the past week and a half, as I have been putting color coated stickers on patient’s files in the New Horizons Clinic, I have had plenty of time to think. I try not to think about why poor Maddie and I were asked to color coat the already organized 10,000 files into 100 group sections classified by completely meaningless color groups, so I think about the time I have spent here in South Africa and how I envision my role as a social entrepreneurial brain surgeon/OBGYN in the future. Thankfully the constant thoughts flowing though my mind pass the time pretty quickly.
First off, I envisioned Africa to be much different. Sub-Saharan Africa is portrayed in the media as a desolate place and I think I expected to see people wandering around languished with poverty and disease. Although I have unfortunately seen people that fit my preconceived notion, I overlooked the idea that Africa, especially South Africa is very developed. I had the same ‘other-worldly’ expectation when I travelled to China. The first thing I remember thinking when I arrived in Beijing was, ‘wow, they have highways and cars too!’ It’s fascinating how susceptible our perception of reality is. At home I was in such a routine that it was hard to imagine myself in a different reality, but now after spending almost 2 months in South Africa, it’s going to be strange going home and seeing all the cows kept in pastures instead of grazing freely next to me as I walk down the street. It’s important to remember reality looks different all over the world, but in times of discomfort of confusion, it’s reassuring to remember every person is so similar in essence, we all just live a different reality. We all want, need and crave the same basic things and just because someone speaks a different language or has a different skin tone does not change the fact that he or she will cry in times of sorrow and laugh in times of joy. My world perspective continues to expand which makes me one happy camper.
Public health was our main topic here in South Africa. The TBB curriculum focuses the idea of public health around the HIV/AIDS epidemic, which has ravished a majority of Sub-Saharan Africa. However, HIV/AIDS is not the overarching concern anymore. South Africa has the largest ARV program in the world – people have access to medication. The problems stem from the effects of HIV/AIDS. The big questions we discussed included, ‘why do people not adhere to treatment regimes,’ ‘why is it so hard to prevent the spread of preventable diseases,’ and ‘how can education play a role in eradicating both the disease and the stigma surrounding it.’ It was challenging to discuss solely the HIV/AIDS epidemic in seminar and then go out into the community and see people mainly plagued by TB, cancer, diabetes, or hypertension, because if they had HIV it was most likely controlled.
That is not to say HIV/AIDS is not a major concern. It is still a massive and pressing issue in the area and I don’t want to belittle the disease. There are many people that refused to be tested because they are embarrassed to tell their families or in denial of a positive status. I had a very close encounter with HIV the other week. I was working with Danray in the wellness team and finally on Friday after my constant nagging and persistence she let me administer the HIV testing even though for liability reasons I shouldn’t have. I reassured her I would not prick myself and that it was crucial training I needed to have in order to become a doctor – she finally agreed. The first patient I tested in the back of her van at the Knysna Elephant Park just so happened to be HIV positive. We had probably seen 25 people who tested negative that week and out of the 3 positive people we saw, I had to break the news to one of them. After I tested the blood pressure, I got all the materials out to test the blood sugar and HIV simultaneously. This is a tricky maneuver in the back of a van. I pricked her finger, wiped off the first blood that came out to avoid any contamination, then used a very small pipette to suck up the blood droplets and put two into the HIV test and another one on the glucose reader. This again is a tricky maneuver because you can’t let go of the tension in the pipette so the blood stays in the tip and you have to suck up enough blood at once so the tests can be accurately read. All that being said, I am not a pro at this particular task yet, but I’m sure I will have much more practice in the future. After I put the two droplets of blood into the HIV test, I put the two drops of diluent that activates the test. ‘Two stripy means positive, one stripy means negative,’ Danray proclaimed all week. If there are going to be two stripes on the test, you know immediately and as soon as I cleaned up the materials and looked down at the test I shot Danray a concerned look. This woman was HIV positive and she will live with this disease for the rest of her life. I was also marginally concerned about the HIV positive blood on my gloves and the fact that I had an eyelash in my eye that was causing much discomfort, but I couldn’t dare touch it. I had to administer a second HIV test to confirm the results and Danray gave the woman a referral form for the clinic. All I could do was sit there, stunned at the path of her future I felt like I just dramatically interrupted. I couldn’t even console her because I don’t speak her language. It was now up to her to go to the clinic and get blood drawn for further testing. Although I felt useless after the dramatic situation played out, I was reconciled in the fact that one more person is aware of her status and hopefully will take the appropriate measures to help control her disease. Aside from the initial shock, I didn’t grieve in the negative situation. I was motivated to keep spreading awareness and testing people for HIV. I wanted to reach as many people as possible because HIV is controllable, but only with the knowledge and support from people in afflicted communities. The encounter left me wondering what more I could do.
On another occasion of my persistence paying off – the last day of work in South Africa I was able to go shadow a doctor in the town clinic. This was a magnificent change from the sticker gig of the previous 7 days! I sat in with Dr. Leslie Vanderburg, a very slender, energetic woman. I could tell that she meant business and many aspects of her professional demeanor and medical knowledge were inspiring. She was also left-handed and could walk incredibly fast, which I connected to on a personal level. I was able to observe around 15 appointments and 2 emergency situations. The appointments were mostly spoken in English, which was incredibly helpful. Although I was aware of what normally happens in doctor’s appointments in the public clinics, it was humbling to witness the actual encounters – and the wide range of problems that the patients presented. Dr. Vanderburg quickly debriefed me about the patient before and after each meeting so I felt informed about the decisions she made. The majority of her work consisted of ‘review’ and ‘scripts’, which are monitoring chronic patients and assessing any further changes to their health and writing and revising prescriptions, respectively. There is a clear disconnect between the doctors and sisters working in the clinics because only the doctors can prescribe a majority of patient prescriptions and they also have to do all the minor surgical work and see everyone that the sisters have a question about. This means the doctors see mostly chronic patients to refill prescriptions or as Dr. Vanderburg put it, ‘to come in and complain about any issue they can think of.’ I went to the clinic on a very eventful day because I was also able to witness the doctor put a hemorrhoid back up a patient’s anus and hear the excruciating sounds of a patient receiving a catheter in attempts to drain 3 liters of urine (I couldn’t watch this procedure because the patient was embarrassed, but I did see the bowl of blood that it produced). Both of these small procedures, although harder to listen to than watch, validated my desire to become a doctor, especially in a public sector clinic that attends to poorer people living in adverse situations. The second story most likely will not have a happy ending. The doctor told me that the man with the catheter complications will most likely die if he is unable to get to George as quickly as possible. However, to get to George you have to go through Knysna, and the service at Knysna hospital was unacceptable, as they incorrectly inserted the catheter in the first place. His bladder will explode if the urine is not drained, but a simple ‘in-out’ catheter (put a catheter in, drain the urine and immediately take it out) was not effective. The two doctors in the town clinic did all they could, but the deficiencies in the public health system make it almost impossible for the man to get the adequate treatment he needs immediately. Witnessing this dilemma first hand made me question what I can do to help both the patients in need and the failing system that is contributing to their unfavorable situations. How do we change policy and practice simultaneously?
On a positive note - It was fun to see my host mother, Sindi, at work because she is the administration clerk in the town clinic.
Speaking of Sindi, she is a wonderful woman! She works extremely hard to manage all of the town clinics files and appointments. She possesses a kind demeanor and patience and also mothers her daughter Iphesh while the father is away at work. Sindi made it a priority that Iphesh goes to an English school and will most likely send her to Greenwood, which teaches it’s students based on the Oxford curriculum, so many students get scholarships to study abroad. Sindi is right in investing in Iphesh’s education, even though it is very expensive, because the girl is intelligent. She is a cheeky manipulator, but has a powerful presence and unbelievable English skills. I have no doubt Iphesh has a bright future ahead of her because Sindi has a strong devotion to her daughter’s well being.
Sophie and I have talked to Sindi about a range of topics, but we mostly talk about our experiences with working in the public health sector and her job as a clerk in the clinic. One main issue she see plaguing the system is lack of communication between the health care staff. The clinics each have managers, who are just appointed sisters. This is the equivalent to an RN in the United States managing and overseeing an entire doctors office or small clinic. Many nurses in the United States also hold administrative or managerial positions within their everyday work, but it is unlikely that a single nurse would be in charge of a practice. A nurse has little to no experience in management or business operations, especially the sisters in ZA that solely went to school to obtain a nursing degree. Sindi is frustrated because as a clerk in the clinic, she has knowledge about and manages the administration aspect of the system. She knows she doesn’t have the skills or knowledge to start an I.V, but she doesn’t try to, she does her part in the operating system. The managers of the clinics tend to oversee every action and hold the power in every decision, which often times mitigates the effectiveness of the system as a whole because they are often times not the most effective managers because they rightly engage their energy at the more pressing issues at hand - the patients. There clearly needs to be someone in charge, but I think hiring a manager, someone with proper training and who can focus on operating a more effective and efficient system is not a bad idea. That might be wishful thinking though – the budget of the public health sector doesn’t really have ‘spending money.’
I could talk about public health long enough to probably write a couple short novels, but if any of you devout followers have made it this far in my marathon blog post then you probably are longing for a change of pace. Well you are in luck! I will share the rest of my miscellaneous observations and adorations for Africa now!
1) Everyone has TV’s – no matter how poor you are – you have enough money for a satellite and a TV. This phenomenon confuses me to no extent. It’s strange to look at the poverty ridden townships, where literally every house is made of wood, cardboard and tin and see satellites protruding from all of the leaking roofs. TV is a culture. Our TV is always on and we eat dinner on the couch in front of it. There doesn’t seem to be any noteworthy shows, but the source of entertainment is stimulating for people. Speaking of TV, Keegan got kicked of Idols, so my new favorite is Thami and the judges think he is going to win, but I won’t even know because there are still 3 weeks left!
2) Obviously being one of the only white females in a black township draws some attention. I don’t mind the attention because I’m a clear minority and people are just acknowledging the discernable differences. I’ve been asked to come home with guys, hangout with guys, drink with guys, give guys money for drugs, probably do drugs with guys, and just be friends with guys, but I find it so hard to distinguish between the genuine offers and the manipulative ones. We were warned Kwanokuthula is dangerous and we were reminded of the eminent danger when my roommate Sophie had her bag stolen from her after being held up at knifepoint. But I still want to believe everyone is sincere in his or her offers. Of course I never took anyone up on any offer, even as harmless as it probably would have been, but I can’t help contemplate if I’m missing out on half of the reality of Africa. I have talked to many blacks, coloreds and whites, all with different stories and experiences, but I wonder what would’ve come of a hangout with a guy that approached me off the streets. What would he want to say to me or what aspects of his life were different from what I have already seen? I want to hear the whole story – everyone’s individual full story. I had a really cool encounter with a local black man as I was walking back to a café after running on the beach. He approached me asking for directions and I felt cool because he first thought I was a local and second I could actually help him out. I told him I was going in the direction of the main road, so we just naturally started walking together. He caught on to my different accent and asked where I from. I explained to him that I was volunteering with Plett Aid and I hoped to become a doctor someday. He told me there was a new medical facility being built somewhere close to Plett and that I should study there. I told him that I very likely would be back as a doctor someday. He also told me that his fishing mates had left him and now he had no idea where they went with the white Bucky (pickup truck). As our conversation came to a close when I reached my destination, I left him with a hopeful ‘good luck’ in finding his friends and I genuine ‘it was nice to meet you.’ It’s these simple encounters that leave me hopeful and happy. I would love to believe that all people have good intentions and are authentically kind and friendly, because most all of them that I have talked with have been. But than I remember that all people are not nice because somehow America managed to elect Trump as our president (!?) But that is a whole different story and not any African’s fault.
3) Apartheid still exits - separation is very evident. No black or colored people live in town and even in town there is a white street and a black area up the hill. The only time blacks come on the white street is to go to the grocery store or ATM. All of the staff in restaurants is black or colored, serving all white people. The townships are all black or colored and they gawk at the sight of a white person in them. 6 foreign students came as quick a shock you can imagine. It appears to me that no one is doing anything to integrate all South Africans and end racial separation once and for all. However there is such an income/wealth gap that I’m not sure any reasonable change could be done. The white people are not going to up and move from their comfortable homes into a shack in the townships and the blacks and coloreds have no means of affording a house in town. The progress has stagnated post-apartheid. The ANC has lost an incredible amount of support in the last few years, which could be the cause of the slowing social movement. I’m not sure if the people see the evident separation as a problem, and maybe it is not fundamentally affecting the people of Plettenburg Bay, but I feel like my experience with diversity and socioeconomic division in my hometown cause the sheer division of blacks and whites here to be even more staggering.
4) The education system needs to most help. All aspiring teachers and policy makers come quick! South Africa has scored considerably lower than most African nations on national and regional standardized tests. After experiencing public education for myself at Phakamisani Primary, I see the immediate need. Statistics may say that kids are in school, and for the most part they are, but what they are actually learning in school is the main concern. Sadly, that learning is not up to par. South Africa having 11 different national languages doesn’t make things any easier. Students and teachers are forced to transition to English in grade 4 and most of them have no prior experience and the teachers are teaching their usually second or third language. There are a whole slew of problems with the system and a whole slew of solutions that will take time, money and persistence to implement, but I’m still investigating the most effective methods. I’m using all of the questions and possible resolutions floating around in my head as the perfect transition into the education unit in India!
Well you have made it to the end! Congratulations! My next post will be from India and I couldn’t be more ecstatic. I’m sad to leave South Africa, but ready for change. We do stop in Addo National Park for a short 4-day safari adventure, so I will be sure to include a brief explanation of that experience in my next post!
Hang in there back home with the prospects of Trump. The group is crafting plans for protests upon arrival in Washington D.C. – do not fear! However, I will be returning to Africa as soon as I can if anyone wants to join me ;-)
I’m sending my genuine love to you all,
An attempt to document my journey through 5 countries, 3 global issues and billions of people