I know I promised to provide updates about both the core of this issues and my personal well being, but I have found the public health care system so much more exciting and thought provoking to blog about so I apologize for my lack of details regarding other aspects of the trip.
First off, I love Africa and it has far outdone my expectations. Plettenberg Bay is one of the most gorgeous places I have ever been! The people are beautiful in appearance and charm. They seem equally excited and stunned at the sight of white people walking through their townships and I often get called an Umlungu, or lungu for short, which literally means 'white people' in Xhosa. It's a stark contrast from my life in Iowa to be such a prominent minority figure in a neighborhood, but it is a humbling experience to say the least. I don't mind being pointed out because the people are naturally acknowledging the ethnic and cultural differences I bring to their community. So far, the residents of Kwanokuthula have not had any serious issues with the presence of 6 American students living within their confines, which hints at the idea of further integration of living environments in the future. The post-aptheid segregation is obviously present and I have had people tell me that there are still black and colored South Africans that genuinely hate white people, but by living amongst poverty ridden black people, as a white female, I feel like I am helping to break stigmas. My host family is so sweet and I feel so fortunate to have been placed in such a beautiful, loving home. The mother Sindi, has a 4 year old daughter Iphuey (pronounced e-pee). Sindi is not married, but I think Iphuey's dad comes home when he gets vacation from work. I have not seen him yet though. Her brother also lives in the house, but he works a lot and is not often home so I have failed to remember his name :-/ Sindi's niece Cassandra, who is 18, did live in the house with us for the first week, but she went back home to her township of Knaysna. Sindi is a wonderful chef and provides me and Sophie with some of the best packed lunches in the whole group! We have had cheeseburgers a couple times, which is a crowd favorite and a sure way to get half of the burger stolen from people wanting bites. My favorite is the egg salad or tuna, because they are not a huge hit with the rest of the group and because I can't taste the butter layer as much. I have gone to the grocery store quite a few times to supplement my meat and starch diet with some more fruits and veggies, which has been quite satisfying, but a very expensive splurge. The home Sophie and I live in is quite nice and has modern amenities. I share a very comfy and cozy bed with Sophie and we have a shower and a washer and water that comes from the fridge. I feel very spoiled to be living in such a nice home, when there are so many afflicted by extreme poverty right across the street. I have been very fortunate health wise thus far (knock on wood). There was inevitably a cold that went around the group in the first week and I've accepted my fate of having a runny nose for the remaining 6 months. My biggest concern is that my right eye has been twitching for 5 days now, but no further diagnosis has been made concerning that issue. I did get my nose pierced, but it appears to be healing quite well and only bothers me when I yawn. I do miss paper towels dearly and the only trash can in our house is the big city one outside, so I have had to rethink my trash output which is obviously a good thing, but hard to adjust to. An update on everything exciting and adventurous I've done so far could easily encompass a short novel, so I will provide an abbreviated version in the form of a bulleted list instead. - Hiked -Swam in the ocean -Learned about bird tagging -Observed the local flora and fauna -Bungee Jumped at the worlds largest facility -Spent way too much money on food (local cafes, ice-cream, hotel restaurants, grocery stores) -Inevitably, most likely eaten way too much food -Worked for 2 weeks with the care givers -Learned about public health and HIV/AIDS in Africa through our seminars I am more than enjoying my time in South Africa and it's crazy to think that our time here is almost halfway over. The next few weeks include working at a local elementary school, traveling to Robertson for a week with the Breede River Hospice, a weekend in Cape Town, and then 2 more weeks in Plett and a week in Addo National Park on a safari. I can't comprehend my excitement for the coming weeks, and in that case the coming months, but I will keep you all updated as I learn about myself and the world through these crazy, educational, adventurous days. Vrede (peace in Afrikaans) kt :-)
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The past few days, I have administered all of the observations on every patient we visited. Compared with the first round of blood sugar and pressure tests I did, I became increasingly more accurate and comfortable with each patient. I quickly learned that often times, I need to squeeze a patient’s finger tip after I prick it (especially with elderly patients or ones with poor circulation), to make sure enough blood comes out for the blood sugar device to accurately read and that the blood pressure band will actually not work properly if I put it on upside down.
Although HIV/AIDS is the main ailment that people associate with Sub-Saharan African, there are a multitude of other chronic illnesses that burden the local people. Plett Aid’s main initiative is focused on end of life care and assisting patients to a comfortable and dignified death, so as a result I have seen many more elderly patients dealing with a multitude of ailments rather than people living with HIV. The exposure to varying illnesses and people in ranging socioeconomic situations has allowed me to postulate questions and explore the South African Health care system as a whole, rather than strictly focusing on HIV/AIDS. Tuberculosis (TB) is a very common disease HIV positive patients develop because the immune system becomes extremely opportunistic to infections when the CD4 cell count is considerably low. Diabetes and hypertension are also very prevalent, as well as various types of cancer. Another very common issue in African townships is poor circulation, which in turn lead to ulcer sores and unfortunately a large number of amputated limbs because of lack of treatment or poor care. Families will neglect to clean the sores and they become increasingly potent. The open wounds spread bacterial infections through the body and often times cause the limbs to become septic. As the infection increases through the limbs the patients continue to refuse to go to the clinic because of reluctance or pride or even downright negligence of personal care. The older patients often believe that they are already old so one sore can’t make things worse. I am unsure of how an amputated leg is a positive alternative to going to the clinic for a small sore, but all of the people I have seen with amputated limbs do not seem too remorseful for their negligence in personal care or they are incredibly skilled at staying positive in the face of adverse situations. One man even exclaimed that he loved his “little nub” after a nurse changed his bandages. I find it astonishing that I have seen close to 10 people with amputated limbs – close to the number of all of the HIV, TB and cancer patients I have seen combined. It is equally as astonishing that this cycle of negligence is a common occurrence. Public health care is completely free to all people living in the Plettenburg Bay area. I started to hypothesize that one explanation to why people appear to be less preventative in personal health matters is because they know treatment is free if they happen to fall ill. Of course there are other economic factors including extreme poverty and lack of health care resources that contribute to the low amount of preventative measures people take in poor townships spread through Africa. Compared to the United States where it costs a hypothetical arm and a leg to have any significant health care administered, people tend to live more cautiously and take immediate action when something is out of the ordinary in fear of a serious illness costing their life saving to treat. And then one could argue that living in the United States is less stressful than living in Sub-Saharan Africa and people have more agency to think about the future, rather than being concerned with surviving each day. It’s a difficult idea to explore. Is a free health care system working properly if it is allowing so many people to literally lose and arm and a leg or is it worth paying inordinate amounts of money sometimes to protect your health and well being for the future? Clara explained to me that many people are just strictly not educated about medicine, more importantly, personal health care. She said Plett Aid aims to educate their patients as they administer care, but the organization cannot possibly reach everyone, and second-hand information distribution is often times not as accurate as the primary source. There is a strong push for sexual education and condom use to prevent HIV/AIDS, but I think there is a lack of personal well-being information available to the most afflicted and susceptible communities. Personal well-being classes, including nutrition, an understanding of preventive actions, and active lifestyles, could provide the citizens of African townships the insights and motivation to plan for the future and set achievable personal goals. The sight of a small sore on a toe might not strike apprehension in a person that is also unaware of his/her poor circulation, especially if the sore doesn’t cause much physical pain. This would most likely be true in the United States. I would never go to the doctor because I scraped my knee, but if I scrap my knee in a different environment, especially one that disease transmission rates are horrifically high, I would be extra cautious in cleaning the wound because I know an open sore is more susceptible to a serious infection. The issue is, that most people in the townships wouldn’t take the necessary measures to monitor and maintain the scrap because they are either unaware of the consequences or preoccupied with other seemingly more important endeavors. The lifestyle revolves around the idea that things happen when then happen. Many people’s main focus is to make it through the day. There are no preventative measures taken to maintain long-term health. Clinics are only for the sick. In a system that is already disorganized and inefficient, one can only imagine a day when healthy patients go to the clinics for regular check-up’s. This blog post is made possible by the lack of scheduled time here in South Africa! As I sit here in Plett Aid's office in Kwanokuthula I am unaware of when the care givers will come pick me up and also of what our daily work will involve. I was told that today I would be able to administer the regular tests to patients (blood pressure and sugar) after I nervously asked yesterday and got the impression that I should've asked sooner!
Plett Aid is a non-profit organization that monitors patients social and physical well being in the greater Plettenberg Bay area. They administer to patients that have been referred from local clinics as being stable to live at home, but needing assistance in some regard. As I've shadowed the two carers for another township, New Horizons, I've concluded that their main concern is that the patients make it through every night. The carers mainly take blood pressure and blood sugar and talk to the patient and family about the living conditions and how they are receiving food and water. They will also draw blood or swab for spit to take into the clinics to test for more serious diseases such as HIV and TB. But if something is out of the ordinary with a patient, the carers must consult the professional nurse, who must visit the patient in the home or refer the patient to the clinic, which can take an unimaginable amount of time and energy from the patient's days. Time, like I said earlier, does not exist here. It bothers me very much not to have my day planned out with my calendar, but it seems to work for the people here. I see the lack of time management as inefficient. There would be time to squeeze in another patient if we didn't stop to talk to the neighbor or go the store to buy bread, but I'm learning to understand and accept this way of life. It seems selfish that the carers are not spending every second tending to the patients needs, but from the patients view they might not want to be poked and prodded and talked to for longer than they already are. The culture here is very social, but not always directed at the topic or issue at hand. Although I cannot understand the Afrikaans language that is spoken between carers and patients, after the carers translate or when they speak english to include me, the conversation has usually shifted to a tangential topic. The apparent inefficiency stems from the lack of trained health care providers. The carers have a very limited knowledge of medicine and can administer just a few basic tests, that they are willing to let me do without any previous experience. They know the issues effecting the communities (HIV, TB, cancer etc.) but they lack the medical background and terminology to understand fully how to prevent the outbreaks from occurring in the future. The professional nurses are a step up from care giver and they can diagnose and prescribe medication, as well as do check up's in the clinics. These women are also referred to as Sisters. Then there are doctors who only come to the clinics once a week. They are mainly white women who live in Plett. The clinics do not offer 24 hour services, the hours are similar to an office building, 7am - 4 or 5 pm. If you need emergency care in the middle of the night you can call an ambulance to drive you to George, which is 30 minutes away (I think). This whole system is considered 'public health care' which is entirely free to patients. The private care system is very expensive and I'm unsure about it's complete services. I finally, and successfully, administered the regulatory tests to a patient on Friday. All of the anticipation was slightly exaggerated for the actual moments, but I was proud of myself for accurately measuring the woman's blood pressure and sugar, and maybe more relieved that her data was in a healthy range, despite the fact that she had one leg amputated at the knee about a month ago. I'm learning a lot about the system from just observing, but I long to do more hands-on work. It's easy to disregard small details of day-to-day life in South Africa, but thinking about sights and sounds and interactions after they happen have led to the most interesting analysis. I'm still investigating the core reasons South Africa is so rampaged with non-communicable diseases such as HIV/AIDS, TB, and diabetes, but I think it has to do with the relaxed lifestyle. The history of Africa - Colonial rule that led to inefficient infrastructure after independence was won for many countries in the 1950's and 60's, has never allowed African countries to gain stability in their governing systems. Private sector initiatives were the main priority during the time of huge aid initiates in the 1970's-90's, which has caused public sector organizations to struggle to gain footing in the current day. The public health system is alive and well in South Africa's townships, but there are obvious inefficiencies that continue to cause problems. I will continue to learn about the care giver's role in the public health system this week and then next week I will be working in a local primary school assisting grade four teachers as they attempt to teach the children in English (A dramatic shift from the first 3 years of primary school that are taught in Mother Tongue, Xhosa). I'm learning so much everyday and with limited internet access it's hard to capture my ideas all at once. There are so many people I want to contact and catch up with, but snail mail seems to be quite snail-esque. Feel free to email me or just catch up on my periodic blog posts! I promise to update about the other aspects of my new life in South Africa soon! Peace out from Plett!! Katy I have been gone for almost 13 days now and have been in South Africa for 11 or 12 of those days (I think). South Africa is beautiful. The landscape is an immaculate mixture of mountains (Tsi Tsi Kamma...??), oceanfront, fields, and forest. I like to think of it as all the geography of the United States in one area. The past days have been extremely busy and I feel like I have experienced a lifetime of adventures in such a short period of time. The group dynamic is similar to that of lifelong friends, even similar to family. We all get along very well and have learned so much about each other in the time we've shared.
We started our journey at Ingwe, a forest adventure and team building retreat. We had TBB orientation seminars intersperced with once-in-a-lifetime adventures, including Monkeyland, Birds of Eden, and Africanyon Kaloofing. The time at Ingwe crafted exciting expectations for everyone and reassured me that Thinking Beyond Borders is going to be an amazing, life-changing experience. Yesterday our group packed up and left Ingwe and moved into our host family's homes after a brief overview of Plett Aid and the townships we would be living in. The townships are much different than Ingwe, but they're more representative of what I originally thought of Africa. There are many small houses close together and kids and cows and dogs and chickens roaming the street! You can feel the energy of people laughing and playing together, but there is also a calm air that flows through the township. The lifestyle is relaxed which is a refreshing change from even my suburban area in the states. My host family is so friendly and inviting and the house is spotless and very modern. I was initially surprised to see the wonderful conditions of my home for the next 7 weeks, but of course I'm not complaining! The bed is nicer than mine at home! I'm so excited to start working for Plett Aid, shadowing home care providers, helping in the clinics, at the wellness center, and providing support for a local primary school. I will do another update soon to go into more detail about my amazing experiences, but I need to process all the information and get into the normal routine for the coming weeks before I produce any thought provoking blogging. I'm having an amazing time and I'm safe and taken care of, for all of you worried out there ;-) Peace out for now! kt I officially leave in less than two weeks. That seems equally like an eternity as it does the blink of an eye. I'm experiencing a range of emotions, mostly consisting of excitement and anxiety to get going. But I think I am still in denial that I am actually leaving the country and my parents and family and dog and friends and Starbucks breakfast sandwiches for 7 months. However, I have no doubt that this adventure will be completely worth the challenge of reinventing normalcy and Starbucks will have an even better breakfast sandwich when I return.
I should probably introduce myself and provide some context around this inaugural blogging attempt. My name is Katy Axel and I live in Davenport, IA. I graduated from Central High School last spring. In high school I was over-exerted by some standards (my mom), participating in cross country, soccer, studio dance, show choir, 3 clubs, and as many A.P. classes as I could fit into my schedule. I tried to volunteer my time back to the community as much as possible, but my free time was limited and mostly consumed with activities that I preferred. After all my high school extracurriculars ended, I realized the last 4 years had been all about myself. I carefully sculpted my time and involvement to make my college applications look stunning. However, a heartbreaking March and April proved that no matter how hard I thought I was working to improve myself, I wasn't doing enough of what big name colleges expect. I had looked into gap year programs as a junior, mostly because they had cool websites and cool videos and I enjoyed picturing myself in an exotic location "saving the world." But I wasn't positive that I wanted to spend a year away from school until the college news arrived back. I was overcome with a desire to not focus on myself and my personal ambitions for life. I realized I really do want to save the world, or at least significantly help it, and the only way to attempt that daring feat is to see the world. Thinking Beyond Borders fell into place and I guess the rest of the story is yet to come. I named this blog The Core for two reasons, and I'm going to have two different types of blog posts. The first one is going to be more personal, my daily trials and tribulations in the field. It represents my core, and how I will find strength when I am weak and the power to stand tall and express my ideas. The second type of post is going to be focused on the core of the issues we will be tackling (Public health, education, and sustainability.) The program name, Thinking Beyond Borders, is a very accurate description of what we will be doing for 7 months, but I want to take the knowledge and experience I gain and examine it to the core. I want to understand the basis of these problems and then develop solutions that tackle the core of the issues. That is a very broad and multi year process, but hopefully this blog will be a starting ground to gather my ideas. I'm not entirely sure about the internet consistency and reliability in all of the places I will be traveling, so I will update my blog as often as I can. This will be an adventure of a lifetime and I'm so excited to share it with everyone following along! I will conclude with a quote from my favorite author, Cheryl Strayed: "The thing about rising is we have to continue upward; the thing about going beyond is we have to keep going." It seemed very fitting. Peace out, kt Here's the link to TBB's website: https://thinkingbeyondborders.org |