HIV/AIDS and Healthcare in Durban, South Africa "EXPLORE. DREAM. DISCOVER." M.T.

I'm back home in NY!

2009-05-27T18:16:00.000-07:00

I'm sorry it's been so long since I've posted! I've been waiting for the time to sit down and write some poignant summary of my experiences in Africa but, as I scramble to get Medical School applications in, that time has yet to come. I'm home safe -- just very busy! I'll post more video as well as a conclusion asap.
Thanks for all your love and support!
Much love,
Julie

Elephant Sanctuary

2009-05-04T01:06:00.000-07:00

Tsitsikamma Zip Line Tour

2009-05-04T01:00:00.000-07:00

05/02/09

Jeffrey's Bay

2009-05-04T00:57:00.000-07:00

5/1/09

Very cute little surf town. Like Santa Cruz with Afrikaans.

Performance Pics!

2009-04-30T02:22:00.000-07:00

Day 26 - Human Pathogenesis Project

2009-04-30T02:02:00.001-07:00

Day 26
Wednesday
4/29/09

Thanks to Dr. Norris in San Francisco, today I was able to tour the Doris Duke Foundation Laboratory (http://www.ddcf.org/page.asp?pageId=328) at the Nelson Mandela Medical School. I was met by Marianne, a post-doc from Kenya, who showed me around the facility and told me about some of the research herself and the rest of the Human Pathogenisis Project team are working on. She is mainly focusing on innate immunity and its applications in developing a HIV vaccine. The research facility is a joint effort with Harvard and Oxford with many of the researcher having done work at one of the others. Other faculty travel between two or all three of them. It was a very nice facility and everyone I met was very nice and welcoming. Marianne kept telling people that she was trying to sell me on working at the lab – apparently she doesn’t realize that is something I aspire to do and they’re not exactly knocking my door down to get me in there. There is some fascinating research going on there, I need to do some of my own research and learn more about it. I really like the lab environment. My lab experience is fairly minimal but I really enjoyed my time at the Blood Systems Research Institute in SF – I love the innovation and constant detailed problem solving. I’m fascinated by immunology and infectious disease and am really looking forward to learning more and getting my hands dirty (so to speak) the lab again.

Dr. Marcus Altfeld, Dr. Norris’s colleague and a researcher based out of Harvard/Massachusetts General took us to lunch at a lovely gallery/restaurant. Once again, just discovering places and people I would love to spend more time with right as I’m about to leave.

Dr. Altfeld told me about some of the research fellowship exchange programs the Doris Duke Foundation offers, a great opportunity for someone like me who wants to go into research but doesn’t have much experience. Keep your fingers crossed for me in the upcoming years!

Tonight Nicole and I are putting on a performance for the neighborhood -- a traditional Zulu dance that our sisters taught us. We have outfits and everything! The moves are a little rough but the girls just told us to shake everything as much as we can -- that’s apparently how you make the chief choose you as one of his wives. Luckily there’s no chief here in the suburbs, and I have a great guy at home, so I don’t have too much to stress about. I’ll try to post a video, should be hilarious!

Day 24 -- Final Weekend in Durban

2009-04-30T01:59:00.000-07:00

Day 24
Monday
4/27/09

Tonight ends my last weekend in Durban. Hard to believe. Early Friday morning Mina and I will fly to Port Elizabeth where we’ll rent a car and drive, via the Garden Route, to Cape Town.

Had a relaxed weekend seeing Durban’s sights. Saturday was a beautiful, sunny day. Mine and Nicole’s family took us to a market area near the city center in order to buy the traditional Zulu clothes we need to perform the dance the girls are teaching us. People didn’t hesitate in the least to point in the car and shout “Umlungu!” (white person) as we passed. Anele, our 16 year-old sister, explained that it wasn’t because we weren’t welcome but that they were just surprised. After we bought our short, intricately beaded skirts and necklaces Nicole and I took Anele to North Beach. We spent the rest of the afternoon laying on the beach, swimming in the ocean, and perusing the souvenir stands that line the beachfront. Anele is at that funny age where she talks and talks like she knows everything there is to know but her eyes give away her constant need for approval.

Headed back to Woodlands (the suburb we live in) to go Sean’s family’s house – his brothers Quiniso and Makabongwe were throwing a surprise birthday party for their Mom, Zodwa. It was so cute! Two teenage boys who had spent all day frantically gathering supplies for their mother’s surprise braai (barbeque) including decorating the house with peach streamers and ordering a cake decorated to say “You Are The Best Mom.” Zodwa was surprised and jokingly chastised her boys for being so naughty and saying if they are old enough to pull this off then they were too old to give her any more trouble. She gave a touching speech about losing their father when the boys were young and how proud she is of both of them. Quiniso gave a speech and little Makabongwe read a poem he had written. It’s funny how the boys here don’t seem to wear the same tough-guy mask that most teenage boys back home wear – they’re quick to talk about how much they love their mom’s and pray, sing, or dance in front of strangers at mom’s urging. It was very sweet and very touching. We were served plates piled with barbequed meat and pap (a cornmeal based side, similar to polenta) followed by the most interesting desert – a bowl of lime jello, strawberry ice cream, yogurt, and topped with a slice of chocolate cake. The music came on and everyone danced while Nicole and I helped a few of the other girls do the dishes.

Sunday was grey and rainy – a perfect day to catch up on some sightseeing. Our first stop was the KwaMuhle museum in Durban’s city center where we learned about how Durban’s colonial authorities formulated the structures of urban racial segregation (the “Durban System”) which ended up being the blueprints for South Africa’s apartheid policies. I really liked the statement on the museum’s dedication plaque: “This is a museum about power and powerlessness and the struggle for dignity by ordinary people, let this never be forgotten. Let us be mindful of the abuses of the past and celebrate the human capacity, in all its diversity and richness to overcome.”

Our next stop was the BAT Centre, a colorful bohemian arts center housing arts and craft shops, galleries, artists’ studios and a restaurant overlooking the harbour. After lunch we checked out the current gallery exhibit, a powerful display of works by female artists based on violence against women and children. There seems to be a strong activist/artist community in Durban – I feel that I’m just starting to discover this city right as I’m about to leave.

Today was Nicole’s birthday. We started out our day taking a Contemporary African Dance class led by Adedayo Liadi, the founder of the Ijodee Dance Centre in Lagos, Nigeria. It was so fun – he was an amazing teacher! It was a difficult, high-paced class with all levels (including members of Durban’s Flatfoot Dance Company) but Adedayo made everyone feel welcome. His taught exactly how I feel movement should be taught – with the emphasis on interpreting the moves how your own body dictates, moving from the core in order to give the movement depth, and enjoying feeling your body move rather than worrying about getting it exactly right. Adedayo’s philosophy about dance is that every movement should be communicating something and that, even when we speak different languages, we can communicate through dance. Learning dance with the people of a country is something I always try to do when I travel – for that very reason. One of my fondest memories of my time in Granada, Spain is being at a little old Spanish woman’s apartment laughing hysterically with girls from all over the world while she taught us flamenco. For my going-away night on Thursday, some of us are going to wee his company perform as part of the Jomba! Contemporary Dance Festival. I’m really looking forward to it!

Afterwards Nicole and I splurged and got pedicures at a spa. It was a lovely and relaxing change of pace from the grittiness of the city. And they even served us coffee and fruit – both things we’ve been dying for but aren’t that popular here. A refreshing change from our home diet of KFC and mayonnaise based “salads”.

I forgot to mention one of the things I noticed during our visit with Vusi at Marianhill. As you can see in the picture, Vusi’s toilet is in a detached outhouse in front of the home which is shared by the surrounding homes. This is the set up in most of the townships. I’ve been thinking about how that must be for a man with no use of his legs and the people we met in the community who can barely make it of bed. I keep being reminded of how fortunate I am and am so appreciative of my health.

A lil' about TB in South Africa

2009-04-29T00:48:00.000-07:00

Tuberculosis is a major public health problem in South Africa and, due to its high infectivity, is posed to become a larger threat than HIV/AIDS. The incidence of TB infection continues to increase dramatically. According to the World Health Organization’s (WHO’s) Global TB Report 2008, South Africa had nearly 453,929 new TB cases in 2006, with an incidence rate of an estimated 940 per 100,000 population – a major increase from 1998’s incidence rate of 338 per 100,000 population. The spread of the epidemic has been greatly exacerbated by the development of both MDR (Multi-drug-resistant) and XDR (extensively-drug-resistant) strains, primarily documented in the KwaZulu Natal (KZN) province.

South Africa adopted the DOTS (directly observed treatment, short course) in 1996, after the National Department of Health realized that its previous TB control efforts had been ineffective. The DOTS strategy is the only that is globally recognized for effective TB control and is embedded in five principles, as described by the Tuberculosis Management Plan for South Africa:
1. Government commitment to sustained TB control activities.
2. Identifying infectious patients via sputum smear microscopy.
3. Direct observation of treatment for at least the initial two months of standardized short-course anti-TB treatment.
4. A regular, uninterrupted supply of standardized drug combinations.
5. A reliable, standardized reporting system which allows assessment of treatment results and overall program performance.

A multi-faceted approach to the TB epidemic is crucial due to its highly infectious nature via aerosol transmission. Identification of infectious patients is the necessary first step. If a patient has been in contact with a person with infectious tuberculosis, they are most often diagnosed via smear microscopy sputum examination after presenting with the appropriate symptoms. If acid-fast bacilli are detected, the patient is diagnosed with smear positive tuberculosis. Other diagnostic procedures, which are not commonly in use in South Africa, are chest x-rays, TB culture, and the tuberculin purified protein derivative (PPD) test.
It is crucial to initiate treatment of infectious patients as soon as possible in order to prevent further transmission. Standardized drug combinations include bactericidal, sterilizing, and resistance-prevention drugs.
Patients who are diagnosed with TB should also be tested for HIV as over 44% of new TB patients also test positive for HIV. Not only are HIV-positive persons far more likely to develop TB post exposure to TB bacilli, it is evidenced that TB infection also accelerates the progression of HIV disease. Patients who are simultaneously diagnosed with HIV and TB begin ARV treatment post-completion of the prescribed TB treatment regimen. HIV-positive patients who test negative for TB can be given TB preventative therapy, in the form of isoniazid prophylaxis, in order to reduce their risk of infection by up to 60%.

Even with DOTS policies in place, the emergence of MDR-TB and XDR-TB is an indicator of the poor implementation of South Africa’s TB Control Program. The number of laboratory-confirmed MDR-TB cases in South Africa has more than tripled from 2,000 cases in 2005 to 7,369 in 2007. The KwaZulu Natal (KZN) province, the epicenter of South Africa’s HIV/AIDS epidemic, has also been the most acutely affected by the emerging drug-resistant TB strains. In 2006, the WHO announced that a new extensively drug-resistant strain of TB (XDR-TB) had been detected in Tugela Ferry, a rural town in KZN. Of the 544 patients studied in the area in 2005, 221 were determined to have MDR-TB as defined as Mycrobacterium tuberculosis that is resistant to at least rifampicin and isoniaizid – two of the frontline drugs used to treat TB in South Africa. Of these 221 MDR-TB cases, 53 were determined to be XDR-TB as defined as MDR-TB plus resistance to at least three of the six classes of second-line agents. The median survival time from collection of the sputum specimen was 16 days for 52 of the 53 infected individuals – a previously unprecedented fatality rate for XDR-TB. A 2008 study that examined isolates collected from 2004-2007 showed that 5.6 percent of 17,615 TB cases were XDR-TB. The actual reported cases of XDR-TB have increased from 74 in 2004 to 536 in 2007. KZN continues to be the epicenter of the MDR/XDR-TB explosion; as of 2007 XDR-TB had been reported in at least 39 hospitals throughout the province with well over 30 new cases of XDR-TB being diagnosed each month in KZN alone.

It could be argued that the emergence of MDR/XDR-TB is evidence of a systematic failure of the global community to tackle a curable disease; in this case the South African government’s initial lethargic reaction to the crisis could be held accountable. The factors that have contributed to the emergence of MDR/XDR-TB are avoidable and merit urgent remediation. Well-documented factors include high treatment interruption rates and subsequent low cure rates due to inappropriate treatment regimens, irregular drug supply, incompetent health personnel, and/or non-adherence. Another significant factor fueling the MDR/XDR-TB outbreaks in South Africa is the lack of infection control in institutions. Not only are advanced and expensive environmental control procedures such as negative pressure rooms rare, the most basic measures of triaging patients and use of personal respiratory protection are under-utilized at best. Tuberculosis is recognized as a disease that preys upon social disadvantage causing infections to be concentrated in poverty-stricken areas. Observance of the Marianhill clinic in Durban showed that not one health care worker wore personal respiratory protection when attending to symptomatic TB patients – neither in the clinic nor at home visits.

The most critical factor in addressing MDR/XDR-TB is prevention through strengthening basic DOTS management and improving management of patients requiring re-treatment with second line drugs. An unprecedented strengthening of overall TB control is not just recommended – but imperative. In 2006, WHO urged a response to the XDR-TB outbreak akin to global efforts to control SARS and bird flu. XDR-TB poses a more serious global health-threat than HIV/AIDS due to its aerosol mode of transmission. There are many complicating factors at play including the ethical and human rights ramifications of mandated isolation and insufficient funding to reduce hospital crowding and improve DOTS management at all levels. As Singh argues, “Given the South African government’s poor track record in dealing with the country’s HIV/AIDS epidemic and what is at stake if it adopts a similar lethargic and denialist response to the country’s XDR-TB outbreak, the international community must be vigilant in monitoring the government’s response to this emerging crisis.” International complacency paves the way for the predictable next phase – a global pandemic of completely drug-resistant TB.

References:
Child Family Health International. Tuberculosis Management Plan for South Africa. HIV/AIDS and Health Care; Durban, South Africa. No date given.
Singh JA, Upshur R, Padayatachi N (2007) XDR-TB in South Africa: No Time for Denial or Complacency. PLoS Med 4(1): e50. doi:10.1371/journal.pmed.0040050.
USAID Health, Infectious Diseases, Tuberculosis, Countries, South Africa. www.usaid.gov/our_work/global_health/id/tuberculosis/countries/africa/safrica. Accessed 16 April, 2009.

Zodwa's Birthday Braai Pics

2009-04-28T02:27:00.000-07:00

Day 21 - Isu Labasha Workshop @ Marianhill

2009-04-28T02:15:00.001-07:00

Vusi's House; the detached building outside is the toilet

Day 21
Friday
4/24/09

“As a woman, I have no country. As a woman, I want no country. As a woman, my country is the whole world.”
— Virgina Woolf

Had a very inspiring and thought stimulating day today! Last time we were at the Marianhill clinic a few of us had promised Vusi we would come help him put on an educational workshop at the local high school. Due to multiple changes in plans we were unable to meet with Vusi before workshop-day and headed up to Marianhill this morning with no idea of what we were getting into.

At the clinic Vusi informed us that apparently we were solely responsible for presenting to one of the most intimidating audiences I can think of – 200 high school students. Especially a tough crowd when discussing sex-related issues such as HIV/AIDS, STIs, and teen pregnancy. We also learned that there was no transportation planned – a bit of an issue since the school was a ways away and Vusi only had his walker. With no use of his legs Vusi gets around with his walker by doing pretty much half a tricep dip with each step; his mobility is impressive but it’s no way to get more than a block. In midst of arranging transportation three Zulu girls, appearing to be in their late teens, arrived. Vusi introduced them as the members of the Isu Labasha (Youth Vision) organization that had organized the workshop and were going to accompany and translate as necessary.

We eventually got a taxi to take us through a complex maze of dirt roads to the high school, a horse shoe shaped arrangement of three buildings surrounded by barbed wire. Curious faces peered out the windows as we walked by – later I found out that we were the first white people to visit the school for as long as anyone could remember. We separated into two groups: Caroline, Nicole, and I covering HIV/AIDS, STIs, and teen pregnancy and Sean and Isaac covering TB and drug/alcohol abuse. As soon as we entered the packed classroom about 50 teenagers in yellow and green uniforms exploded into loud laughter, shrieks, and chatter. We eventually calmed them down long enough to do our spiel, which was mainly composed of true/false questions. Every few minutes the room would erupt from blank stares into peals of laughter, reason unbeknownst to us. We fielded the few questions they had and switched classrooms. It was hard to tell if they were paying attention to anything we were saying or if we were telling them anything they hadn’t heard a thousand times before. However, after we finished and the students were released for lunch, one girl came up to Sean and I to thank us. She shyly explained that she had TB and wanted to teach her fellow classmates but was afraid they would be scared of her. Another girl, about 15 years old, approached me to tell me she had been coughing and sweating at night for a couple months but the doctor told her she didn’t have TB or HIV – and what should we do? She kinda stumped me with that one – like many other times here, I really wished I had more medical knowledge. I think I gave her a sufficient answer.

We met with the principal for a few minutes who explained that they would love to have this happen regularly as teen pregnancy and HIV/AIDS are huge problems within the student population. It’s scary to think about HIV/AIDS being a huge problem amongst these giggling 14-18 year olds in cheery school uniforms. We gave him the number of our local coordinator here and told him we would do our best to set something up.

On the way back I asked Pinky, one of the Isu Labasha girls, about the organization and the workshops they put on. I was blown away by her answers! Apparently Pinky, who’s only 21 and lives in the Marianhill township, was tired of seeing her community, especially the teenagers, being ravaged by HIV/AIDS, unemployment, poverty, and hopelessness and decided to do something about it. With a high school education and no funding or experience doing anything like this, she decided to start an organization to educate the community and “give them hope.” She came to Vusi who helped her get the organization off the ground. Now Isu Labasha has grown to six members, between 17-22 years old. They regularly present day long, standing-room-only, workshops to the Marianhill community about HIV/AIDS, education, TB, STIs, and other issues the community faces. They have no funding but are able to solicit enough groceries from local markets to provide a home cooked lunch for the attendees. Pinky says they are currently applying to become an official non-profit but they are struggling with the paperwork. She explained that there’s so much more the organization wants to do, such as helping train teens in marketable skills and providing food parcels, but they just don’t have the money.

I was amazed – here’s this young girl from this poverty-stricken community in a culture where women have minimal power who has been courageous and committed enough to do more than most people with a lot more education and resources will ever do. I have some great interviews with Vusi, Pinky, and the others on video – I can’t wait to edit it together. I was struggling with how to best help this community ever since our home visits with Vusi but I think this is my answer. Vusi and Isu Labasha have so many great ideas about how to help this struggling community and could be so effective with even a little financial support. I was so overwhelmed by Pinky and Isu Labasha’s determination, bravery, and wisdom beyond their years. They have such amazing potential and we, in the US, have an abundance of the resources they need. My heart is compelled to do whatever I can to support them as true change makers and leaders in the world.

Day 19 -- Chatswsorth Hospice

2009-04-28T01:59:00.000-07:00

Day 19
Wednesday
4/22/09

Had another very intense and moving day yesterday. Not much time to write now but I want to get some of it down before the details escape me. Waiting for some of the others to get up so we can go pick up rental cars for the day. It’s a national holiday, election day, and we’re going to head to the beach -- an area we think will be low risk for a political uprising.

Spent yesterday at Chatsworth Hospice, in the Chatsworth area of Durban – a primarily Indian community. I was really looking forward to the day as hospice/end-of-life care is one of my primary interests in health care. Chatsworth Hospice, and all the people we met there, were absolutely lovely. Unlike the state hospitals, Chatsworth is well funded – by private donations, fundraising events, and the money they make selling cucumbers from their greenhouse – as well as clean and cheerful. Services are provided free of cost to patients. It’s amazing how the energy in the air changes when the staff actually wants to be there; there are only 23 paid staff members, most of them nurses who were burnt out from working at traditional hospitals, and the rest volunteers. Every few minutes someone new insisted we drank some more coffee or tea or tried a piece of cake or biscuit, all formally laid out on a tray for us with saucers and properly folded napkins. The hospice itself has only ten beds but they technically have over a hundred patients, all seen via home visits. The rooms themselves are primarily used for short symptom and/or pain-control stays, after which the patients are sent home to spend their remaining time with family. On Wednesdays many of the patients are brought in for day care which includes meals, arts and crafts, massage and reiki, and a variety of activities. It was so refreshing, after what I’ve seen in the last few weeks, to see health care personnel who truly care about the patients, talking about them as if they were dear friends.

We first attended the Interdisciplinary Team (IDT) meeting, where last weeks home visits were discussed. The IDT was composed of two sisters (nurses), two social workers, a psychologist, and the medical director – all of Indian descent. Patients were discussed with genuine compassion and even a bit of humor as they debated the merits of allowing certain patients to have a nip of alcohol here and there if they desired. I was surprised how much emphasis was put on “caring for the caregiver” and being conscious to not take it personally when family members displace their fear and anger onto you. I was very much reminded of Maitri, the Zen AIDS hospice I volunteered at in San Francisco. One social worker spoke of a fourteen year old lymphoma patient with whom she’s building a birdhouse in order to establish trust and a connection with him while giving his overwhelmed parents a break.

After the meeting we headed out with Sister Sybil to do her end-of-life oncology visits. We were to see five patients -- two patients with advanced stage breast cancer, one with advanced stage tongue cancer, one with a brain tumor, and another with colon cancer. On the way to each house Sybil gave us the lowdown on the patient and their social/family issues.

At the second home visit, to the man with advanced cancer of the tongue, we found a very frail man lying in a bed piled with blankets surrounded by his wife, two teenaged sons, and one daughter. The wife, a small, soft-spoken Indian woman, greeted us with a small smile through her red, watery eyes. I held on of the man’s bony hands in my own as she quietly explained to us how, the night before, she had knelt beside her ailing husband’s bed and told God that she was turning Ronnie over to him now, and to take his son back whenever God was willing. She smiled softly as she repeated to us what she had told him, “Don’t you want to see your mother and father? I am your wife. I love you and I will see you on the other side.” She explained that she was going to try her best to obey his last wishes and take the little bit of money they have saved and use it to start a business in order to support the children, a take-away restaurant. Ronnie had always loved her cooking and, as she explained, “I am not a proud woman, but I cook very well… I will call it Ronnie’s Take-Away” I nodded while the woman spoke and tried my hardest not to cry – the last thing I wanted was for her to feel as though she had to comfort me in her time of sorrow. She continued to explain that Ronnie was such a loving man; He was a brother to all who knew him and two of the teenagers in the room were not theirs but children he had taken in after their families couldn’t take care of them.

After the nurse asked her requisite questions and did a brief exam, we all stood to leave. Ronnie’s wife walked us to the door explaining that, even before he was sick, Ronnie was like a baby to her. She always loved to take care of him and always held him like a baby when he slept, especially when he had bad dreams. I didn’t know what to say but stayed behind to hug her and tell her to stay strong and follow her heart when it comes to the business – she will do the right thing. She hugged me back and thanked me. I barely made it out the door before tearing up.

The next house we went to was the man with a brain tumor. He has been a Chatsworth patient and regular day care attendee for a while and is like an old friend to the staff, especially the driver who came in with us just to see him. His wife, a friendly and energetic woman, greeted us at the door and ushered us up to her husband’s room. The man is unable to speak but had an unbelievable sparkle in his eyes, especially when the driver joked with him. His wife proudly showed us the view from their bedroom window, pointing out the lychee trees and the birds that stop by to “chat” with her husband. She asked us numerous questions about our trip and excitedly invited us to come for dinner to have Breyani, which we were very disappointed to turn down as it has become our favorite.

We finished home visits around 2pm and headed back to the hospice. Even though it was a wonderful day, I felt a little off the rest of the afternoon. Not sad exactly – we weren’t out witnessing horrible poverty and social injustices as on previous days – just very touched by the realness and the love I felt in the hospice and in the homes. Generally, hospice patients are beyond the point of any ‘fixing’ and all that’s left is the privilege of being with them and offering love and comfort as they close the book on their life. To be with someone at the end of their life, and think about all the lives they’ve touched, the laughs they’ve shared, the fears and hopes they’ve felt, touches the heart unlike anything else I know. I think that’s what draws me to end-of-life care; unlike other aspects of medicine there’s no fancy technology or promises of ‘getting better’ to hide behind. It’s just pure, raw humanity and, while it’s not for everyone, I think those who work in hospice see the beauty in that.

"Caring for those who are suffering, whether or not they are dying, wakes us up. It opens up our hearts and our minds. It opens us up to the experience of this wholeness that I speak of. More often than not, though, we are caught in the habitual roles and ideas that keep us separate from each other. Lost in some reactive mind state, busy trying to protect our selfimage, we cut ourselves off and isolate ourselves from that which would really serve and inform our work. To be people who heal we have to be willing to bring our passion to the bedside; our own wounds, our fear, our full selves. Yes, it is the exploration of our own suffering that forms a bridge to the person, we're serving." Frank Ostaseski

If you are interested in the Zen Hospice movement I highly recommend the following article:
http://www.zenhospice.org/8_writings_pho_media/print/intention_in_service.htm

If you're in the San Francisco area, consider volunteering at or supporting Maitri:
www.maitrisf.org

Cockroaches are gross

2009-04-23T05:26:00.000-07:00

Since I left my zip drive with my serious blog about my very moving hospice home visits at home, guess what...?
There is a colony of the world's grossest and biggest cockroaches living underneath my bed. I think there is, at least. I'm too scared to lift it up and see but I keep seeing one at a time scurrying out from under there and I can only assume they travel in large, gross packs. Nicole is on sneaker crushing patrol since I'm a huge wimp, but we've yet to be fast enough. I don't mind them on the floor but I would prefer they do not decide to crawl into my mouth while I sleep.
Also, I climbed the world's tallest indoor climbing wall yesterday. A very nerve-wracking thing to do if you have hyperhydrosis of the hands and feet like I apparently do.
Much love,
Julie

Fun with the little guys...

2009-04-23T05:21:00.000-07:00

Scary Ladder Pics

2009-04-23T05:17:00.000-07:00

Drakensberg Hike Pics

2009-04-23T05:13:00.000-07:00

Lesotho Pics

2009-04-23T05:11:00.000-07:00

Day 18 -- King Edwards and Drakensberg

2009-04-21T04:51:00.000-07:00

Day 18
Monday
4/20/09

Been a while since I’ve had a chance to write due to leaving Durban promptly after Friday’s rotations every week to go explore South Africa’s beautiful outdoors!

Spent Thursday and Friday of last week at King Edwards hospital observing the surgical theatre. Due to administrative confusion (an unfortunately common occurrence with this program) King Edwards was initially less than welcoming. Nicole and I decided to forego the official check-in and potential turn-down in favor of donning scrubs and making our way to the surgical ward. Once we made it past the front line, we were pleasantly surprised to encounter surgeons not only willing to explain procedures to us but invite us to lean right in and take a look at a cancerous pancreas or inflamed adenoid. As the teaching hospital associated with the Nelson Mandela school of medicine, we expected King Edwards to be more akin to the hospitals we’re used to in the US. While it was a definite step up from St. Mary’s, I would still describe the conditions in theatre as “pseudo-sterile.” We eagerly observed a laproscopic gallbladder removal and biliary bypass (to remedy obstructive jaundice) on Thursday. Friday was a little more gory (which I loved!) with a bilateral orchidopexy on a 3 year-old who’s testis had yet to drop and, from my notes, a “debridement R femur, sequestrian reaming, IM canal with trigen reamers.” That translates to a cutting through the patient’s thigh, re-breaking a right femur that had healed wrong, and installing a large metal pin down the length of it. Orthopedic procedures are undoubtedly the best from an observer’s perspective as they are so large scale – you can’t miss the metal hammers, power tools, and sound of bone cracking!

After rotation on Friday, some of us headed up to the amazingly picturesque Royal Natal National Park at the ukhahlamba-Drakensberg Range. The Drakensburg Range forms the boundary between South Africa and Lesotho and provides what is described as “the country’s most awe-inspiring landscapes.” We checked in to our backpackers lodge and were promptly drawn by loud music and even louder chatting in multiple languages to the lodge bar. I think we were all feeling a little too Indiana Jones-esque as we downed shot after shot of whiskey at R12 ($1.20) apiece. By the time we staggered back to our 8-person room and crawled into our bunks, I think we all knew we were in trouble for our 7:30am Lesotho trip.

After the nausea-inducing van ride up into the mountains and through border control, the stunningly beautiful, mountainous views made us all feel a little better. We made our way through the hills, past baboons and old men on horse back wrapped in traditional woolen blankets, to a small Basotho village. Somehow accumulating six barefoot Basotho children along the way, we followed our guide up a steep (and similarly nausea-inducing, due to the high-altitude) hill to reach a rock summit where we were greeted by even more gorgeous views. We eagerly devoured our disgusting lodge-packed lunches of cheese and butter sandwiches, sharing most with the kids, while the guide told us about the history of Lesotho and the Basotho people. I had the best intentions but was far too distracted by the views, warm sun, and tiny boy who managed to consume seven of our sandwiches, to learn much of anything. The kids were by far the best part of the trip – we took turns giving them piggy back rides and swinging them around in the air while they laughed at us slaughtering their names and the Besotho word for hello. On the way back down we were led on a search for beer – indicated by a white flag (for regular beer), yellow flag (for pineapple beer), or green flag (for marijuana beer) flying from the top of a hut. We spotted a white flag and followed it to the “brewery,” a small clay hut with two large buckets and old men sitting around laughing and dancing. We were offered large plastic cup full of a thick beige liquid that tasted like the contents of an ashtray had been put through a blender. The members of our group who are being drug-tested for residency in three-weeks had their fingers crossed that we had not accidentally stumbled into marijuana beer territory. How do you explain that to admin? “See I was in the mountains, and there were these old men on horses, and baboons, and this child eating corn – I was giving him a piggy-back ride – and we were looking for a white flag…” Yeah right.

On the way back to the lodge we stopped at the home of a Sangoma (witch doctor) who welcomed us in. The guide translated as he told us how he knew of his gifts as a Sangoma (psychic dreams as a teen) and the most common ailments he sees -- emotional disturbances, headaches, stomach pains, and men who’s “horses don’t gallop.” His necklace of horns and chickens feet rattled as he laughed at the last one.

The next morning we awoke bright and early to hike up to the second tallest waterfall in the world – the Tugela Falls I think. The altitude made me dizzy soon after we started our 12 km adventure – luckily it wasn’t long before I was distracted by trying to discern between loose rocks and dependable ones as we struggled to climb up a 100 meter gorge. Just when I thought my wimpy forearms couldn’t make it any further, I was at the top looking at what may be the most breathtaking view I’ll ever see. Rolling green hills and jagged mountain peaks stretched out around us for what looked like eternity. I was very grateful to not be one of those throwing up from altitude sickness as I took in the amazing views and breathed the crisp mountain air. After a brief lunch break, we continued on. The second-tallest waterfall in the world is apparently also the world’s narrowest, consisting of a slight trickle of water spilling over the cliff’s edge. Very cool nonetheless!

While the way up the way up the mountain was grueling, the way down was utterly terrifying. My fear of heights kicked into full gear as we soon faced a rickety rusted metal ladder affixed to the edge of a cliff. I took a deep breath and tried not to panic as I looked straight down the 30+ meters to the jagged rocks below. Not wanting to have the time to panic I headed down third, staring at my feet and gripping on for dear life with shaky hands as I tried to remember to breathe. I finally made it to the bottom only to reach the top on another – the same but even longer. I was mentally congratulating myself for making it without crying or needing help down like some of the other girls when a tripped over a tennis-ball sized rock and landed shin first on the jagged edges of another. Oops – I guess that’s what I get .

After a long drive home I was eager to fall into bed – bruised, dirty, and exhausted after an amazing weekend.

Day 13 - Marianhill

2009-04-16T04:30:00.000-07:00

Day 13
Wednesday
4/15/09

I feel like I witnessed so much today… I don’t think my writing can do it justice. A few of us went to the Marianhill Health Clinic, a small rural clinic on the outskirts of Durban. Marianhill is a run-down township, composed primarily of single room homes made of either sheet metal or bricks. The clinic consists of 5 rooms – a waiting area, two exam rooms, pharmaceutical storage, and the counseling room. Vusi, the clinic’s counselor/community health worker, is a small man with a huge smile. He is technically in charge of pre and post HIV test counseling but serves as the community’s advisor on any and all issues related to health. People come to Vusi seeking help for drug and alcohol abuse, family violence, STIs, and, overwhelmingly, help securing government aid for food. Vusi can sometimes offer little insofar as resources but always offers a listening ear and a kind, encouraging word.

Before we left for home visits, two patients came through Vusi’s office. The first woman blotted tears from her eyes as she explained to us in broken English that she had been drinking ”too, too much” and her life had fallen apart. She came to Vusi for help and it has been one month, 15 days since she has drank and she has found employment once again. The second woman, a younger one with a baby squirming on her lap, came to Vusi with hopes he could somehow help her obtain food. She is HIV+, but unable to take ARVs as she has no food at home and no money or work since being sick. This really means NO food – not like when I think I have no food at home. She has two children, the baby (who is also HIV+) and a school age son. She wept as she told us that she wants nothing more than for her son to finish school but he often has to come home midday and go to bed as he is just too weak from hunger – they sometimes go weeks without food.

After those sobering conversations, we readied ourselves for the home visits. I think we were all a little surprised when Vusi pulled himself out of his chair using only his arms and asked if one of us could get his wheelchair out of the closet. Marionhill’s roads are not paved and many of the homes are only accessible by a narrow, uneven path. How could a man in a wheelchair successfully live here, let alone make home visits to patients?

At first Vusi insisted on wheeling himself uphill, insuring us that it was his exercise. On our way into downhill, I’m sure we were quite a sight – five Americans struggling to maneuver Vusi’s chair on the uneven dirt road, Vusi cracking jokes that people were going to think he was being kidnapped.

Sure enough we had to leave Vusi parked in the road for our first home visit as his chair was far too wide for the narrow path. As we went to get the information he needed, I wondered how he had the energy and the enthusiasm to do this every week tirelessly. We followed the path to a two room home, made of sheet metal and other scraps, housing 12 people. Babies swaddled in towel scraps and toddlers with bare feet piled out of the doors, some playing cheerfully in the dirt, some just sitting in the shade, swatting at flies. An old woman sat outside on a blanket – after my eyes adjusted to the glare of the sun I realized she had no legs. Two other women live there, the other nine are children of various ages. Not all of these children were born to these women; it is common here for women to take in the children of friends or family members who pass away or otherwise abandon them. Their main problem, never mind the cramped and unsanitary living conditions, is no food. They only receive government grants (aid) for two of the children; the others are ineligible because they do not have birth certificates for them. The older woman is ineligible because she doesn’t have an ID and the trip to the police station to obtain one is nearly impossible for someone with no transportation, no money, and no legs. It was so hard to be able to do nothing besides listen and nod. These people are living in conditions we can’t imagine and have absolutely nothing. A bag of cornmeal or rice would be sufficient to get them through the week but they don’t even have that.

Our next home visit was equally difficult. An older woman welcomed us into her living room, where we found babies perched on every surface. She explained that three of the babies belong to her daughter who was off looking for work. The other three belong to her granddaughter who only comes home when her “belly is big,” a few days after giving birth she disappears. The woman hasn’t seen her for over six months and just assumes she is sick somewhere, maybe dead. She lists the health problems of each child while she cradles a tiny two year old who has yet to walk. The woman has taken her to the doctor many times but no one can tell her why her legs don’t work and they basically just wish her luck and shoo her out the door. Same as the last home, there is not nearly enough food. They haven’t had electricity for a few months so the woman cooks up what little porridge they have on an open flame in the front yard to split between the children, usually taking none for herself. She doesn’t seem to feel sorry for herself in the least, but finally admits she is very, very tired.

The third home is a woman living alone, a neighbor comes by daily to take care of her. She is on ARVs but hasn’t taken them for over a month as she too has no food. She’s been through TB treatment twice already and is on it again. Vusi hands her a towel to blot her eyes as she explains to us that a little over a year ago her baby died and no one could tell her why. She has no family and cannot find work as most days she can’t leave bed. If her friends stopped coming by, she would just die in there alone. Once again, I felt helpless as I just listened and nodded.

The last home we stopped at housed an old woman and her 16 year old grandson. From what I could understand her grandson has severe asthma but, judging from his frail appearance, I would imagine that’s not his only ailment. He has no medication and has had to drop out of school. Now he has no friends and his life is “wake up, maybe eat, sit all day, go to bed.” The boy’s eyes barely left the ground the whole time we were there.

On our way to the preschool we are greeted by a man who limps out of his home after spotting Vusi, an old friend. They both poke fun at each other, patting their bellies and saying the other has been eating “too much putui” (a traditional starchy dish made of cornmeal). The man tells us that he got laid off of his job after his leg stopped working a couple months ago, the doctor thinks it was a stroke. He has a wife and four small children at home, all dependent on him. They have enough food for now but are almost out of money. His wife has been looking for work but has not had any success.

We walked glumly to the preschool where our mood was instantly lifted by a horde of adorable children throwing themselves against the gate at our arrival. The teacher gathered a group of them together for a picture. After I turned the camera around to show them their picture-selves, they were hooked! In seconds I was swarmed by children clamoring over each other to be the closest to the camera lens when the flash went off. Each time I turned the camera around they’d fight to point at themselves and shriek with glee. I happily played this game for ten minutes until it was time to go. After peeling what seemed like a thousand clingy little hands off my legs in order to walk out the door I seriously considered kidnapping a few of them to bring home with me.

As we wheeled Vusi back up the hill to the clinic, we discussed what could be done for these people. He admitted that he didn’t really know. Most, if not all, of these people would prefer to be working but jobs are scarce and many are too sick to work. Government grants are very difficult to obtain and are only becoming more so. Vusi has been trying to secure support to set people up with small gardens. With a few tools and some seeds people could grow spinach, onions, carrots, and beans in their yard providing them with food to eat and possibly something to sell to make a little money. While this seems like the most sustainable solution, he’s yet to be able to obtain the necessary financial support for the few items he would need to start.

I can’t stop thinking about Vusi’s idea and how to make it a reality. What we saw today is not the kind of thing you can just witness and just walk away from.

Day 12 -- Safari Weekend

2009-04-16T04:24:00.000-07:00

Day 12
Tuesday
4/14/09

Returned last night from a great long holiday weekend. Went to the Hluhluwe-Umfulazi Park, Mkhuze, and St. Lucia estuary. The Hluhluwe-Imfolozi Game Reserve is the oldest game park in Africa and is the only under formal conservation in KwaZulu Natal where the Big 5 (lions, buffalo, elephants, rhinos, and leopards) can be found. The first morning we were treated to two zebras, a mom and her baby, wander right up to the viewing deck! A few minutes later a herd of antelope gracefully leaped across the savannah. It was amazing and so beautiful. The next morning, while on the deck doing yoga, a monkey planted itself on a tree branch 15 feet away from me, cocked its head, and watched me curiously until a slamming door sent it scurrying away. On that afternoon’s safari we saw giraffes lazily grazing in the trees, white rhinos lumber across the road, warthogs munching on grass, and, my favorite, a herd of elephants! The landscape was so beautiful and to see all these animals, living fairly undisturbed, was a real gift.

The next day we headed to Mkuhze where we stayed at a lodge that looked like it was right out of Out of Africa. The highlight was the boat safari we went on with Jean, an extremely knowledgeable guide of both wildlife (especially dangerous game) and Zulu culture – not to mention one of the toughest bawdiest women I’ve ever met. In between scanning the water for hippos to peak above the surface, Jean shared with us her wisdom from 18 years of being a dangerous game guide including plenty of stories about ignorant tourists getting their car hood smooshed by a confused elephant’s foot. Something I found fascinating – according to Jean many people report an inexplicable feeling of calm when surrounded by a group of female elephants but not male elephants. This is attributed to the fact that elephants communicate using sonar and, since the females are constantly communicating chatterboxes, the waves travel through your body and cause a peaceful feeling. How crazy!

After spotting a few hippos, Jean offered to take us home through a traditional Zulu village since we were “such a pleasant group.” We drove across the mountain top, with the sun setting behind us, as Jean hollered “Sawubona Ma!” or “Yebo!” to everyone that passed. Apparently she knows them all and has been granted special permission from the chief to drive through as long as she only brings tourists infrequently. The houses ranged from small stucco homes with fancy iron grates across the windows to single rooms made the traditional way – a grid of sticks layered with stones and found bricks. Many of the homes were painted bright blues, pinks, and greens forming a beautiful landscape against the hillside. The kids were just as excited to see us drive through as we were to be there – as we passed by a house, even one 100 yards from the road, they’d come running and waving out of the front door only to get shy 15 feet away from the truck where they’d stop dead in their tracks, giggling and trying to hide behind each other. Jean spewed tons of interesting tidbits about Zulu culture such as Zulu men walk through doorways ahead of the women, in order to check for danger. They view western men walking behind the woman, especially with a hand on her back, as pushing the woman into potential danger. Some of the information wasn’t as fun – according to Jean there was very little violence against women and children in Zulu culture until a strong western influence came to South Africa. The accompanying shift towards industry drew Zulu men, who were highly respected in their own communities, into the cities to work as low paid and poorly treated laborers. The men began turning to drinking and asserting their crumbling power in their own communities though violence. I’m always saddened and a little torn when I see a culture changing and the traditional ways slip away – when is it a natural evolution and when is it just a shame?

Marianhill Pics

2009-04-15T05:38:00.000-07:00

Will write more about today asap. A very sobering day doing home visits in Marianhill where in every house the same story -- no food. A woman spoke of going weeks with just water and her son going to school to write his exams and coming straight home to bed, too weak from hunger to do anything else. The kids at the end of the day were amazing -- the face of youthful joy and hope even in dire circumstances.

Zulu Village Pics

2009-04-15T05:31:00.001-07:00

2009-04-15T05:28:00.000-07:00

Quick Update!

2009-04-14T04:02:00.001-07:00

Sorry to be getting so behind on my blogging! Got back late last night from a long holiday weekend at the Hluhluwe-Umfolozi Park and Mkhuze. Will update asap with more info incl some great Safari pics!
Much love,
Julie

Day 7 -- St Mary's; Surgery and OB

2009-04-14T03:51:00.000-07:00

Day 7
Thursday
4/11/09

I thought of something that I should probably explain to my blog readers. You are all probably aware of the interplay between semantics and political correctness, aspecially in the US. For simplicity and consistency's sake, I am writing using the same race/ethnicity identifiers most commonly used in South Africa and in my conversations with people here. This primarily includes "black", "white", and "coloured". That doesn't mean I am necessarily comfortable with those terms or support their use.

Finished up our shortened week at St. Mary’s today. Yesterday was spent in theatre (surgery) where I witnessed my first cesarean! It was amazing to see the baby lifted directly out of the womb, gasp, and then start wailing. However, I was surprised to see the antiquated way the incision was made – vertically from navel to pubic bone – very unlike the small below-the-bikini line incisions we’re used to. After the final suture was placed, the patient was promptly rolled out and up to the cesarean recovery room, a large room lined with beds 10-12 inches apart.

Today I was in MOU (the Maternal Obstetrics Unit). While we didn’t see a vaginal delivery, I saw enough of the labor process to decide I may not want to give birth unless I can have a continuous flow of epidurals beginning a week before birthing. The MOU sees up to 20 patients a day and are doing the best possible with the resources available. Yet, coming from the US where birthing centers are made to be comfortable and sterility is prioritized, I was shocked by some of the patient care I saw today. The waiting room was full of ten women sitting on plastic chairs grimacing as they wait to fully dilate. One by one they’re taken into an exam room where the sister (nurse) checks blood pressure, heart rate, dilation, and cervical effacement. The sheet underneath the patient is not changed between patients unless it is soiled by a significant amount of bodily fluid. Gloves are used most of the time, but not always, for blood draws. There were no rails on the bedsides – a few of the patients I observed seemed a hair away from rolling right off the bed. The ward was so hot and sticky that women are fanning themselves as they wait through contractions without any pain medication given. Post-examination, the doctor or nurse hands the patient a sanitary napkin which they press to themselves as they waddle back to the waiting area. I was amazed at how tough these women are.

Politics came up again today, no surprise since the air is thick with the upcoming election. An older white doctor pulled me aside today to whisper “Don’t tell, but I regard your Barack Obama as my president too. We have a new president coming in as well but, in order to be a free world, freedom of the press is necessary. Enjoy your stay!” and then walk away. Later on, I spoke to one of the host family’s twelve year old sons about the election. According to Makabuongwa, aka Makabee, people should vote for Zuma because “he is a very good man, just like Barack Obama.”

After rotation we were able to enjoy some of the beautiful weather by going to the beach. Makabee and his friend Mini were excited to put on their “costumes” and come along, thankfully so as we were completely dependent on them for directions. Tonight is a mellow night as tomorrow morning we’re heading out to the Mkhuze Game Reserve and St Lucia estuary for the long holiday weekend. We’ve been warned about hippos “picking up the car and throwing it away,” so wish me luck!

Day 5 -- St Mary's distrct hospital

2009-04-14T03:45:00.000-07:00

Day 5
Tuesday
4/9/09

Today was the first official day of rotations. We grumpily arose before dawn for our 6:45am pickup which took us to St. Marys, one of Durban’s district (public) hospitals. A brief tour took us through the pediatric department and maternity ward. Both wards consist of large rooms with rows of beds – privacy is not an option. In the pediatric ward a doctor gently assisted a toddler-aged malnutrition patient in taking a few wobbly steps on tiny skin-and-bone legs while he cried empty, tearless, sobs. In the maternity ward we were told that no epidurals are given but the number of cesareans has jumped due to the HIV/AIDS epidemic. A sign on the wall requests “Parents are kindly asked to take care of their babies and do not give them to strangers,” in both Zulu and English. It is not uncommon for newborns to be abandoned.

Nicole and I were sent to Ithemba, the PEPFAR funded ARV clinic. In South Africa the government provides ARVs, but not until the patient’s CD4 count is below 200 – far below the US recommended guideline of 250-350 (with some peaople pushing for treatment inititation at 350-450). Patients come to Ithemba for all of their HIV/AIDS needs including check-ups and prescription allocation, which includes pill counting in order to check for compliance. The man behind the counter tells us it is a very slow day for the clinic. I can’t imagine what a busy day looks like as the line stretches around the corner and the waiting area has patients queued up five rows deep. A few of the patients actually look sick; most of them just look bored or are chatting and laughing.

My first stop is in “Vitals,” the first room all patients pass through. According to the nurse, they see approximately 100-150 patients per day with 60-70% being women. Patients are brought in once per week to start and then progress to once per month dependent on compliance. One of the check in questions is whether or not the patients is on or has completed treatment for TB as the vast majority of patients test positive. Most patients come in for testing once they have a nagging sickness, very few get tested regularly without symptoms.

1st line: d4T+3TC+RVP or NVP
2nd line: AZT + dd + LPVlr

Next stop is the pill count room, where patients bring their remaining pills to be counted. The actual count is compared to what it should be with 100% compliance and, if “not balanced,” the patient receives compliance counseling. As far as I could tell the counseling consists of the patient being scolded and warned not to do it again but, with lines of patients out the door, there’s little time for more. The clerk let me “pill count” a few patients while he watched over my shoulder which, for some reason, rendered me unable to do the most basic addition. I began to get the hang of it after a few patients which gave the clerk enough confidence to get up without warning and leave for five minutes. Not wanting to seem completely helpless, I just kept on counting.

After the requisite tea time, Nicole and I went in search of a doctor to shadow. Since it was a slower day we ended up spending the rest of the afternoon in a conversation with the one physician on duty, a beautiful younger Indian woman with a firecracker personality. We learned all about the upcoming elections, SA’s government corruption, her frustrations with tradition Zulu culture and patient compliance. Everyone here has a strong opinion about the charges against Zuma being dropped, and the doctor was no exception. According to her, the ANC will win no matter what as they are the majority and will have it no other way. She explained that the vast majority of Zuma’s support comes from people, especially the black population, wanting to support the “party that brought SA to freedom” and have no understanding of “stupid, stupid Zuma and the rest of his monkeys.” Zuma’s win will make SA the “next Zimbabwe” and the doctor is already working on obtaining her visa to “get the hell out of here.” Her outrage as a physician is understandable – polygamy is a major cause of HIV transmission in SA and Zuma is notorious for having four wives (he had five before one’s recent suicide). After a young HIV+ woman accused him of rape, Zuma claimed it was consensual and that he is safe from contracting HIV because he took a shower afterwards. The government is taking money away from healthcare and other urgent needs in order to erect the giant stadiums being built for the 2010 World Cup and other superficial post-apartheid fixes such as changing street names to more pre-colonial monikers such as Smith St to Dr. Methumbi Rd. It was fascinating to hear such candidness from someone with such firsthand knowledge of how SAs government corruption is fueling the spread of HIV/AIDS – and very depressing at the same time. The doctor has thrown her hands up and it’s easy to see why.

After another tea break, our conversation turned to girl talk – US and SA comparisons of cost of living, plastic surgery, where to go on holiday, interracial marriage, etc. The doctor had a million questions about our boyfriends and relationships, the cost of everything in the US, and US city vs suburb living. The cost of living is much less here -- one Rand is worth approximately 10 cents with our lunch today costing 12 Rand ($1.20). The doctor couldn’t believe we wouldn’t be constantly going on holiday to places like Egypt and Thailand, where we would be so rich. It’s strange that, even as a respected physician, she hasn’t been able to come to the US for holiday as she would have to “save up for two years for one week.” Oh… and she was very surprised to meet thin Americans since she thought we were all… insert puffer fish gesture here.

Looking forward to tomorrow – we’ll be in surgery observing cesareans, absess draining, and more.

Day 4

2009-04-07T08:09:00.002-07:00

Day 4
Monday
4/6/09

I’ve been thinking a lot today about what it means to fully immerse oneself in another culture, as I’m trying to do here in Durban.

The biggest culture shock when I arrived was the somewhat panicky feeling of having lost my freedom to, for the most part, go wherever I want whenever I want. Here, in our middle class neighborhood, the streets are considered not safe to walk at night due to threat of mugging. It is recommended to travel in groups at all times and with a man whenever possible. Of course my first thought was something along the lines of “Oh God, why didn’t I just go to Cape Town?” However, after some thought, I realized that this is reality for the people of Durban – and most of the global population. We tell people to get exercise or go to the doctor, without realizing they either have no way to get there or are afraid to leave their homes. I’m surprised how casually Akhona talks of the frequent murders in city where her cousin lives, and where she goes for holiday. Taxi drivers are in such rivalry that it frequently turns deadly; Akhona’s cousin was killed last year by a bullet aimed at her uncle while standing outside of his taxi. I am embracing this reality as part of experiencing life here (while being very safe, Dad!). Families either stay indoors or drive to their destination after dark, rather than freely roaming the streets. They don’t seem to see this as a negative – it’s just the way life is. I’ve been packing my purse each day being conscious of what I would be okay without if I happened to be mugged and found it’s amazing to learn how much can be stuffed into a bra for safekeeping – memory cards, cell phones, cash, debit cards, and more.

I’ve also been feeling a little silly about my out-of-place concern about nutrition and exercise. I place great value on my health and well-being – I typically choose vegetables over meat, water over juice, quinoa over white rice. My lifestyle here, so far, has consisted of no exercise other than walking while fueled by heavy curries and fried foods. This morning I risked being the “crazy American” by doing some yoga on the patio. Apparently the girls are familiar with yoga as, according to them, I look just like Jennifer Aniston and it’s because we both do yoga. I ended up having Akhona (my 11 year old "sister") join me -- it was really fun to see her so excited about doing Sun Salutations! The Mom (Mantombi) shyly asked me to teach her some "simple things" tomorrow. It makes me happy that I may leave my family with an ongoing benefit of our cultural exchange. I’ve decided to find a compromise by eating salads at lunch and hiking on the weekends while graciously devouring whatever is proudly presented by my family. Sure I wouldn’t normally have a plate of KFC, French fries, white bread, and pudding for dinner -- but this experience isn’t about what I’d normally do.

The most rewarding part of my day was little Alutha throwing her arms around my legs when I walked through the gate screaming “Hi Yu-lie! I want ice cream!” How could I possibly turn that down?

Day 3

2009-04-07T08:09:00.001-07:00

Day 3 Sunday 4/5/09 Advance warning – the following is extremely long and tangential! Hopefully not everyday will be this full or I will definitely develop carpal tunnel. Feel free to skim… In the last two days I feel like I’ve seen extremes of both sides of Durban – from a fancy new casino to a township pre-school with 15 girls living crowded together in a single makeshift room. Yesterday myself, 4 other students (Caroline, Adriel, Anella, and Megha), and one of the other students “little sisters” went to uShaka, Durban’s Sea World. Apparently a lot of money has recently been poured into Durban’s beachfront area in hopes of decreasing crime and increasing tourism. uShaka consists of a fancy new aquarium, complete with dolphin and penguin shows, and a water park. Caroline and Adriel’s homestay mom, Bongi and her kinda-boyfriend (who her daughter explains as a friend “with intentions”) met us at uShaka. As most hosts to foreigners, they wanted to take us to see the best Durban has to offer – Suncoast Casino. We enjoyed some disgusting and overpriced cocktails and headed home. We are all just getting oriented so directing a cab to four different houses was a bit of an ordeal – luckily our cab driver was very understanding and didn’t rip us off too bad, I think. At home I proceeded to teach Alutha, the youngest daughter some very improper English. She could repeat “clap your hands” and “eyes”, “nose”, and “mouth” but couldn’t point to them until I made it “clap your eyes” or “clap your ears” while slapping at the body part being named.. So this morning I woke up to a 4-year old slapping herself in the head singing “clap your head!!” Brilliant. Today was a brief orientation and tour of some of the townships. We went over some cultural differences that I’d wished I’d known but had kind of noticed already such as a different understanding of privacy. It is common for the kids to come into your room, lay with you on your bed, look through your stuff, play with your camera, etc. I see how some people could be bothered by such but having grown up with two younger siblings I guess I know better, and I was honestly glad for the company. We then met up with Steven, a local Zulu man, who guided our tour around the townships while giving us an overview of the current social and political situation in the area. Steven’s seemingly perpetual smile turned into a loud chuckle any time one of us made a lame attempt at pronouncing any Zulu word necessitating a clicking sound! I found Steven’s story a fascinating example of someone who doesn’t have to be doing the work that he is but his heart wont let him just sit back and do nothing. From what I understand, as the safety manager at the local Toyota plant, its part of Steven’s job to go to the neighborhoods of the Toyota employee’s who have HIV/AIDS and assess their needs. He also serves as a liason between the Japanese Toyota employees and their South African employees by taking them on tours when they are in the area. While doing this, his observations of the downtrodden schools, children living in the streets, and families torn apart by AIDS, have led him to become a sort of ambassador between all the neighboring townships, despite political affiliation. Apparently, the neighborhoods are decisively ANC (African National Congress) or IFP (Incarta Freedom Party) affiliated. While there is still a lot of tension between the political parties it was significantly worse before Mandela’s ’94 election, when members of the opposing political parties would engage in “necklacing,” igniting a rubber tire around the neck of a member of the opposing party and burning them to death. It is estimated that hundreds to thousands of people were killed this way. Our first stop was the village of Malukazi, a small village composed of mud and stucco huts complete with cows lazing in whatever patches of shade were available. A group of people were gathered underneath a large tree listening to what Steven explained to be a campaign speech for the ANC, due to the upcoming election. I couldn’t help but feel overwhelmingly awkward as we walked by – our group wouldn’t have screamed “AMERICAN!” louder if we were wrapped in red, white, and blue flags. I know we are there to learn and observe but it seemed nothing more than voyeuristic at the moment. I asked Roy what people thought of us being there and he assured me that they understand about people wanting to learn about different cultures and they’re just as curious about us. He must have sensed my discomfort; after a pause he asked “when you see tourists in America, do you think they are being rude.” I guess not. I did definetly feel uncomfortable about the members of the group who were just snapping pictures and looking at the locals blank-faced – so I took it upon myself to practice my horrific Zulu by proclaiming “Sawubona! Unjani?”, meaning Hello! How are you? to anyone who looked my way. They may have thought I was insane but at least it made me feel less like a creepy voyeur. Steven led us into a larger one-room building strewn with goat skins. He explained this to be the place of worship and pointed out the wooden shields lining the walls and goat carcasses drying on hooks. There was a locked cage in the middle of the room containing stacks of soda bottles, dozens of cookie boxes, and a bowl of fruit. Despite my best intentions I could not understand what this was for, besides to some group of people to eat after returning from something. The sound of drums called us outside, where a large group of men were heading down the dirt hill towards us. The drumming, chanting, and dancing continued until they entered the “church,” the rest of the group close behind. We left them to their worship and Steven explained that Malukazi is one of the few villages where the ANC and IFP coexist peacefully thanks to the daughter of one member marrying a higher-up in the other. He explained the two political parties as “being in bed” with each other, which cracked him up. We headed down the freeway for a bit and pulled off amongst a community of homes made from discarded sheet metal with a stucco wall sprouting up here and there. Up a small dirt hill was a constellation of four single room buildings, a clothesline outside waved tiny bright flags of children’s’ clothing. Steven explained that, when passing here yesterday, he saw a horde of children playing outside and stopped to investigate. Thinking we should see this, he arranged a meeting. We stepped inside one room, probably 15x12 feet and about 90 degrees but cheerfully decorated with the English alphabet and colorful drawings. A woman, introducing herself as the director, explained to us that the two people behind us had opened this school and it as the only in the area. She translated their Zulu into heavily accented English, explaining that they take children from 2-18 years old who otherwise would have no education and possibly no place to live. They count on donated bags of corn to feed the students, many of whom live in the adjacent rooms. She led us into another single-roomed building, crammed with seven bunk beds – this is the boys room. The girls live in another just like this, with the beds squeezed in wall-to-wall. In between is a room with a sink, stove, two “toilets,” and two washing faucets – all obviously hand built. The woman explained anything that could be donated from overseas would be so appreciated as they are in desparate need of food, blankets, clothes, books, pencils… everything. A handful of children chased us around curiously, darting behind each other and giggling loudly. I said hi to one little girl leaning against the wall with a shy smile. With a lot of gesturing patching together our words she told me that she loves school, has one dress, and likes to read stories. When I asked what she needed, she whispered “I would like a dolly.” If my heart breaks like that many more times this trip I don’t know what I’m going to do. After big hugs from everyone, Steven took us down the street and welcomed us into his home with the same warm hospitality I’ve witnessed from everyone here so far. His house was beautiful and his pride was obvious as he showed us around. Soon thereafter we headed home, many of us nodding out in the overheated van. After a lovely dinner with our host Mom and the two youngest daughters (while watching the Cartoon Network), Anele (the 16 year old) flew through the front door, a whirlwind of questions and stories. The topic of the evening was how she wants to be adopted by Brad and Angelina because they love African kids. Hey, I totally understand why she’d want that! Finally getting ready for bed. I’m sweaty, greasy, and probably stinky -- I’m not sure if I’m embracing the experience here or am just too lazy to bathe. I’m sure Akhona will burst through the door any second with her five opinions on the matter!

Photos from Day 3

2009-04-06T02:57:00.000-07:00

Hopefully this works!

http://www2.snapfish.com/thumbnailshare/AlbumID=297771621/a=164706779_164706779/otsc=SHR/otsi=SALBlink/COBRAND_NAME=snapfish

Day 1

2009-04-06T02:55:00.000-07:00

I apologize that this is going to updated fairly sporadically -- internet is more of a luxury here than I expected!

Day 1
Friday
3/3/09

Arrived in Durban today after a long day of travel. In true Julie fashion I almost, but not quite, missed 2 of my 3 flights. Thanks to Ivan's miraculous ability to act rationally when I'm freking out, I only had a minor anxiety attack :). A ton of turbulence on all 3 flights. Luckily, the captain on the flight from Washington DC to Jo’berg was kind enough to comfort us all with, “ladies and gentlemen please observe the ‘fasten seatbelt’ sign. You are in an aluminum tube traveling at over 800 kilometers an hour – anything could happen.” Soothing, right?

I watched a great movie on the flight that I would highly recommend to anyone interested in maternal health, global health, Africa, or HIV/AIDS called “Yesterday.” It’s a poignant Zulu film (with English subtitles) about a young mother in South Africa finding out she’s HIV+ and what she faces within her family and community while she struggles to stay alive until her daughter starts school. I would also highly recommend the South African wine – but that’s another story.

Ron, the driver picked me up from the airport and brought me to my host family’s house. On the way he pointed out to me the different neighborhoods, still segregated by race as they were during apartheid. People are either white, black, Indian, or colored – a term I was surprised to hear! Apparently, if you don’t technically fit into one of the other categories (usually a blend of two or more of them), you are considered colored. He was surprised we don’t use that term; it was challenging to explain that it’s not a hateful term but more outdated and no longer PC.

Then I arrived at my host family’s house and was engulfed by a tornado of girls. There’s the mother (who pretty much kept quiet during all of this), 3 daughters (1 high-school aged, 1 middle-school aged, and one 4 years-old), and an eleven-year old cousin. The youngest is absolutely precious; she only speaks a few words of English but enough to squeeze the teddy bear I brought her and say “I like.” The younger two girls wanted to know everything about the US – do we all have I-pods, have I seen Mary-Kate and Ashley Olsen, etc. The older daughter was more interested in Obama (whom she says everyone here loves), the weather in New York, and if everyone in America thinks everyone in Africa “lives in huts and wears lion skins for clothes.” This was all after they finished bartering Ivan’s jewelry and the “I love NY” t-shirts I brought. They also tried to teach me some basic phrases – none of which roll off the tongue nor can I remember.

Now, time for bed. Tomorrow’s an off-day, since I technically arrived a day early, so I’m going to try to get ahold of the other 3 also here early and see a little of Durban in the daylight.

Not to forget – thank you to everyone in San Francisco who made my visit and farewell so wonderful!

Much love from SA,
Julie

My African Family

2009-03-23T17:19:00.000-07:00

I just learned that, while in Durban, I will be staying with family composed of the mother and three daughters, ages 15, 11, and 4. A house full of women!

Welcome and Thank you!

2009-03-23T17:02:00.000-07:00

Welcome to my blog! I'm may be procrastinating packing for my departure in 3 days by getting this blog up and running. But, as this is a very important part of my trip, it was easily justified :)

I want to give the biggest THANK YOU to everyone who has made this trip possible for me. I have been awarded generous grants from the Jessica Jennifer Cohen Foundation (www.jjcf.org) and the Sara's Wish Foundation (www.saraswish.org). I encourage you to check out both of these foundations and learn more about the great work they are doing in the memory of two amazing young women. I've also been blessed with many generous donations through my firtgiving.com fundraising page and there are many more people who are supporting me through their time, guidance, and encouragement... the list is endless!

Below is my original fundraising page which will give you an overview of my trip:

Dear Friends and Family,

I am very excited to have been offered the opportunity to travel to Durban, South Africa in April 2009 as part of a service-learning program through Child Family Health International. While in South Africa, I will rotate through hospitals, public health clinics, and hospices in order to learn about the challenges faced by Durban's post-apartheid public healthcare system including HIV/AIDS, environmental health issues, and other underlying causes of poor health in the region.

Thank you so much in advance for visiting my page and reading about this program. I will be providing you all with updates on my fundraising efforts as well as more pictures and stories from my trip than you would ever want to see/hear.

Please consider making a donation, no matter how small. I, as well as the 33 million people living with HIV today, thank you! Also, please contact me with any questions you have as well as updates on your life. I love to hear from you!

julieanne_brooker@yahoo.com

WHY?

As many of you know, I am currently in the process of applying to Medical School. I have learned a lot in my pre-requisite courses but far more through the experiences I have had outside of school. As many of you also know, I have been involved in HIV/AIDS prevention and treatment work for quite a while now and have been fortunate to work with needle exchange programs, domestic violence and HIV initiatives, as an HIV test counselor, and at an Immunology Lab where I support researchers working towards HIV vaccines and improved treatment options. In 2006, I raised over $2000 for the San Francisco AIDS Foundation thanks to a team of wonderful and generous volunteers who supported me as I trained to run the San Francisco AIDS Marathon in memory of Timothy Hardin, my friend John's brother, who died of AIDS in 1991.

There is so much being done to prevent the spread of HIV and improve treatment options for those already infected. However, we mustn't sugar-coat the issue. For the last 2 years, I have been volunteering as a Emotional and Practical Support Provider at Maitri, an AIDS Hospice here in San Francisco. The truth is, many people are still dying from AIDS -- many people just like you and I. The harsh reality of this disease and it's effects did not truly hit home for me until I was at the bedside of a patient I had grown to love as a friend -- after months of doctor's appointments, lunch dates, walks in the park, late night conversations -- when he passed away. This one patient soon became two then four, five, six... and this is only a microcosm of what's happening all over the world right now.

AIDS has killed more than 25 million people since it was first recognized in 1981, making it one of the most destructive epidemics in recorded history. More than 6,800 people are newly infected every day, and over 33 million people are living with HIV today. Women and girls are the new face of AIDS, especially in the hardest hit regions, such as Africa. In Sub-Saharan Africa, young women (ages 15-24) are three times more likely to be infected than young men.

I plan to dedicate my medical career to working to fight the AIDS epidemic and I thank you all very much for helping make this possible -- for me and all those I hope to help.

WHERE?

Durban is the capital city of Kwa-Zulu Natal province, and is the second largest city in South Africa. It is located on the Indian Ocean and boasts mild weather, beautiful beaches, and diversity that represents South African society creating a unique fusion of cultures: it is home to the Zulu nation, descendants of indentured laborers from India and British settlers. Of course, you will also find people of Afrikaans, Xhosa, Sotho and Tswana heritage among many others in Durban. Durban has an important history in the political development of the country throughout the apartheid era, it being the site of the first African National Congress (ANC) national convention, and also where the young Mahatma Gandhi was inspired to lead movements based in nonviolent principles. Its political history combined with some of the most notable health challenges facing sub-Saharan Africa today makes Durban an ideal location to spend time attempting to understand common complexities of public health and primary care.

Thanks again!