Lingo Quiz Answers!

And now the moment you've all been sitting on the edge of your seats for the last four weeks for...

1) dassie - a rock badger: a rodent about the size of a groundhog that is frequently seen along the South African coast

2) joll - party! As in "Hey man, let's have a joll!"

3) hooter - a car horn

4) bakkie - a type of truck

5) kangaroo care - where mothers take care of their babies by wrapping them in a pouch against their chest; this is especially important for premature babies, since the mother's heartbeat and body temperature mimic conditions in the womb

6) big five - the biggest animals you'll see on a South African safari: elephant, lion, leopard, rhinoceros, and cheetah

7) wimpy - the South African equivalent of McDonald's, and home of the champ burger--breakfast + lunch + a bun = one nasty burger.

8) crazy store - kind of like a dollar store in the states, just a bunch of random cheap stuff all thrown into bins in a store

9) matric - a student in the last year of secondary school (short for "matriculant"), like an American high school senior

10) dop - system where workers get paid part of their wages in wine or other alcoholic beverages, now thankfully outlawed

Congratulations to the one and only contestant, Ray, and to Grandma for knowing what a dassie was. I'll try to put up one more post soon with some final thoughts about my last two weeks in South Africa and the whole experience in general.

South African lingo quiz!

(Apologies to Ray for stealing his idea)

So seeing as English is the one and only official language of this blog, I have decided that I need to make sure that my readers are linguistically competent by writing up a little vocab test of some common English phrases heard frequently here in South Africa (my mentor Dr. Perold is still trying to convince me that "English" and "American" are two separate languages). I promise that all of the following words and phrases are in fact English and not Afrikaans, so do your best to figure them out and the actual meanings will be along in a few days. Good luck!

1) dassie

2) joll

3) hooter

4) bakkie

5) kangaroo care

6) big five

7) wimpy

8) crazy store

9) matric

10) dop

The Tough Stuff

This weekend in Robertson all the local wineries opened their cellars for a weekend of free tastings, huge parties, and wacky events (complete with an entire swimming pool full of red wine, equipped with a slide and diving board for those drunken souls who plunged in to stain themselves fuchsia and gulp down the polluted beverage in one of the most bizarrely hilarious and disgusting acts I have ever witnessed). Since our program director happens to be cousins with the winemaker at one of the cellars, we received a VIP tour of Graham Beck, whose most recent claim to fame has been the production of the champagne of choice of the Obama campaign to celebrate on election night (South Africa’s new president, on the other hand, went for some snobby French stuff instead at 10,000 Rand a bottle—meaning each bottle was worth more than it costs to build an entire house in one of the townships here—when a bottle of his own country’s finest goes for less than 80 Rand, which is less than US$10). Although Graham Beck is a model of responsible community engagement, setting aside a large portion of its land for nature reserves and environmental rehabilitation as well as sponsoring schools for farm children and skills centers to help uneducated adults learn English and marketable skills, it’s definitely the exception to the rule, and the entire weekend really just showed the huge racial and socioeconomic divides that exist in this country, which continues to have one of the highest levels of income inequality in the world.
I touched on this in an earlier post, but I’ve personally been shocked by the extent to which racial issues touch every aspect of daily life here, and how difficult it seems to be for this country to move on. There are signs of progress, to be sure—Nelson Mandela is almost deified here, and countless South Africans have told me that he is the reason they no longer hate one another, one even saying that he refuses to leave the country now because he is too scared at the thought of being abroad when Mandela finally passes away—but the generation that fought for equal rights is growing older now and their children are struggling to find their own identity under the new system.
This weekend, it seemed like all the young chic white people in South Africa descended on Robertson to gaudily celebrate their wealth, status, and hideous pseudo-European fashion sense by engaging in socially acceptable alcoholism and idiocy. Maybe they’re trying to cling to what’s left of their superiority after the racial upheaval here, maybe they’re trying to find a new identity and distance themselves from their parents’ generation while hanging on to the socioeconomic success that their parents’ crimes bought them, or maybe they’re just out to get drunk and hook up. Whatever it was, it just made me really angry to see all these white folks being driven around to parties and wine tastings all weekend by colored chauffeurs (and there were definitely no blacks or coloreds at the tastings themselves), and then leave the next day without ever coming into contact with the real community here or dealing with the fact that and I honestly felt like I was just contributing to that dynamic just by being present.
On that note, I have to say that it’s a really tough dynamic to go about changing, especially for someone who just arrived in the country three weeks ago. In fact, most of the time it’s easier to feel like part of the problem: I live in a house outside of town where my meals are cooked for me each day by colored staff, I have to be driven around town in a nice car by another colored man (apparently so I don’t go careening onto the wrong side of the road or mistaking kilometers for miles and other American things like that), I stay at a volunteer shift for half a day where I’m only really able to interact with the white doctors because they speak English (my Afrikaans is coming along nicely though, in my opinion: I can now confidently ask you whether you’d like to help deliver a baby today), and on weekends I head out of town to places that most of the locals can’t afford to go—and I have the audacity to even suggest that I’m actually here to help, to understand the community and its issues, to make a difference? Honest to God, I would rather go live in the slums and walk into town for internet and laundry and eat the same food every day and sleep in a hut every night.
One of my recent reads has been “Into the Wild,” and this makes me want to be Alexander Supertramp and do something independent and rebellious and sacrificial. Maybe I’ll start by trying to grow a beard.

Medical Update

Things at the hospital were pretty much business as usual this week—a lot of abscesses needing drainage, a lot of broken bones, one kid with bubble gum stuck down his ear, and a lot of pregnant mothers. I did get to spend some time in the ARV (anti-retroviral: the drugs that fight HIV) clinic, which was a fascinating experience. With any medication that a patient has to take on their own over a very long period of time, you’re going to have issues of people missing dosages or neglecting to take their meds or other adherence problems like that; with ARVs, these are especially serious because failing to take the drugs for any significant period of time often means that the virus becomes resistant to them and the drugs are then worthless. It actually turns out that in terms of all conditions requiring long-term medication (like diabetes, hypertension, TB, or HIV), patients who are on ARVs are actually the most adherent to their drug regimen, and TB patients who are also on ARVs usually do a better job of adhering to their TB medication than patients who aren’t on ARVs. The reason is that any ARV patient is required to undergo counseling before they are put on the drugs, and there is an intensive process including a home visit and designation of a “treatment buddy” who will be responsible for making sure the patient takes the drugs at the right times and comes in for all their appointments—with other conditions, they basically just send you out the door with a prescription and don’t check on you for another six months. There are still a ton of adherence issues, especially with alcohol abuse being such a huge problem around here, and any time a patient stops taking their pills they have to be switched to a new regimen because the virus will quickly become resistant to their previous one (a lot of times, patients see their condition improving when they start taking the drugs and they feel so much better that they assume they’ve been cured, so they stop taking their medication, which is tragic because it means that they have to be taken off a regime that was working and put on a new one which may or may not work as well—if they fail both first and second line ARVs, their only option is to stay on the second line drugs and hope that a spot opens up in a clinical trial for some experimental drug).

In other news, Dr. Perold has moved on from referring to me as “colleague” to “my sexy American friend”—this is traditionally one of the ways South Africans indicate that you have been accepted into their tribe or culture, and I consider it a tremendous honor.

World's highest bungee? Yeah, jumped that.

True story: all 216 meters of it, off a bridge near Knysna along the southern coast. It’s difficult to describe the sensation: at the top they’ve got all this pump-up music playing for you and you’re not sure whether to be nervous or to join in with all the crazy African guys who are having a dance party and pretending to flap their wings and then all of a sudden you’re strapped in and off the edge and it’s just…quiet. I can honestly say that I didn’t scream at all, though there may or may not have been some awkward-looking swimming motions on the way down. The whole experience was absolutely worth looking like an idiot for though. And no, I absolutely did not tell my mom beforehand.

The rest of the weekend we spent touring the “Garden Route” down along the southern coast, an outdoorsman's paradise with beaches and surfing and seaside cliffs and ostrich farms and caves that are absurdly warm on the inside and forests and baby cheetahs and albino lions and hostels with random fun Brazilian and German guys who got shafted by their car rental agency and spend their days spray-painting their broken down Beetle as payback. Good times.

Cape Town!

So we've also just returned from a weekend jaunt down to the mother city, which now officially holds the title of "Most Beautiful City on the Planet" in my book and every other book that matters. The whole city is filled with gorgeous colonial architecture interspersed with neighborhoods that have a distinctly traditional African feel to them, and the whole city gives off this international, cosmopolitan vibe that you really feel walking through its streets at night (in a large group, of course, since the violent crime rate is also off the charts).
On Saturday we visited Robben Island, which for years served as a prison for political prisoners and enemies of apartheid including Nelson Mandela himself. We saw the quarry where he worked, the cell where he stayed, and the courtyard where he hid the manuscripts of his written works, and our tour guides were all former political prisoners of the island. It was a pretty powerful experience that was only slightly cheapened by the appearance of a "Robben Island gift shop" at the end of our tour--in my opinion, some things were never meant to be commercialized or tourist-friendly, but at least it's open to the public.
We also climbed Table Mountain, the huge flat-topped behemoth that towers over the waterfront of the city--pretty much a straight vertical set of rocky projections that they pretend are stairs but are actually each three feet in height and make you feel like you'll have calf muscles the size of watermelons when you reach the top, which you finally reach about two hours later to discover that they've got a nice little cafe at the top and a cable car running up and down the other side of the mountain so that all these people can sit enjoying the view and sipping their tea and laughing at you as you straggle in. But the views from the top of the mountain at sunset were definitely worth it--I would have climbed twice as far for that kind of experience. Probably not three times as far though.
On Sunday we visited the still-under-construction-and-has-been-under-construction-since-1000 B.C. World Cup Stadium in Cape Town, which is looking glorious (have I mentioned yet how obsessed everyone is with 2010 here? They don't even say "World Cup", if you just mention "2010" everybody already knows that you can only be talking about the World Cup, and the local radio station has been counting down the days ever since it was announced that the cup was coming to Africa). We also took a tour of the Cape Point peninsula, famous for its African Penguin colonies (where the youngsters were looking fabulously ugly as they molted off their fuzzy brown coats) and for the Cape of Good Hope, the south-western-most point of Africa, where Diaz and all those other famous explorers first came into harbor. The wildlife tally also included baboons, ostriches, seals, and a really exciting sighting of a rare African Rock Whale off the coast of Cape Point!
I think this weekend will be a trip down the Garden Route, which includes the southern coast of Western Cape, some cool forests and caves and other nature-y things like that, so stay tuned!

Health Issues in Robertson

Just an overview of some of the more prevalent issues that we're dealing with in Robertson and the Western Cape area. These will probably come up again, but just to give you some background on the big ones:
1) HIV/AIDS: obviously, this is a huge one and something that has to be considered for just about every patient that comes in. South Africa has the highest official HIV prevalence rate--over 11% (in my personal opinion, this is only true because most other African countries don't have reliable systems of reporting prevalence or because they intentionally underestimate it, but it's nevertheless a gigantic problem for South African health care--the life expectancy in the country has dropped by 10 years just due to AIDS, which is such an enormous and terrible impact it's almost unreal). In South Africa, any person who is found to be HIV+ and who has a CD4 count of below 200 is eligible for free anti-retroviral (ARV) therapy, and also receives free counseling from the state. Any person who is having an HIV test done is required by the state to also attend counseling, which is a huge step in the right direction, because it helps determine people's level of familiarity with what a positive test will mean for them and which patients have proper support systems in place to help them in their course of treatment. One of the clinical psychologists I've talked to and worked with is also training local volunteers to act as counselors for other stages of the disease's progression, including helping people deal with the news that they're positive, keeping them on their strict treatment regimen, and helping their family deal with the illness or death of a loved one. In his experience, the people who are hit hardest by the news that they are positive in terms of psychological indicators like depression or anger actually end up doing the best on treatment, because they're the most likely to treat the disease like a serious problem and give it top priority. It's a bit scary when people take the news stoically or with no reaction because you have to wonder whether they appreciate what it means or whether they're going to make the appropriate lifestyle changes to deal with its consequences. Unfortunately, there are still all sorts of myths and popular urban legends about HIV and its treatment that are extremely detrimental, including one particularly tragic belief that having sex with a young virgin will cure someone of HIV. Combine these with the huge social stigma that exists around the disease and a general lack of appropriate education on the subject, and it's not too difficult to see why the disease is spreading so rapidly among certain populations (mostly young black women who live in the townships or slums).
2) Alcohol abuse: we are in the winery region here, so problems with alcoholism and all the social and physical ills that accompany it are rampant. Drunk driving is a huge issue, and there's not nearly the stigma against it or community response to it that there would be in America--it seems to be one of those things that most people just turn a blind eye towards. Domestic abuse causes further concerns, and there have been several women in our hospital who have either been abused or who have overdosed on drugs or poison to get away from or send a message to an abusive husband. In those cases, the doctors at the hospital usually try to get the patient plugged in to another support network, most often the local church. It's not just a male issue though, because the region also has some of the highest rates of fetal alcohol syndrome (caused by mothers drinking too much while pregnant) in the world, leading to a large number of children being born undersized, jaundiced, or mentally impaired. A number of the work-related injuries we see also stem from alcohol abuse.
3) Diabetes: there's not the type II epidemic here that we've seen in the states (as you can imagine, obesity is far less of an issue), but type I diabetes poses a real problem in terms of long-term treatment. After all, how do you ensure that a person who's received only minimal education will actually be able to accurately check their own blood sugar and administer the correct amount of insulin on a daily basis? Most often, patients show up at the hospital with severe hyperglycemia and have to be stabilized and kept on a strict diet and daily schedule until they can be taught to properly manage their blood glucose themselves. And it doesn't help that most people can't afford regular refills of the blood glucose testing strips that are needed for the glucometers that are cheaply available.
4) Dental hygiene: unfortunately, hardly a week goes by in this hospital without the need to perform a procedure that they refer to here as a "dental," which basically means going in and removing all of a child's baby teeth under general anesthesia. This is largely the result of free or cheap candy and soda that's available to children or handed out at events, but the children then can't afford toothbrushes or toothpaste so their teeth quickly rot and have to be removed.
5) Trauma/orthopedics: I've probably seen more broken bones in the past two days than in all of the rest of my life combined. They're caused by all sorts of things: car accidents, work accidents, falls, rugby accidents, abuse, you name it, but there are so many of them that it would be impossible to afford fiberglass casts for everybody, so we're stuck making old-fashioned plaster of paris ones (which, in my opinion, is actually pretty fun, like papier-mache with people!)
6) Pregnancy/maternal-fetal health in general: the area also deals with an unusually high number of pregnant women by American standards (one of the doctors here is convinced that population control is the key to all of the country's problems), and so there are lots of issues to deal with in terms of nutrition, teenage mothers without support systems, complicated pregnancies, etc. Many babies are born under-weight, so they have a system here called "kangaroo care", where the baby is wrapped close to the mother's chest, with skin-to-skin contact that helps keep the baby's temperature at the right level and places it right next to the mother's heartbeat--the closest thing to the womb you can get for premature babies. And unfortunately, we also see far more than our fair share of miscarriages, which for me is one of the most painful and unfortunate issues that we have to face.
Obviously, there are lots of other problems that could make the list: TB, STIs (especially syphilis), opportunistic infections, etc., but hopefully these ones will give you a better idea of the kind of problems we're seeing and how they relate to some real social and economic issues in the community here.