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!
Thursday, May 28, 2009
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.
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.
Thursday, May 21, 2009
The Great Swine Flu Scare of 2009
The scene: Li has been feeling a bit under the weather recently, and woke up this morning with a cough, joking about how she has swine flu, she's the next Patient Zero or Typhoid Mary (Swine Flu Li), the one who dooms Africa to another pandemic, how all the kids at her school are going to be dead by next week and we won't be allowed to go back to the States. Ever. And as we're all joking about this, she opens her e-mail and blurts out "Ohmigosh guys, my sister's teaching assistant just got confirmed as a case of swine flu!" The same sister whose classroom she visited to make a film for her South African students the day before she left the country. So now we're all holding our breath, semi-literally, and praying that we didn't actually just bring another terrible disease on all these people who have quite enough disease to deal with already (and also that we don't die, which would put a bit of a damper on the whole experience).
NOTE: Just as a reassurance, we're pretty sure she's outside the window for presenting with severe flu-like symptoms at this point--no fever or aching joints--so we're fairly certain it's "crisis averted, full steam ahead," but still good for a laugh and a brief spell of blind panic.
NOTE: Just as a reassurance, we're pretty sure she's outside the window for presenting with severe flu-like symptoms at this point--no fever or aching joints--so we're fairly certain it's "crisis averted, full steam ahead," but still good for a laugh and a brief spell of blind panic.
Where the water spins clockwise...
Goieiemore, good morning, ladies and gents, one and all, welcome to the ridiculous ramblings of Andrew in the unreal world of the Western Cape of South Africa, where the mountains are majestic, the wineries are wacky, and the people have some of the most beautiful, aching stories ever told. I'll try to keep this updated as often as I can, but no promises (and no pictures! Sorry, but down here they've got this thing called bandwidth rationing, which basically means they buy internet usage in chunks and uploading photos devours those chunks like whoa, so tough luck. Gut it out for six weeks. It will be worth it.) To give you a bit of an introduction, I'm just going to do a little scene-setting and a few brief intros here so you'll know where and who and what I'm talking about later on:
The setting: Just picture the most beautiful place on earth you can possibly imagine, and then multiply that by like eleven. And that's just the view from the front door. The Western Cape is famous for it's rolling mountains and green valleys, which offer perfect soil for the millions of rows of grapes that grace their slopes and stock their wineries. The villages (including Robertson, where I'm staying) are quaint and rustic and basically adorable, although like everywhere in South Africa they've been severely tainted by the racial issues that have torn this country apart. Even now, each town is divided into a "township" (basically a slum, where the blacks--mostly descended from native tribes--were forced to live during apartheid), a "bo dorp" (for people they call "coloreds", which is basically anyone of mixed race or non-European descent other than blacks), and an area where the whites live. You really can't overestimate the extent to which apartheid and the resistance to it and the rebuilding in its aftermath continue to shape the lives and worldviews and literally the geography of how people relate today in South Africa. But if there had to be a place to deal with hard lessons and deep-rooted issues, you couldn't ask for a more gorgeous bit of paradise. Personally, I'll be working at the hospital here in Robertson and visiting various clinics in local townships and areas as well as driving out in a mobile clinic to serve some more rural areas.
The cast of characters:
The CCS Team (CCS = Cross Cultural Solutions, the NGO that I'm working for):
--Adrienne, a 19-year-old Canadian student who just finished her first year at McGill University, working at the high school in Robertson township (called Nqkubela, and the "q" in there is a tongue click on the palette of your mouth--seriously, isiXhosa might be the coolest language on earth)
--Audrey, an MBA student at UNC, also working at the township high school. She's also kind of the mom for our little family of volunteers, as well as a sassy Southern wine connoisseur and hard-core pilates drill sergeant.
--Li (aka "Bruce", for the huge popularity of her fellow Asian Bruce Lee among the kids here, aka "Swine Flu Li", for reasons to be discussed later), who graduated from Skidmore in '05 and now works for CCS in New York--this is her 4th CCS program.
--Josee, another Canadian, about my age and training to be a respiratory therapist, working at Vrolike Vinkies (pronounced FRO-lick-uh FUN-keys in Afrikaans), a local day care center.
--Kayla, the grandma of our group, also from New York, where she is retired but volunteers as a librarian at a school in Harlem. She is working at a care center for disabled children, and I'm always scared that one of these days she's just going to get blown away in the huge winds that come rushing down the valley.
--Emre, my roommate, the only other guy in our group, just graduated from Texas Tech and hopes to go to medical school, so we've definitely got a lot in common and he's a pretty awesome guy.
The supporting cast:
Lynda and Luann: the program directors for CCS here in South Africa, both with fantastic accents and permanent smiles
Graham: our driver, who takes us to our placements each day, used to be an official chauffeur for the South African government and once drove Nelson Mandela and Jesse Jackson together around the country. The man is capable of all that high-speed tire-burning spin-busting stunt-car driving stuff you see in movies, but he does it all with impeccable manners and formality--if you're going to leave someone in the dust, you may as well do it properly I guess.
Dr. Perold: my supervisor at the hospital, a superbly nice man and an excellent physician, he always refers to me as "colleague" and is the inspiration for this blog's title--before a procedure or a meeting with a patient, he'll turn to me and ask, "Now colleague, tell me, how would they deal with this on House, M.D.?", and every time I'll reply very seriously that we're going to have to operate right away, which he gets a real kick out of. Then after we're done, he turns to me with a huge grin and goes, "Just like House M.D., right?" Honestly, the cases and issues he deals with every day are so huge that they could probably give him his own show, and hopefully I'll have time to fill you in on some of the more interesting cases and counseling sessions and observations on community issues that we come across (spoiler alert: There will be a lot of childbirth stories. As in, I've already scrubbed in on 5 c-sections in my first three days at the hospital, which has fewer than 50 beds, only 4 doctors, and one "theater," the South African equivalent of an OR. Unbelievable.)
That's probably enough for a first post. If you're among the approximately 2 people that stuck around to read this far (thanks Mom!), feel free to post any questions or comments and I'll do my best to get to them--internet's a little spotty but I should be on a couple times a week. Thanks for reading, hope all your own summers are coming along gloriously, and I can't wait to share this experience with all of you!
The setting: Just picture the most beautiful place on earth you can possibly imagine, and then multiply that by like eleven. And that's just the view from the front door. The Western Cape is famous for it's rolling mountains and green valleys, which offer perfect soil for the millions of rows of grapes that grace their slopes and stock their wineries. The villages (including Robertson, where I'm staying) are quaint and rustic and basically adorable, although like everywhere in South Africa they've been severely tainted by the racial issues that have torn this country apart. Even now, each town is divided into a "township" (basically a slum, where the blacks--mostly descended from native tribes--were forced to live during apartheid), a "bo dorp" (for people they call "coloreds", which is basically anyone of mixed race or non-European descent other than blacks), and an area where the whites live. You really can't overestimate the extent to which apartheid and the resistance to it and the rebuilding in its aftermath continue to shape the lives and worldviews and literally the geography of how people relate today in South Africa. But if there had to be a place to deal with hard lessons and deep-rooted issues, you couldn't ask for a more gorgeous bit of paradise. Personally, I'll be working at the hospital here in Robertson and visiting various clinics in local townships and areas as well as driving out in a mobile clinic to serve some more rural areas.
The cast of characters:
The CCS Team (CCS = Cross Cultural Solutions, the NGO that I'm working for):
--Adrienne, a 19-year-old Canadian student who just finished her first year at McGill University, working at the high school in Robertson township (called Nqkubela, and the "q" in there is a tongue click on the palette of your mouth--seriously, isiXhosa might be the coolest language on earth)
--Audrey, an MBA student at UNC, also working at the township high school. She's also kind of the mom for our little family of volunteers, as well as a sassy Southern wine connoisseur and hard-core pilates drill sergeant.
--Li (aka "Bruce", for the huge popularity of her fellow Asian Bruce Lee among the kids here, aka "Swine Flu Li", for reasons to be discussed later), who graduated from Skidmore in '05 and now works for CCS in New York--this is her 4th CCS program.
--Josee, another Canadian, about my age and training to be a respiratory therapist, working at Vrolike Vinkies (pronounced FRO-lick-uh FUN-keys in Afrikaans), a local day care center.
--Kayla, the grandma of our group, also from New York, where she is retired but volunteers as a librarian at a school in Harlem. She is working at a care center for disabled children, and I'm always scared that one of these days she's just going to get blown away in the huge winds that come rushing down the valley.
--Emre, my roommate, the only other guy in our group, just graduated from Texas Tech and hopes to go to medical school, so we've definitely got a lot in common and he's a pretty awesome guy.
The supporting cast:
Lynda and Luann: the program directors for CCS here in South Africa, both with fantastic accents and permanent smiles
Graham: our driver, who takes us to our placements each day, used to be an official chauffeur for the South African government and once drove Nelson Mandela and Jesse Jackson together around the country. The man is capable of all that high-speed tire-burning spin-busting stunt-car driving stuff you see in movies, but he does it all with impeccable manners and formality--if you're going to leave someone in the dust, you may as well do it properly I guess.
Dr. Perold: my supervisor at the hospital, a superbly nice man and an excellent physician, he always refers to me as "colleague" and is the inspiration for this blog's title--before a procedure or a meeting with a patient, he'll turn to me and ask, "Now colleague, tell me, how would they deal with this on House, M.D.?", and every time I'll reply very seriously that we're going to have to operate right away, which he gets a real kick out of. Then after we're done, he turns to me with a huge grin and goes, "Just like House M.D., right?" Honestly, the cases and issues he deals with every day are so huge that they could probably give him his own show, and hopefully I'll have time to fill you in on some of the more interesting cases and counseling sessions and observations on community issues that we come across (spoiler alert: There will be a lot of childbirth stories. As in, I've already scrubbed in on 5 c-sections in my first three days at the hospital, which has fewer than 50 beds, only 4 doctors, and one "theater," the South African equivalent of an OR. Unbelievable.)
That's probably enough for a first post. If you're among the approximately 2 people that stuck around to read this far (thanks Mom!), feel free to post any questions or comments and I'll do my best to get to them--internet's a little spotty but I should be on a couple times a week. Thanks for reading, hope all your own summers are coming along gloriously, and I can't wait to share this experience with all of you!
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