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.