Xhosa culture

I’ve been here a month now; I’m in my new house and have taken over my new ward. It has been a fascinating month and there is a lot to tell. I’d like to start with a word about Xhosa culture.

The most striking feature is the sense of community and willingness to share that the Xhosa show. It doesn’t seem to matter what their place is within a family, any money that someone has is always shared amongst the family. It is normal for a large family to be supported by a grandmother’s pension or someone else’s disability grant or a child support grant. It’s not as if the grants amount to much, maybe as little as £15 a month seems to be enough to keep quite a few people going.

The Xhosa seem to enjoy a party. We had a leaving do for one of the doctors this week and loads of people turned up and danced like no-one was watching, everyone seems to have rhythm (which makes the Brits stand out even more). Interestingly the party started at around 5pm and by 7:30 everyone had packed up and gone home. Also most of the men were drinking alcohol, but only the older women drink alcohol. I’m not sure why but I think it is not the done thing for young women to drink (which makes the Brits stand out even more).

Their society is clearly much closer to death than Western society and it isn’t perhaps surprising that people are more fatalistic about death. It is common for children to die at home without anyone making an effort to bring them to hospital and also fairly common for adults (often with advanced HIV) to refuse to come to hospital and die at home. That’s not to say that there is no mourning. When a married man dies his wife wears all blue or all black for a set period, it seems to vary for how long but can be a year. I haven’t seen any men dressed in black for a year though. The funeral is also a big deal and people save considerable sums to make sure that their family is able to provide a suitable feast when they die.

The strike is now officially over- I've no idea how many people died as a result but even one is too many. Hopefully we can move on now.....

On living here

Quite a few people have asked me what the living
conditions here are like. Basically they are pretty
comfortable and the social culture shock I was
anticipating has not really materialised. I've been in
temporary accommodation but am moving to my new home
next week. It's called a 'Park home' but in the UK we
would call it a 'Portacabin' or if it was by the sea
even a 'static caravan'. It has a hot shower and
toilet, a separate double bedroom, a fridge-freezer
cooker etc. You don't need central heating here.

There is not much around the hospital but there is a
shop for very basic things and a beer shop (called a
shabeen). The nearest place with a collection of shops
is 30km along a dirt road and it is a further 60km to
anything resembling a supermarket. If you plan well
however you can eat and drink very well.

Week nights are often spent socialising with the other
people living in the hospital compound, mainly
doctors, pharmacists etc. Some people have satellite
T.V. (not me) so it is possible to watch some of the
major sporting events as well. Weekends start at 1pm
on Friday so there is time to get away to the beach or
to a city whenever you are not on call.

Just an update on the strike- it seems to be getting
worse, everyone is spooked today because of a report
that a nurse was shot on her way to work quite near
here (no-one knows if it was related to the strike but
the rumours haven't helped). We are trying desparately
to get medication out to our HIV patients and those in
hospital are at least being fed and getting most
medications. Everything else is on hold though (a
woman gave birth unattended in a corridor yesterday
for example), the big hospitals we would refer on to
are not accepting any patiens at all. The end is not
even in sight at the moment and morale is generally
pretty low, again lets hope there is a resolution soon.


___________

More on the strike

I didn't want this blog to read like a diary but the general strike in South Africa is dominating everything at the moment. Mostly it has been a saddening experience but in some ways also quite interesting.

It is sad because of the impact it is having on peoples lives. Patients are afraid to come to hospital and nurses are afraid to go to work. One simple example is a woman who badly broke and dislocated her elbow five days ago. She tried twice to come to hospital but was chased away by militant strikers and finally she made it in yesterday. Normally she would be sent on to a larger hospital but that is completely out of action so she has to wait even longer. Basically somewhere in the country some people have died who would have survived if it were not for the strike.

It is little better for the staff, yesterday the nurses at one of our local clinics were beaten by strikers until they left their posts. It's not to say that many people don't support the strike because they do, they are asking for a 12% pay increase and they deserve it, but hopefully it will be resolved soon.

As for the interesting side, one of the South African doctors pointed out that militant strikes are actually a spill over from the Aparteid era. At that time the unions were one of the few places that black people had power. People didn't want to strike because if they did they were often fired and replaced with other people who needed the work. For that reason the unions used to use force to make sure people came out on strike.

The Xhosa language

I though you might like to know about the local language. The local tribe are called the Xhosa, it is a very big tribe with many millions people, similar in stature to the Zulus. Nelson Mandela is a Xhosa and was actually born and brought up close to here. If you were wondering how to pronounce Xhosa it's harder than you might think, the Xh is actually a click, a bit like the noise people make when they want a horse to go faster. To make things harder there are 3 different clicks to get your tongue around, ‘c’ is a bit like making a ‘tut’ and and ‘q’ is like the sound of a cork popping. The Guiness Book of Records even lists a Xhosa phrase as the most difficult tongue twister in the world, it includes the work for windpipe which is 'uquoquoquo'. As you can imagine I’m having all sorts of fun and games trying to incorporate this into my daily speech but at least people seem to appreciate it if you just give it a try. Not surprisingly I have to work with an interpreter all the time at the moment and probably will have to for the whole year. If you are accepted by people here they like to give you a Xhosa name, I’m hoping mine will have a click in it that I can show off when I get home.

Just a note on the strike, it is supposed to get worse tomorrow with the unions calling for a complete shut-down of the country. We have been promised a skeleton of staff for the hospital which I hope we will get. Understandably the nurses have been quite scared as working nurses in larger central hospitals have been physically abused but other strikers. Fingers crossed then…

The toi-toi!

Toi-toi means picket in Xhosa and there is one on today. Basically the unions have called a strike and all the hospital staff are obliged to take part whether they want to or not. In fact the nurses are reluctant but they face a real threat of physical violence if they work. Flying pickets have been dispatched from nearby towns to enforce this and the police have been on site to prevent any trouble. There is a toi-toi which involves lots of singing and dancing happening outside the gates and this should be enough to satisfy any flying pickets.

From the doctors point of view we were asked to discharge as many patients as possible this morning and put others on weekend leave. Inevitably there are quite a few patients not well enough for this. I've had a look round the hospital and they are getting food and medicines but not much else. There are six of us (5 doctors and a pharmacist) also on site to try and deal with any emergencies.

It should all blow over by tomorrow when the strike finishes and if there are no dire emergencies the impact will not be too great and I don't think there is a real threat of violence at the moment but it has been a pretty interesting day!

The people

So what are the patients of Madwaleni like? Well they are certainly very poor, the employment rate is less than 5%, apart from the hospital a few shops and a few schools it is not obvious where job opportunities would come from. There are government handouts to women with children under 14 and those with disabilities (including HIV) but there is not much money floating around. It can cost R20 to make a round trip to the hospital which is a big ask for many people so you have to think carefully about when and how often to follow up patients (although we can offer some financial help to some people for transport).

As there is generally not that much to do for people around here things move slowly! Patients seem fairly happy to be admitted for fairly long periods partly because it is warm and they are well fed when they are here. Food scarcity is definately a problem for some people and children are regularly admitted with malnutrition.

Most of the patients live in huts made from home-made bricks. Very few have electricity or running water so they collect rain water or drink river water. For some reason there is not culture of digging latrines so there are basically no toilets in many of the villages- apparently the dogs and pigs do the clearing up!

That's all for now- but basically I'm having a great time so far and I will post again soon about what I've been getting up to.

Tom

First impressions

So I've been here for 5 days now and these are my first impressions. As we drove from the airport to the hospital in the dark I noticed that there were no lights on in the houses beside the road. Then in the distance there was a group of lights which turned out to be the hospital, basically it is one of the few places in the area to have electricity and is also one of the major employers.

A few things happened that didn't surprise me; firstly I got a really warm welcome from everyone at the hospital, from the doctors, the nurses and all concerned. I went straight to clinic on the next morning and saw quite a few really sick people including children and babies. The hospital was very clean, although some of it is brand new and really nice other bits look very old and in need of some TLC. I have a huge amount to learn here- some of the medicine is different but all the processes are going to take a while to get used to. Everyone here seems to work really hard.

Perhaps more interesting are the things that did surprise me; firstly there were empty beds on the wards, quite a few of them, which I have never seen in the NHS. The other was that all the staff and some of the patients rely on mobile phones for communication, even if they have no electricity at home they charge the phones at work or another communal places and make very short phone calls to save money. Another was that the hospital has a tennis court- not in great condition but a tennis court none the less.