Yesterday I had the pleasure of delivering a healthy baby girl from a 14 year old mother. She looked completely bewildered as this child was handed to her, almost as if she hadn't realised what had been growing inside her these past 9 months. Teenage pregnancy is not an unusual occurance, in fact it might even be the norm in this area, and one of the reasons is illustrated by another patient of mine. She is a 26 year old who has been left infertile and childless following an ectopic pregnancy. She is absolutely distraught as you might expect any 26 year old to be. However, it is not just her yearning for a child that distresses her but also her yearning for a husband as in Xhosa culture she has little chance of finding a man without first proving her fertility. With such high unemployment her only realistic chances of an income are a husband working in the mines and child support grants which means her future is far from secure. The impact on the HIV epidemic of the need to prove fertility before marriage is plain to see. These young women are clearly having unprotected sex with casual partners with little thought for their own health.
If a woman manages to avoid HIV infection whilst proving her fertility the problem is not over. Choosing to marry brings many advantages but it also comes at a price as she will be entering into a very unequal partnership. Put simply, most Xhosa men are very reluctant to use condoms and women do not have enough bargaining power within their marriage either to insist on their use or to persuade the husband to have an HIV test in the first place. Add to that the very high prevalence of HIV in men who spend most of their time woring away at the mines and this puts married women in a very dangerous position.
If a woman passes the fertility test without being infected with HIV she is actually in a much safer position should she choose to remain unmarried. Not only has she proven her fertility but because she is unmarried she is in a much stronger bargaining position when it comes to condom use. She is much more likely to be able to refuse sex if the man will not use a condom and as such unmarried women are in a better position to protect themselves from HIV than married ones.
Whether many women think of this dilemma when considering marriage I'm not sure but I do see many unmarried women with children who seem to have put aside the idea of marriage as they have become a little older and wiser. For these women the chance to build a future through education and training seems to me to be of the upmost importance and is one of the reasons I'm so keen on the idea of microfinance in this area.
Sunday 28 September 2008
Sunday 7 September 2008
On a lighter note.....
Way back at the very beginning of my time in the Transkei I landed at the airport and was picked up by a driver from the hospital called Mabena. His English, while better than my Xhosa, was not great but we managed to pass the time during the journey with a conversation based largely on the words Liverpool, Steven Gerrard, FA cup and Premiership. I boasted of my time as a goalkeeper for my college while he told me that he was captain of his team and promised to give me a try out. Ever since then I have been known to Mabena as 'my goalkeeper' and he has been known to me a 'my captain' although despite my constant nagging the try out has yet to happen.
Luckily for me the hospital has recently formed a team and as the tallest guy around and quite frankly the only one who showed any interest I was a shoe-in for the number 1 shirt. Practices have largely consisted of 5-a-side games on a tennis court with no goalkeepers so I was a complete unknown when we had our first game recently.
The day of the game started with few surprises. Firstly, our captain had his first beer will before the scheduled meeting time of 10am. Secondly, the actual meeting time turned out to be about 12 o'clock and after driving half an hour to the pitch I was told that the opposition had not yet set off and were 2 hours away. So no great surprise then that the game kicked off about 4 hours late. What was more surprising was that each team had a full set of clean kit, the goals had nets, there was a ref with a whistle and two linesmen complete with football socks tied around stick for their flags.
The game itself was a scrappy affair on a dusty and uneven surface and as full-time approached with the score was locked at 2-2. The full-time whistle blew and no-one was satisfied so it was decided to play extra-time. By this stage the opposition were passing beer bottles between them as they played so I felt we had a chance. It was deep in the second period when a looping shot came in and with half an eye on bowling it out for one last counter-attack it slipped through my hands and trickled over the line. Gutted wasn't the word. I sheepishly returned the ball to the centre circle but the final whistle blew shortly after. I apologised to my team mates as we sauntered off but within five minutes it seemed to have all been forgotten. The focus turned almost immediately to the pub and how we were going to beat them in the pool competition later anyway. It's comforting to know that whether in Africa or Anfield some things never change.
Luckily for me the hospital has recently formed a team and as the tallest guy around and quite frankly the only one who showed any interest I was a shoe-in for the number 1 shirt. Practices have largely consisted of 5-a-side games on a tennis court with no goalkeepers so I was a complete unknown when we had our first game recently.
The day of the game started with few surprises. Firstly, our captain had his first beer will before the scheduled meeting time of 10am. Secondly, the actual meeting time turned out to be about 12 o'clock and after driving half an hour to the pitch I was told that the opposition had not yet set off and were 2 hours away. So no great surprise then that the game kicked off about 4 hours late. What was more surprising was that each team had a full set of clean kit, the goals had nets, there was a ref with a whistle and two linesmen complete with football socks tied around stick for their flags.
The game itself was a scrappy affair on a dusty and uneven surface and as full-time approached with the score was locked at 2-2. The full-time whistle blew and no-one was satisfied so it was decided to play extra-time. By this stage the opposition were passing beer bottles between them as they played so I felt we had a chance. It was deep in the second period when a looping shot came in and with half an eye on bowling it out for one last counter-attack it slipped through my hands and trickled over the line. Gutted wasn't the word. I sheepishly returned the ball to the centre circle but the final whistle blew shortly after. I apologised to my team mates as we sauntered off but within five minutes it seemed to have all been forgotten. The focus turned almost immediately to the pub and how we were going to beat them in the pool competition later anyway. It's comforting to know that whether in Africa or Anfield some things never change.
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