Here is a mixed bag of some of the things I’ve seen since being here and there has been quite a range.
The oddest experience I think was seeing a man who had a painful bottom- he seemed reluctant to take his clothes off in front of my interpreter. I thought he was shy because she was a woman but it turned out that it was because he didn’t want her to see the pistol he had hidden in his coat. Mental note to self- don’t mess with the taxi drivers around here!
Another that sticks in the mind was a 14 year old girl I saw a few days later who was 8 months pregnant and had just found out she was HIV-positive. She just sat there in her school uniform sucking a lolly-pop as if nothing was the matter.
Unlike what you are told about South Africa there seems to be very little gun crime in the Transkei (the odd taxi driver excepted). Apparently most with a criminal tendency tend to move to the cities as they are not tolerated here. That’s not to say that there isn’t a constant stream of drunken men who have been fighting but they seem to stab each other instead and so far the consequences have not been too bad.
The same can’t be said for the roads which are lethal. Just before I arrived 17 school children were killed in a coach crash. On call a few weekends ago 6 (drunken) men were brought in after overturning their truck. One died at the scene another while we were treating him and another on the way to the referral hospital.
Had a typically African experience this week. We went to a peripheral clinic and there was a young man who needed to have his blood taken. The problem was that he was in the middle of his 4 week circucision school which is where the boys go off into the bush to learn how to become a man. As a result he was not allowed to see any married women at all so I went to take his blood in the security hut at the entrance to the health centre. When I got there I found this man crouching behind the door dressed only in a blanket covering his shoulder and a some leaves tied around the end of his penis. Under the blanket he was covered from head to toe in white clay. It was uneventful from then on but an interesting start to the clinic.
By the way there are plenty of PHOTOS on my facebook page just follow the links below
http://www.facebook.com/album.php?aid=11146&l=cf191&id=573386765
http://www.facebook.com/album.php?aid=5776&l=a3887&id=573386765
Saturday, 25 August 2007
Tuesday, 31 July 2007
Some medicine
As much fun as it has been learning about a new culture the main reason I came here was for the medicine. So far it has been mostly ups and a few downs- but the obvious place to start is with the HIV programme where I spend most of my time. The background as many people know is that there is an epidemic of HIV/AIDS in Southern Africa. The good news is that there is effective treatment for HIV and there is money available from various sources to pay for it. The challenge therefore is effectively distributing the drugs. The first challenge is for people to test for HIV and part of the programme is a ‘Voluntary Counselling and Testing ’ approach which uses various methods including attending public gatherings to encourage testing.
Once tested people can join the programme but of course this is also voluntary and not everyone joins. Once selected as needing the drugs the main problem is how to get people to take the medicines properly. Basically, people need to take tablets twice a day 12 hours apart every day and more than likely for the rest of their lives. If they take the tablets chaotically the HIV will become resistant to the drugs and will become difficult or impossible to treat and people will go back to square one. Patients with resistant HIV may also pass this to other people who themselves will be difficult to treat from the outset which would be a disaster. If you read the Daily Mail this would be like developing the ‘HIV super-bug’.
It is difficult for most people to finish a course of antibiotics let alone comply with these measures and in particular many of the patients are illiterate and have never used a clock or a calendar before. To address this problem the programme has formed a series of support groups; they are run by local people and involve a gathering, usually once a week, when they talk about and are educated about these issues and also get something to eat and drink. Anyone without a clock is given one, everyone has a treatment partner to help them and they are strongly encouraged to disclose their status to their family because keeping the drugs hidden from people in their tiny houses would only lead to chaotic drug taking.
The programme is exactly 2 year old, so far about 700 people have been put on medication and there are a further 700 who are on the programme but so far don’t need the drugs. There is no waiting list to start drugs and currently we are starting about 10 per week. This is scratching the surface of the problem but it is a good start. As you can gather it is a major undertaking and in some ways is more like a business than a hospital but there are no half measures. People are either taught how to take the drugs correctly and are supported so that they can continue to do so or we are wasting our time. So far the results have been really good, only a handful of people have been lost to follow-up and less than ten have developed resistant virus. The challenge ahead then is to sustain the early success and to allow the programme to grow without compromising on quality.
Once tested people can join the programme but of course this is also voluntary and not everyone joins. Once selected as needing the drugs the main problem is how to get people to take the medicines properly. Basically, people need to take tablets twice a day 12 hours apart every day and more than likely for the rest of their lives. If they take the tablets chaotically the HIV will become resistant to the drugs and will become difficult or impossible to treat and people will go back to square one. Patients with resistant HIV may also pass this to other people who themselves will be difficult to treat from the outset which would be a disaster. If you read the Daily Mail this would be like developing the ‘HIV super-bug’.
It is difficult for most people to finish a course of antibiotics let alone comply with these measures and in particular many of the patients are illiterate and have never used a clock or a calendar before. To address this problem the programme has formed a series of support groups; they are run by local people and involve a gathering, usually once a week, when they talk about and are educated about these issues and also get something to eat and drink. Anyone without a clock is given one, everyone has a treatment partner to help them and they are strongly encouraged to disclose their status to their family because keeping the drugs hidden from people in their tiny houses would only lead to chaotic drug taking.
The programme is exactly 2 year old, so far about 700 people have been put on medication and there are a further 700 who are on the programme but so far don’t need the drugs. There is no waiting list to start drugs and currently we are starting about 10 per week. This is scratching the surface of the problem but it is a good start. As you can gather it is a major undertaking and in some ways is more like a business than a hospital but there are no half measures. People are either taught how to take the drugs correctly and are supported so that they can continue to do so or we are wasting our time. So far the results have been really good, only a handful of people have been lost to follow-up and less than ten have developed resistant virus. The challenge ahead then is to sustain the early success and to allow the programme to grow without compromising on quality.
Wednesday, 18 July 2007
More Xhosa culture
As much as I want to tell everyone about the medicine here I’m still learning so much about the Xhosa culture that I’d like to share some more.
It is currently the male circumcision season; at this time of year you see groups of young men parading down the streets carrying weapons such as knives and spears. It is all part of the preparation for their coming of age celebrations which involve a big party and a circumcision. After the party the new men burn all their clothes and wrapped in blankets with faces painted they leave to spend 3 weeks living in the bush with an elder. During that time they are taught all the skill needed to be a man in Xhosa culture, this includes hunting and even how to kill another man. At the end of the three weeks they can return to their village and dress in normal clothes and continue their life as a man.
The whole thing is interesting in itself but also has some medical implications. Firstly the tradition says that the same blade should be used on all the boys on a given day. In theory the rules have been tightened up in the HIV era but in practice this still goes on. As well as the risk of HIV transmission there is also a risk of wound infection. Apparently there is a whole ward full of men with circumcision infections at the referral hospital. Apparently they regularly come to our hospital but I’m yet to see one.
The other tradition I’ve learned about is Xhosa marriage; our social worker has just got married, she has had a legal marriage, a Xhosa marriage and is waiting to have a ‘White wedding’. Before the first marriage her fiancé had to negotiate with her family about how much ‘labola’ he was prepared to pay for her. The currency is ‘cows’ but for her one cow was equal to R1,500 (about £100), he eventually agreed to pay 17 cows! The traditional wedding involved her doing a lot of cleaning, making lots of tea for people and cooking a lot of food. She now has to wear a head scarf for a month as a sign of her marriage and most married women wear them lifelong.
If she has a baby it become a bit weird, she will have to bring the child directly to her mother-in-laws house and has to live behind the front door for a month just eating sleeping and feeding the child, her husband is allowed to visit but not to stay.
It is currently the male circumcision season; at this time of year you see groups of young men parading down the streets carrying weapons such as knives and spears. It is all part of the preparation for their coming of age celebrations which involve a big party and a circumcision. After the party the new men burn all their clothes and wrapped in blankets with faces painted they leave to spend 3 weeks living in the bush with an elder. During that time they are taught all the skill needed to be a man in Xhosa culture, this includes hunting and even how to kill another man. At the end of the three weeks they can return to their village and dress in normal clothes and continue their life as a man.
The whole thing is interesting in itself but also has some medical implications. Firstly the tradition says that the same blade should be used on all the boys on a given day. In theory the rules have been tightened up in the HIV era but in practice this still goes on. As well as the risk of HIV transmission there is also a risk of wound infection. Apparently there is a whole ward full of men with circumcision infections at the referral hospital. Apparently they regularly come to our hospital but I’m yet to see one.
The other tradition I’ve learned about is Xhosa marriage; our social worker has just got married, she has had a legal marriage, a Xhosa marriage and is waiting to have a ‘White wedding’. Before the first marriage her fiancé had to negotiate with her family about how much ‘labola’ he was prepared to pay for her. The currency is ‘cows’ but for her one cow was equal to R1,500 (about £100), he eventually agreed to pay 17 cows! The traditional wedding involved her doing a lot of cleaning, making lots of tea for people and cooking a lot of food. She now has to wear a head scarf for a month as a sign of her marriage and most married women wear them lifelong.
If she has a baby it become a bit weird, she will have to bring the child directly to her mother-in-laws house and has to live behind the front door for a month just eating sleeping and feeding the child, her husband is allowed to visit but not to stay.
Saturday, 30 June 2007
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.....
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.....
Friday, 22 June 2007
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.
___________
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.
___________
Thursday, 14 June 2007
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.
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.
Tuesday, 12 June 2007
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…
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…
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