Starting week 4

Today starts week 4 in South Africa!

This past week was pretty awesome. SO BUSY and crazy (I was pretty exhausted), but satisfying. We were working again near Nelspruit, in a small town call Barberton. We were working at a rural hospital there, and also traveled to the outlying community clinics in that area. I respect so much what they do there, they work so hard, and with so few resources...

The rural clinics were really the best part. Before I came here, I had read about the initiative towards decentralizing health care, especially for HIV care. Basically before a few months ago, you could only get HIV drugs in big hospital centers. Which is a problem when 20% of the population is infected, and when many of the patients who need drugs are not within traveling distances of the big medical centers. In addition, there are not enough physicians to staff areas outside of the big medical centers to start people on treatment. So there was this government initiative to fund training for nurses to initiate antiretrovirals (ARV) on less complicated patients, and refer more complicated patients to medical centers.

While I was reading about this initiative, I couldnt help thinking: "wow, that sounds great, but how long is that going to take to make that happen? And will it? Or is it just a lofty pipe dream that sounds great on paper and makes some politicians sound humanistic?" Well, not that it is without it's faults, or is working perfectly, but it is happening!

I think my favorite clinic we visited this week was Glenthorpe. It was about an hour from Barberton, which is already pretty rural, and we had to drive probably 10 miles on a ruddy dirt road to get there. This clinic is inside of a paper mill, which is one of the biggest employers in the area. It is literally in the middle of nowhere, and the workers live in barracks in the paper mill along with their kids and wives.

It seemed pretty bleak as we drove in for the first time. Small tin barracks, a small school with the roof coming off...You know the people are rarely able to get out of this tiny world given the lack of transportation.

Inside the clinic I met "sister" emily (they call nurses "sisters" here). She is overworked, dedicated, and drives up to this remote area every day because she cares about testing people for HIV and starting them on treatment. When we got there, there were some crossed lines of communication (not unusual here), and she thought our purpose was to teach the patients about health, and so she had invited all her mothers to come in for "education." Something we were unprepared for, but decided to roll with it. We moved probably 30 moms and their kids into this tiny room, shoulder to shoulder, kids crawling around all over the floor. So I am trying to give a "talk" to people who are largely illeterate and speak only minimal English. It ended up being really fun, and the women had a lot of good questions (I think my favorite was "You said that we should eat fruits and vegetables. The fruits and vegetables we have here are mostly bananas and avocados. I was told I can't eat bananas and avocados while I am pregnant. What should I eat?"). I wished I could have taken a picture of all these beautiful women and children packed into the room, but in those situations you can't...There is this mistrust when you take people's pictures in a situation like that that you are going to use the photo to advertise they have HIV, which is still very taboo here.

As usual, lots of heartbreaking situations....
The pediatric ward in the hospital had a number of HIV+ children who were abandoned at the hospital. My favorite was "Niki" a little boy who was 22 months old, would wear old man pajamas and a robe, and sit in a chair in the middle of the peds ward, watching everyone with his head in his hand, like he was in charge of the place. After about an hour, I finally got him to smile :) But his expressions and the way he carried himself told how much older he was, and how heavy his heart was.

A week ago, I was counting the days until i could go home. This week, although I miss home, it is harder to imagine going back...