There is a little boy I can’t get out of my head. I saw him one afternoon at an extremely rural clinic on the paper mill. The nurse there asked me to see him because she was uncomfortable treating children. The boy was 6, HIV + since birth, never on medication. He was being seen in clinic that day because he had been exposed to TB at home, and they were concerned that he may also have TB.
The boy walked into the clinic behind his grandmother. She looked exhausted, worn down, and hopeless, the child looked downcast. From the door, I could see his cheeks puffed out bigger than they should. When he came in, I realized they were his greatly swollen parotid glands (saliva glands at the back of your cheeks). I examined him and found evidence that he has had lung disease for years…Likely not getting enough oxygen for a long time. I evaluated his chest xrays, one from 2008, one from a week before his visit, and confirmed my suspicion that he has had lung disease for some time, likely secondary to his HIV. I also suspect he had TB.
I told the grandmother we were going to have to treat him for TB, and about 2 weeks after that, we were going to have to start him on antiretrovirals. She sighed, and her face fell further, if that was possible. She admitted she was overwhelmed. One of her daughters was dead, one was hospitalized a day before with advanced AIDS complications, and she was left to care for all the grandchildren. As I talked to her further, she noted that she had another 7 month old baby at home who had also been abandoned, and likely exposed to TB. She sighed and said she would walk home and get the baby, so we could check him out as well. It took her about 30 minutes to walk there and back with the baby. In the meanwhile, the 6 year old sat with us. He stared straight forward, face expressionless, nothing we did could make him smile. How many 6 year olds do you know that can sit still without entertainment for half an hour? It broke my heart, and made me fear his young spirit was already broken. His deep, wide, dark eyes seemed that they had already seen much darkness and disappointment, and this had aged him. Finally, Vivian found a mint in her purse, and offered it to the boy. He took it and put it in his mouth, and I thought I saw a tiny smile as he sucked on it. It encouraged me to see a little light back in his eyes. I can only hope that as he receives treatment, he will have somewhat of a new beginning; that as his health improves he will feel life returning to his body and have hope for his future potential. Sadly, I know his health is not the only obstacle he must overcome.
A day later, we visited his mother in the hospital. She had the same wide, dark eyes, sunken with the pain and what she has seen. We updated her on her son, and a bit of worry crossed her expressionless face. Towards the end of our conversation, she suddenly perked up and demanded to be put on antiretrovirals. She had been refusing them in the past, and I think her hospitalization and the sickness of her son made her want to take control of her health. Again, my cautious optimism made me hope that she would follow through so that she could take care of her son, and not become another thing to fail him.
As I mentioned in my previous post, I am struggling a little with knowing in a week I will have to transition back to a completely different world. I thought about this as I took a walk around my neighborhood in Pretoria this afternoon. Although I have never done anything quite like this before, I have definitely had experiences where I have gone out of my comfort zone and had a difficult transition back. And I think I need to remember that every experience is a part of the bigger picture of our lives…And that in the short term, it is sometimes hard to see how a short term experience will fit in to the bigger picture. But it always does. Every experience leaves impressions on us and ultimately becomes seamlessly woven into the whole – as much as we feel so fragmented by our experiences in the short term.
So I hope and pray that as I leave, I will not feel fragmented or disillusioned or disconnected. I pray that I will have faith that this trip has been another thread in the story of my life, and as it continues to be woven together on the loom, this thread will also become woven in, and become a part of the bigger design.
I am deeply grateful for this experience, and humbled by it. I know I am changed, and I hope that I will stay changed, and not forget the lessons I have learned. I hope that this experience will become integrated into the person I am, that it won’t have to be compartmentalized or sequestered or become isolating.
Monday, August 9, 2010
Saturday, August 7, 2010
"Home"
I have one week left of my time in South Africa.
I spent my first week or 2 here crying, feeling so homesick, aching to come home. Then week 3, there was a transition. Something changed, shifted in my brain, almost as if something had permanently remodeled so that I am no longer able to think the same way. Now I feel I will have a hard time coming back.
I think the thing I struggle with here, is that I am in, and not of. I have worked every day with now 4 different tribes of people, with 4 different languages, and me struggling through understanding their culture and trying to communicate effectively in the things that are not said. I have been so touched by the people here, so humbled by their experiences and stoicism…Despite this, I am definitely still an outsider. So many times I have wanted to take a child into my arms, to hold them in their loneliness…I have wanted to reach across the huge cultural lengths with my adult patients and tell them that deep down, despite our experiences, we are the same…But I am definitely still an outsider. And honestly, I am still much more comfortable in my own cultural setting…It is hard to see so much pain, concurrently so much beauty, to want to reach in, and to still be so distanced.
At the same time, I feel that something in me has shifted and I don’t know that I will still be “of” home when I get back. I now feel removed from my home culture. And I am just anticipating not adjusting well to being home, not fitting back in. And part of that doesn’t make sense to me. There are people at home that I love and miss and why wouldn’t that itself be something to make me fit back in, to feel back at home?
I feel between two worlds, not fitting in either, and it feels lonely.
I struggle with the concept of “home.” There was college and starting to feel at home there, starting to develop a community and friends. And then I moved to Detroit very quickly. Same thing in Detroit, struggled to fit in, find a place of belonging in a really temporary job where you are constantly re-learning, switching things up, and never getting into a groove anywhere…And started to develop community there and feel at home, feel passionate about the location and my integration there, and then felt called to San Diego.
I was really excited about San Diego, especially as I grew to love it and develop community. And I had more of a constant group of coworkers and work situations (although of course, I pick a dual specialty which causes more switch ups and making it harder to feel at home). That said, I bought a home, it was exciting to develop community, to love the place of San diego, to love the work I am doing, to love to feel integrated into the world around me. Exciting to think I could stay there after residency if I got a job…That I wouldn’t have to necessarily relocate and throw up my whole world again. Finally, was starting to feel at “home.” After years of writing about this concept, trying to understand it, I felt the potential of having it.
And now I am in this strange limbo. Being changed, being different, having seen, having felt, and I wonder how much I will be able to feel “home” anywhere.
Perhaps all this is a bit dramatic, but I am definitely struggling with the tug of being in a weird place emotionally.
What keeps going through my head are the lyrics to one of my favorite songs by Cinematic Orchestra (enough that I am afraid I am going to get tired of the song). "There is a place I call home...There is a place that I'm no longer alone."
I spent my first week or 2 here crying, feeling so homesick, aching to come home. Then week 3, there was a transition. Something changed, shifted in my brain, almost as if something had permanently remodeled so that I am no longer able to think the same way. Now I feel I will have a hard time coming back.
I think the thing I struggle with here, is that I am in, and not of. I have worked every day with now 4 different tribes of people, with 4 different languages, and me struggling through understanding their culture and trying to communicate effectively in the things that are not said. I have been so touched by the people here, so humbled by their experiences and stoicism…Despite this, I am definitely still an outsider. So many times I have wanted to take a child into my arms, to hold them in their loneliness…I have wanted to reach across the huge cultural lengths with my adult patients and tell them that deep down, despite our experiences, we are the same…But I am definitely still an outsider. And honestly, I am still much more comfortable in my own cultural setting…It is hard to see so much pain, concurrently so much beauty, to want to reach in, and to still be so distanced.
At the same time, I feel that something in me has shifted and I don’t know that I will still be “of” home when I get back. I now feel removed from my home culture. And I am just anticipating not adjusting well to being home, not fitting back in. And part of that doesn’t make sense to me. There are people at home that I love and miss and why wouldn’t that itself be something to make me fit back in, to feel back at home?
I feel between two worlds, not fitting in either, and it feels lonely.
I struggle with the concept of “home.” There was college and starting to feel at home there, starting to develop a community and friends. And then I moved to Detroit very quickly. Same thing in Detroit, struggled to fit in, find a place of belonging in a really temporary job where you are constantly re-learning, switching things up, and never getting into a groove anywhere…And started to develop community there and feel at home, feel passionate about the location and my integration there, and then felt called to San Diego.
I was really excited about San Diego, especially as I grew to love it and develop community. And I had more of a constant group of coworkers and work situations (although of course, I pick a dual specialty which causes more switch ups and making it harder to feel at home). That said, I bought a home, it was exciting to develop community, to love the place of San diego, to love the work I am doing, to love to feel integrated into the world around me. Exciting to think I could stay there after residency if I got a job…That I wouldn’t have to necessarily relocate and throw up my whole world again. Finally, was starting to feel at “home.” After years of writing about this concept, trying to understand it, I felt the potential of having it.
And now I am in this strange limbo. Being changed, being different, having seen, having felt, and I wonder how much I will be able to feel “home” anywhere.
Perhaps all this is a bit dramatic, but I am definitely struggling with the tug of being in a weird place emotionally.
What keeps going through my head are the lyrics to one of my favorite songs by Cinematic Orchestra (enough that I am afraid I am going to get tired of the song). "There is a place I call home...There is a place that I'm no longer alone."
Sunday, August 1, 2010
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...
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...
Sunday, July 25, 2010
Week 2
(again, some political content, please do not forward or share without my permission)
I have now officially been here 2 weeks.
I didn't expect to become so overwhelmed by the situation here. I didn't expect for it to affect me as deeply as it has...I expected that I would see a lot of hard things, and I would do what I could. But my heart is heavy, and I feel helpless in a gigantic situation.
This past week was hard. The first week, I saw lots of hard situations, but an attitude of hope and encouragement along with the hard situations.
The second week I was presented with a much bleaker picture.
I attended a staff meeting last week at the hospital I was working at. The big topic of the meeting was that the pharmacy was about to run out of anti-retrovirals (lifesaving drugs for people with HIV/AIDS). THey had received a letter from the local medical government official that the new shipment of drugs was going to be delayed indefinitely. Someone from the government had forgotten to pay the bill, and thus, the drug company refused to send the drugs.
Two steps forward and one step back. I want to be hopeful for the situation of HIV/AIDS in this country. This is a disease that is killing people, creating orphans, spreading like wildfire, and infecting 21+% of the population. I want to believe that the people in politics are starting to pay attention. I want to be hopeful about the fact that Jacob Zuma is acknowledging the disease, increasing funding towards treatment, and encouraging the population to be tested. I want to be encouraged by this and feel this is moving things forward.
So here is the process:
someone finally decides to get up the courage to be tested -> they test positive -> they get a CD4 count to determine how advanced their immune depletion is ->if their immune depletion qualifies them, they start on antiretrovirals (ARV).
So when you have a block in the drug supply, here is the problem:
1. For people who are already on ARVs, if they stop while they are waiting for the drug supply to come back, their virus has a chance to replicate and mutate, and potentially become resistnat to the drugs they are taking (and in SA, there are only 2 cocktails available - in the US there are more...But if you become resistant to one, you only have one other option).
2. Do you continue to test people when the drug supply is down? It is good for people to know, so that people can potentially prevent spread. But say you find out you are positive. And a follow-up CD4 count is very low, showing you have likely had HIV/AIDS for a long time, and your immune system is very compromised...Then you are told the drug supplies are out, and you will have to wait until they are replenished before you can start treatment. In the meanwhile, you may develop and overwhelming infection and die. So people are encouraged to test, but if they do, you are telling them you can do nothing about the results?
I had heard before I started, and observed since I have been here, that there is a lot of resistance to change. Resistance to change hospital policies on infection control, resistance for healthcare providers to care for people with HIV, resistance for the people of the country to accept the disease, resistant for people to get tested and acknowledge it is a possibility they are infected...And I have noted this resistance to change, which is both frustrating, and something I don't want to acknowledge is there. All the same, I can understand why the resistance to change occurs now...Why should you care about testing if there is nothing you can do about the results? Why should drs take care of HIV patients when they run into situations where their hands are tied and they have to stop treating? I feel almost as if it is a learned helplessness.
I must say, I admire very much the doctors and nurses at Rob Ferriera Hospital. They have a very difficult job to do, they persevere, and they handled this situation with a lot of grace. Everyone was frustrated, but knew there was no use in blaming or focusing on why the situation is the way it is. They focused on how they were going to deal with it. This is an attitude I have found very rare, even in the US where we run into situations that aren't quite as impossible.
And as usual, some patients stood out to be this week.
One woman was almost exactly my age...Born within a few weeks of me. It is weird to think of how different our births would have been, how different our paths would have been over our 29 years. And both of us born the year HIV was described/identified...Her world, going to be completely changed by this epidemic, mine, only if I choose for it to be.
Anyhow, she had been on therapy for 3 or 4 years. She had never had a good response, her viral load had never been supressed (the mark of effective treatment is that your viral load - the amount of HIV in your body, goes down). And because of this, her immune system was quite impaired. When the doctors were deciding whether to put her on a new cocktail (which has huge implications - if she fails the first, and then fails the second, in this country she has no other options), they discovered that she was only taking her treatment 1 or 2 times a week. Which will make the treatment ineffective, and also potentially create virus that is resistant to the treatment. So the decision was made to take her off treatment until she could "sort herself out."
I saw her later in the waiting room. Just sitting there, expressionless. And I can't even begin to wonder what her experience is, and why she was where she was. Was she depressed? The patients here are so stoic that it is not often a possibility that is considered. Was she hopeless? Did she feel like she was going to die anyway and there was no reason to take the treatment? Did she not have anyone in her life encouraging her to live? I am sad to say that I didnt have the communciation skills in her langugae to be able to ask these questions. Nor do I know if there is a cultural concept for these things. But all I could see was someone born within weeks of myself, on the other side of the world, whose course and environment were so different from mine...And I felt guilty, that in my world, I had parents unaffected by HIV, that they are still alive and available to encourage me...That I haven't seen friends and family die of HIV, while sitting by helplessly...That I have had the opportunity to go to college and med school and have a steady career which is fulfilling...That I haven't had to battle this disease myself - with it's stigma, with it's chronic treatment that may cause side effects, with it's blame, it's ability to change (or fail to start) relationships...
Ack.
I have now officially been here 2 weeks.
I didn't expect to become so overwhelmed by the situation here. I didn't expect for it to affect me as deeply as it has...I expected that I would see a lot of hard things, and I would do what I could. But my heart is heavy, and I feel helpless in a gigantic situation.
This past week was hard. The first week, I saw lots of hard situations, but an attitude of hope and encouragement along with the hard situations.
The second week I was presented with a much bleaker picture.
I attended a staff meeting last week at the hospital I was working at. The big topic of the meeting was that the pharmacy was about to run out of anti-retrovirals (lifesaving drugs for people with HIV/AIDS). THey had received a letter from the local medical government official that the new shipment of drugs was going to be delayed indefinitely. Someone from the government had forgotten to pay the bill, and thus, the drug company refused to send the drugs.
Two steps forward and one step back. I want to be hopeful for the situation of HIV/AIDS in this country. This is a disease that is killing people, creating orphans, spreading like wildfire, and infecting 21+% of the population. I want to believe that the people in politics are starting to pay attention. I want to be hopeful about the fact that Jacob Zuma is acknowledging the disease, increasing funding towards treatment, and encouraging the population to be tested. I want to be encouraged by this and feel this is moving things forward.
So here is the process:
someone finally decides to get up the courage to be tested -> they test positive -> they get a CD4 count to determine how advanced their immune depletion is ->if their immune depletion qualifies them, they start on antiretrovirals (ARV).
So when you have a block in the drug supply, here is the problem:
1. For people who are already on ARVs, if they stop while they are waiting for the drug supply to come back, their virus has a chance to replicate and mutate, and potentially become resistnat to the drugs they are taking (and in SA, there are only 2 cocktails available - in the US there are more...But if you become resistant to one, you only have one other option).
2. Do you continue to test people when the drug supply is down? It is good for people to know, so that people can potentially prevent spread. But say you find out you are positive. And a follow-up CD4 count is very low, showing you have likely had HIV/AIDS for a long time, and your immune system is very compromised...Then you are told the drug supplies are out, and you will have to wait until they are replenished before you can start treatment. In the meanwhile, you may develop and overwhelming infection and die. So people are encouraged to test, but if they do, you are telling them you can do nothing about the results?
I had heard before I started, and observed since I have been here, that there is a lot of resistance to change. Resistance to change hospital policies on infection control, resistance for healthcare providers to care for people with HIV, resistance for the people of the country to accept the disease, resistant for people to get tested and acknowledge it is a possibility they are infected...And I have noted this resistance to change, which is both frustrating, and something I don't want to acknowledge is there. All the same, I can understand why the resistance to change occurs now...Why should you care about testing if there is nothing you can do about the results? Why should drs take care of HIV patients when they run into situations where their hands are tied and they have to stop treating? I feel almost as if it is a learned helplessness.
I must say, I admire very much the doctors and nurses at Rob Ferriera Hospital. They have a very difficult job to do, they persevere, and they handled this situation with a lot of grace. Everyone was frustrated, but knew there was no use in blaming or focusing on why the situation is the way it is. They focused on how they were going to deal with it. This is an attitude I have found very rare, even in the US where we run into situations that aren't quite as impossible.
And as usual, some patients stood out to be this week.
One woman was almost exactly my age...Born within a few weeks of me. It is weird to think of how different our births would have been, how different our paths would have been over our 29 years. And both of us born the year HIV was described/identified...Her world, going to be completely changed by this epidemic, mine, only if I choose for it to be.
Anyhow, she had been on therapy for 3 or 4 years. She had never had a good response, her viral load had never been supressed (the mark of effective treatment is that your viral load - the amount of HIV in your body, goes down). And because of this, her immune system was quite impaired. When the doctors were deciding whether to put her on a new cocktail (which has huge implications - if she fails the first, and then fails the second, in this country she has no other options), they discovered that she was only taking her treatment 1 or 2 times a week. Which will make the treatment ineffective, and also potentially create virus that is resistant to the treatment. So the decision was made to take her off treatment until she could "sort herself out."
I saw her later in the waiting room. Just sitting there, expressionless. And I can't even begin to wonder what her experience is, and why she was where she was. Was she depressed? The patients here are so stoic that it is not often a possibility that is considered. Was she hopeless? Did she feel like she was going to die anyway and there was no reason to take the treatment? Did she not have anyone in her life encouraging her to live? I am sad to say that I didnt have the communciation skills in her langugae to be able to ask these questions. Nor do I know if there is a cultural concept for these things. But all I could see was someone born within weeks of myself, on the other side of the world, whose course and environment were so different from mine...And I felt guilty, that in my world, I had parents unaffected by HIV, that they are still alive and available to encourage me...That I haven't seen friends and family die of HIV, while sitting by helplessly...That I have had the opportunity to go to college and med school and have a steady career which is fulfilling...That I haven't had to battle this disease myself - with it's stigma, with it's chronic treatment that may cause side effects, with it's blame, it's ability to change (or fail to start) relationships...
Ack.
Thursday, July 22, 2010
Quote from staff meeting
only in Africa could this comment at a staff meeting not be inappropriate & cause someone to meet with HR (stop reading if you are easily offended): "I am the mother of this unit. And I have large breasts, engorged with the milk to feed and nurture you (while grabbing her breasts)"
Wednesday, July 21, 2010
Tired!
I am so so tired!
Have you ever been in a country where you knew just a little bit of the language? And you spent all day trying to communicate and trying to understand? And it took up all of your mental energy? And at the end of the day, regardless of how you spent your day, you are exhausted? That is how I feel now. Except that it is English I am speaking...And I have a translator for Swazi-speaking patients. But that is how big I feel the cultural divide is currently.
But alas, I have decided to dedicate a post to the positive things here:
1. It is raining tonight, despite the fact that it "never" rains here during the winter.
2. There is a wonderful woman who runs this hotel, named Coba. She mothers everyone from staff to visitors. She if effusive, energetic, friendly, and is always trilling about with her Afrikaans accent. When I get home from work, tired, and must finish up my reporting for the day (which I have to do in the hotel lobby because it is the only place my 3G card works here), she fusses over me and brings me coffee and tells me to take a break so that my eyes don't ignite.
3. The bed and breakfast we are staying at right now is beautiful and comfortable, and is suprisingly cheap because of the area we are in. The cooks, Sannie and Della, cook wonderful, DELICIOUS food with fresh ingredients. They made me a lunch today to take to work (I can't remember the last time someone packed me a lunch), and it was wonderful.
4. I have received great encouragement from friends and family via email, from those who have been in this program and those who haven't.
5. Upon arriving at work today, in a public hospital, I was greeted with the nurses singing the morning prayers with the patients before clinic got started. It was just about the most beautiful thing I have heard, and although it was in Swazi, I understood it. Maybe the emotion in the tone of it's deliverance, or the soul-rawness of it. At any rate, it was a moment of connection before starting my day.
6. I love the way the women carry their babies here. The babies are placed on their backs, legs wrapped around them (sort of like if you were giving a kid a piggy back ride), and they tie a blanket or shawl around the both of them to keep the baby in place. Not suprisingly, South Africans have the best adherence rate for slings for congenital hip dysplasia (because the way they carry them is sort of like that sling). Anyhow, today a mother came in for her treatment, with her one year old tied to her back. While we were talking to her, the child was playing peek-a-boo with me around his mother's shoulders and smiling an adorable smile. I asked the mom about him, and because of prenatal treatment, he did not convert, and is HIV-. An encouraging way to end the day!
Have you ever been in a country where you knew just a little bit of the language? And you spent all day trying to communicate and trying to understand? And it took up all of your mental energy? And at the end of the day, regardless of how you spent your day, you are exhausted? That is how I feel now. Except that it is English I am speaking...And I have a translator for Swazi-speaking patients. But that is how big I feel the cultural divide is currently.
But alas, I have decided to dedicate a post to the positive things here:
1. It is raining tonight, despite the fact that it "never" rains here during the winter.
2. There is a wonderful woman who runs this hotel, named Coba. She mothers everyone from staff to visitors. She if effusive, energetic, friendly, and is always trilling about with her Afrikaans accent. When I get home from work, tired, and must finish up my reporting for the day (which I have to do in the hotel lobby because it is the only place my 3G card works here), she fusses over me and brings me coffee and tells me to take a break so that my eyes don't ignite.
3. The bed and breakfast we are staying at right now is beautiful and comfortable, and is suprisingly cheap because of the area we are in. The cooks, Sannie and Della, cook wonderful, DELICIOUS food with fresh ingredients. They made me a lunch today to take to work (I can't remember the last time someone packed me a lunch), and it was wonderful.
4. I have received great encouragement from friends and family via email, from those who have been in this program and those who haven't.
5. Upon arriving at work today, in a public hospital, I was greeted with the nurses singing the morning prayers with the patients before clinic got started. It was just about the most beautiful thing I have heard, and although it was in Swazi, I understood it. Maybe the emotion in the tone of it's deliverance, or the soul-rawness of it. At any rate, it was a moment of connection before starting my day.
6. I love the way the women carry their babies here. The babies are placed on their backs, legs wrapped around them (sort of like if you were giving a kid a piggy back ride), and they tie a blanket or shawl around the both of them to keep the baby in place. Not suprisingly, South Africans have the best adherence rate for slings for congenital hip dysplasia (because the way they carry them is sort of like that sling). Anyhow, today a mother came in for her treatment, with her one year old tied to her back. While we were talking to her, the child was playing peek-a-boo with me around his mother's shoulders and smiling an adorable smile. I asked the mom about him, and because of prenatal treatment, he did not convert, and is HIV-. An encouraging way to end the day!
Tuesday, July 20, 2010
Urban Hospital, Cultural Clash
Today I started working at Rob Ferriera hospital, an urban public hospital in Nelspruit. It is quite a contrast to last week. Moreso than I have felt yet while I have been here, I sense my “otherness.”
In the ACTS clinic last week, the patient population was totally foreign to me. A people whose lifestyle I understood poorly, and a language I didn’t speak. And although I think the doctors there have done an excellent job learning the language and the cultural practices so that they can be effective physicians, they are still very Westernized, and it was very comfortable for me to work with them. In addition, they wanted us to come, asked for us to come, and were eager for us to be there and teach.
Yesterday we arrived at the hospital, and the minister of health of this province had not sent a letter or given advanced notice that we would be there or that we had permission to be there. So yesterday we could not work, and subsequently, our position and role has been ill-defined. Today the minister of health appeared in person to give her permissions. Although all the staff have been quite kind, I can imagine it is not a great way to start your week to find people who you perceive as “auditors” to be spending the week with you.
This week, I am working with all South African physicians, which is wonderful, but I definitely feel like more of an outsider, and am feeling the cultural rub. When they shake your hand here, when you greet, it is a bit of an involved handshake, releasing, repositioning, and then releasing and going back to normal handshake position. It felt like a secret handshake to me the first day, I know I still can’t do it quite right, and I am practicing in my room out of their vision. The patients all speak another language as well, but mostly Swazi, not the SwiZulu that was spoken last week. I have picked up that “Dokotela” means doctor.
Not knowing the culture, I speak and act with more cautiousness this week, wanting to not overstep boundaries or do or say something culturally unacceptable.
In addition, today I was paired with an older male, a general practicioner (many of the physicians here, especially in the public sector do not specialize), who does most of the peds work. Upon being introduced to me, I could tell he was uncomfortable hearing that he was going to be taking advice from someone who appeared to be about 20, was a woman, and was white. While we were waiting for the first patient, he was talking about why he hadn’t specialized, why he had never been to America, etc. Almost felt like he was defending himself. I felt awful. I didn’t want him to feel emasculated or threatened by me or made to feel inferior by me. It was a challenge all morning, when I saw things being done incorrectly, to make suggestions without feeling like I was bossing him or criticizing. At one point, he left the room to see a screaming patient…I suspect he took longer than he needed to, because he told the nurse to keep sending me patients and I could see them and dismiss them without him being in the room…Maybe I am overanalyzing that. It is hard, when my main job is to teach out of what is not working and what is missing, to not FEEL like an auditor.
I have to keep encouraging myself that I can just do the best I can. I can just be as gentle as I can, as understanding as I can, to have as much wisdom as I can in the settings I am in. I hope and pray, that my heart is open, my eyes are open, and I am seeing and hearing without putting too much of my own cultural superiority on things. And that in the meanwhile, in the midst of the chaos, in the midst of trying to speak and understand a totally different cultural language, I am seeing and understanding the beauty of what is around me.
I continue to be struck by the numbers of orphans here. I think half of the pediatric patients I saw this morning were AIDS orphans. In the Mpumalanga province, approx 28% of the population is infected with HIV. That sounds like an enormous number, one that you can’t quite get your head around, but when you start to see all the orphans, a generation of children abandoned, your head starts to get around it.
I was also made aware today of how much denial and stigma exists around the disease, even a disease that is now getting political attention, that is getting national festivals around curing and preventing, that is infecting almost a THIRD of the population. Stigma and denial still exist. We saw a woman today who was 36 weeks pregnant. She is an educated woman (which is not true of the entire population). During her prenatal care for her last child in 2006, she was diagnosed with HIV. She has not since seen a dr about HIV. She did not come to the dr during this pregnancy until today, almost at her due date, knowing that medicines were necessary throughout her first pregnancy to help prevent mother to child transmission. In addition, her CD4 count is now 22, which is SEVERE immune suppression. It could have been prevented from getting that low had she presented to care at some point between 2006 and today. The only way I can explain this is denial. Denial that this disease was in her, that she was part of the stigma…Because otherwise, there is no logical explanation for why she would not come.
In the ACTS clinic last week, the patient population was totally foreign to me. A people whose lifestyle I understood poorly, and a language I didn’t speak. And although I think the doctors there have done an excellent job learning the language and the cultural practices so that they can be effective physicians, they are still very Westernized, and it was very comfortable for me to work with them. In addition, they wanted us to come, asked for us to come, and were eager for us to be there and teach.
Yesterday we arrived at the hospital, and the minister of health of this province had not sent a letter or given advanced notice that we would be there or that we had permission to be there. So yesterday we could not work, and subsequently, our position and role has been ill-defined. Today the minister of health appeared in person to give her permissions. Although all the staff have been quite kind, I can imagine it is not a great way to start your week to find people who you perceive as “auditors” to be spending the week with you.
This week, I am working with all South African physicians, which is wonderful, but I definitely feel like more of an outsider, and am feeling the cultural rub. When they shake your hand here, when you greet, it is a bit of an involved handshake, releasing, repositioning, and then releasing and going back to normal handshake position. It felt like a secret handshake to me the first day, I know I still can’t do it quite right, and I am practicing in my room out of their vision. The patients all speak another language as well, but mostly Swazi, not the SwiZulu that was spoken last week. I have picked up that “Dokotela” means doctor.
Not knowing the culture, I speak and act with more cautiousness this week, wanting to not overstep boundaries or do or say something culturally unacceptable.
In addition, today I was paired with an older male, a general practicioner (many of the physicians here, especially in the public sector do not specialize), who does most of the peds work. Upon being introduced to me, I could tell he was uncomfortable hearing that he was going to be taking advice from someone who appeared to be about 20, was a woman, and was white. While we were waiting for the first patient, he was talking about why he hadn’t specialized, why he had never been to America, etc. Almost felt like he was defending himself. I felt awful. I didn’t want him to feel emasculated or threatened by me or made to feel inferior by me. It was a challenge all morning, when I saw things being done incorrectly, to make suggestions without feeling like I was bossing him or criticizing. At one point, he left the room to see a screaming patient…I suspect he took longer than he needed to, because he told the nurse to keep sending me patients and I could see them and dismiss them without him being in the room…Maybe I am overanalyzing that. It is hard, when my main job is to teach out of what is not working and what is missing, to not FEEL like an auditor.
I have to keep encouraging myself that I can just do the best I can. I can just be as gentle as I can, as understanding as I can, to have as much wisdom as I can in the settings I am in. I hope and pray, that my heart is open, my eyes are open, and I am seeing and hearing without putting too much of my own cultural superiority on things. And that in the meanwhile, in the midst of the chaos, in the midst of trying to speak and understand a totally different cultural language, I am seeing and understanding the beauty of what is around me.
I continue to be struck by the numbers of orphans here. I think half of the pediatric patients I saw this morning were AIDS orphans. In the Mpumalanga province, approx 28% of the population is infected with HIV. That sounds like an enormous number, one that you can’t quite get your head around, but when you start to see all the orphans, a generation of children abandoned, your head starts to get around it.
I was also made aware today of how much denial and stigma exists around the disease, even a disease that is now getting political attention, that is getting national festivals around curing and preventing, that is infecting almost a THIRD of the population. Stigma and denial still exist. We saw a woman today who was 36 weeks pregnant. She is an educated woman (which is not true of the entire population). During her prenatal care for her last child in 2006, she was diagnosed with HIV. She has not since seen a dr about HIV. She did not come to the dr during this pregnancy until today, almost at her due date, knowing that medicines were necessary throughout her first pregnancy to help prevent mother to child transmission. In addition, her CD4 count is now 22, which is SEVERE immune suppression. It could have been prevented from getting that low had she presented to care at some point between 2006 and today. The only way I can explain this is denial. Denial that this disease was in her, that she was part of the stigma…Because otherwise, there is no logical explanation for why she would not come.
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