transition

the spring/summer rains are almost here. the wind is picking up, bringing with it dust, trash, warmth and the rains. the rainy season is ending in capetown but about to start here in kwazulu-natal.

so say that being able to come here has been life-changing. even through the madness that are our days, there are a couple of things that stick to my mind. elzeth is the lady who is in charge of the AIDS orphans and the vulnerable children. she told us the first time that we met her she told us that helping people is not about changing their whole lives, its about improving their lives by only one step. the other thing that has left a lifelong impression is the generosity of spirit of the people that we have met. the other thing that has been amazing and heartwarming is the generosity of spirit of the people that we have met. many of the people that we have met have so little but the little that they do have, they have happily shared with us.

pics

thoughts

our trip is coming to an end. it seems like we were just here and now its time to pack up and leave. a person asked us how we thought we had contributed to the community here. walking home and talking about it with susan, she pointed out that we probably benefitted more than the staff and community here. we are like a breeze that comes and goes, not noticed or missed.

yesterday we got a chance to go to another set of home visits. its hard to explain or verbalize the feelings that one experiences when going to some else's home who truly does not have anything. language and picture seems to stereotype and minimize the poverty, pain, and need which these families find themselves in. how to transmit their message without exploiting their poverty and their humanity?

religion

we are working in the province of kwazulu natal in msinga area in a town called tugela ferry. we are about 6 hours away from johannesburg by car. our work this time is with the home based carers, which are focused on doing home visits (community health) around the area. the main hospital is church of scotland hospital and there are about 13 satellite clinics around the area. a lot of the clinical practice here is defined by the HIV/AIDS epidemic. its sad to see so many infected individuals, the average age of death is 44, people dont grow old enough to even collect their pensions, which kick in at 60.

we had dinner in a home on wednesday. it amazing the generosity of spirit of people. we were a group of 5, they were a family of 4 and had a couple of guest. people around here dont have much, but they still managed to set up a feast that included chicken, beef, veggies, rice, and other little side dishes. i put a little bit of food on my plate and decided that it might be better to go home hungry than gorging and leaving the family with less.

on wednesday also, there was a conference with the home based carers to talk about many different aspects of the services that they provide. it was all in zulu, so we didnt understand most of the conference but the most impressive aspect of the conference was the way song is such an important method of the communication..in the middle of talks, people would start dancing and singing. at one point, a song developed that was all about the arv drugs and regimes.

christianity, both at the hospital and hospice, are a big aspect of the communal life. its interesting to see how christianity defines many of the experience and directs the manner that individuals view their role here. many of the people that work here have a deep seated believe in christianity, but the manner which they view the role here varies considerably. some people see their work here as their calling, chosing an austere life dedicated to the service of others. some individuals see their role here as a hierarchical relationship, where they are imparing this "knowledge" over the "savage masses" and saving their souls. how do you define yourself and your role when you come as an outsider to a community? how do you guard againts being ethnocentric and culturally ignorant and insensitive? i see things now on how we establish a relationship with the other. of the amazing people that we have met here, the most salient characteristic is their ability to see and treat people as their equals, seeing the work here as a collaborative enterprise, a deep respect for the local culture and the people.

culture

things happen so quickly here that it seems that i dont have enough time to sit back and reflect on them. its hard to make cultural observations because our knowledge is so shallow and limited, the observations made are tainted by my outsider perspective.

every experience that we observe is transected by racism, sexism and ageism. the apartheid goverment finally collapsed 10 years ago. there is the obvious race gap between white and black, but this is further complicated by the fact that between whites, there are the afrikaners and the descendents of the british. for the black population, there are many different ethnicities, such as zulu or xhosa.

visiting the arv clinic or doing health trainings in the community, it seems that most of the people are women. even walking on the streets, the impression that you get is that young men are missing. taking the children or attending the arv clinic is a whole day affair that begins at 10 am and can last until 8 pm, depending on the number of people and how complicated the cases are. its easy to judge individuals that miss their appointments and foster resistant as difficult patients, but once you see the many constraining forces (lack of funds to travel, risk of losing their job) you become more sympathetic. the most important lesson that i have learned so far is not to pass judgement, people's lifes are so complicated that as an outsider, you cannot impose your worldview or your assumptions on them.

we visited the nursery last week, which in the united states would be considered an nicu. you see these babies and they cannot be more than 1 pound. babies are usually born in september because in december, most of the men return from working in the mines. the babies that we are seeing now are the premature babies who require intensive care but the hospital is so understaffed and undersupplied that it makes you wonder if these babies will survive and if they do, how their development will be hampered. the nurse was telling us that children are not a priority culture because age is a marker for status.

people's lifes were are simple, dreams are simple. children walk miles to go to school, where their education is basic at best. mothers just want their children to be health, grow up, find a good job (which i understand to mean a stable job), marry and have children.

just pics

HIV/AIDS

every day here seems like a lifetime. there are things that open your eyes, move your heart, and bring tears to your eyes. its easy to overlook the impact of the AIDS/HIV by solely focusing on the adults. we visited the pediatric arv clinic on wednesday. you look at the children and see their moms and realize that it is not only the children but the mother who are infected with HIV/AIDS (transmission to children is usually during pregnancy, labor, and breastfeeding). in my mind, when you picture someone who has a chronic illness, i picture a scarlett letter branding, but when you look at the individual, they look like any other child or adult. the hardest part of the being with the children is seeing how starved they are for affection, how much they need human contact, how hardened their eyes and face have become because of the experiences that they have endured. the dilemma that arises: where do you draw the line where you share yourself with everyone and that part of you that you that must remain private; where do you draw the line of doing that one extra thing for someone and where you are sacrificing yourself.

we got to see a birth yesterday, besides the obvious fact that this is a resource poor setting and this in turn limits the healthcarer's ability to provide treatment and care, the most disturbing part of the whole process was the silencing of the woman's voice. her birthing process was defined by others, out of her control, and made to decrease the healthcarer's inconvenience.

someone told me that going to africa changes you.

home visits

started writing today about what my experience had been so far, but nothing of that mattered after i went on a couple home visits today. my first impression being here is that everything else seems superfluous, putting on makeup seems silly when the people around you barely have clothes to wear, that losing weight is silly when people here struggle everyday to stay alive. all my life in america seems so riddled with insignificant decisions. as strange as it may seem, i feel at home here. i think back to what susan said, that your cells remember their origins.

the trash, the poverty, the hiv/aids doesnt frazzle me. seeing the roads, the potholes, and the craziness of downtown just reminds me of home. we drove up msinga top to go do home visits with mary, she is the head of the home-based service. at first glance, it seems like an ineffective way to get medical services out, but we met with Pili (the home-based worker) and she gave us (or better said, Mary) the low-down on the situation. we walked to 3 different homes, and ended up having a bereavement session with a family that had lost a 3rd member to AIDS. mary told me that up here, the men go to johannesburg to work and come home to die. people dont know what is causing their illness, seems mindblowing to think that in the day and age that we live in, there are people who still do not know about HIV/AIDS.

Tomorrow we will be doing grand rounds in the stepdown HIV/AIDS unit.