I am home!

I am sorry that it has been so long since I updated. July was a pretty busy month, and I was not able to get to the internet cafe as often. After a sad goodbye with my host family, I left South Africa on Saturday. I was thankful that I did not have any flight problems like last time, and I safely arrived in Waco last night. I cannot believe that my time in South Africa is over, and although I am excited to be home, I already miss Durban. I will try to update you as well as I can about the last three weeks of my trip. This will be a fairly long update, so feel free to skim it.

During my sixth week in South Africa, I did a rotation with a home-based care organization in a black township called Kwamashu. They have extremely limited resources, and the government pays the caregivers less than $60/month. Every day caregivers walk several miles to the houses of patients who have difficulty travelling to clinics. The caregivers do not have medical training, so they mainly provide emotional support as well as food parcels and hygiene supplies. They can also bring them their medications from the clinics in the area. Often they just visit the patients to check on them and ensure that they are taking their tb or HIV treatment. That week I came face-to-face with poverty in South Africa. I saw orphans living in tiny houses that smell of human waste, 20 year old girls dying of HIV, and elderly patients bedridden due to stroke. I saw so much suffering in the township, but I also saw a glimmer of hope. I had the amazing opportunity to pray with an 80 year old woman who cannot walk. I loved being able to visit the patients in their homes, to talk with them, and to hear their stories. The home-based care center and voluntary HIV testing site were founded by two retired nurses that attend the Anglican church called Ekuvukeni, which means "resurrection" in Zulu. In the afternoons I got to help cook with the volunteers at the soup kitchen held at the church. The ladies were so fun to talk to, and they taught me how to make scones (they are selling scones to raise money for the church).



The sixth week I went back to the rural hospital in Hlabisa. I again had an amazing experience there, and I am so thankful that I was able to return. I spent a lot of time with a pediatrician from Sweden. Although his job is demanding and often overwhelming, Dr. Johansson is enthusiastic and optimistic. It was incredibly encouraging for me to be able to work with a doctor who has not succumb to the apathy that is so rampant among healthcare workers in South Africa. He came to SA for purely humanitarian reasons, and he has been here longer than any of the other doctors at Hlabisa (15 months). When I asked him if his job was depressing, he said that he tries to do at least one good thing every day. He gets so excited when he is able to help a malnourished child gain weight or begin a patient on life-saving ARV treatment. When I was at Hlabisa hospital in June, I met a HIV-positive 9-year old girl who weighed 9 kilograms (20 pounds). She was extremely wasted and did not even look human. She barely moved her sunken eyes, and every time she tried to eat she immediately vomited. Her prognosis was extremely poor, Dr. Johannson did not think that she would survive. However, when I walked into the pediatric ward in July, I was shocked and thrilled to see the little girl sitting up. She has now been on ARVs (antiretroviral treatment for HIV) for six weeks, and she now weighs 11 kilos. Although she is still very skinny, she is now eating well, her face looks more full, and she is much more energetic. When I said goodbye to all the children, I finally got her to smile. She made my day when she waved at me.

I also got to visit with four children who have been in the hospital since June. When I saw them last month, they had just been admitted to the hospital with severe burns all over their bodies. Apparently someone (I don't know who) had poured lighter fluid on them while they were sleeping and lit them on fire (burns are very common in South Africa because of the use of paraffin stoves). Although they were in severe pain, they were smiling the entire time that we were visiting them. When I returned in July, they looked much better, and their wounds had healed nicely. They were again filled with smiles, and they had an amazing time trying to teach me some new Zulu words. Their names happen to contain clicks, and they thought it was hysterical when I tried to pronouce them. It was great for me to be able to see the progress they made in a month, and the day I left they were discharged from the hospital. My week at Hlabisa showed me how rewarding it can be to work with children, and I am now definitely interesting in pediatrics. I also got to work at the HIV clinic, where Dr. Johannsson initiated ARVs in about twenty patients ranging in age from 8 to 60. I learned a lot about the different kinds of ARVs and their side affects. Most importantly, I was able to understand more about the nature of the HIV crisis. Some of the patients were well-dressed, and others were unemployed. Some seemed well-educated, and others spoke little Enlish. Some appeared healthy, and others looked very sick. HIV is not confined to one type of person, one socioeconomic group or one age. HIV effects every aspect of society.

One of the host families that we stayed with at Hlabisa is Zulu "royalty." Mr. Hlabisa is a Zulu chief, and his wife is a nurse at the hospital. Their house is not fancy, but it is definitely nicer than most homes in the area. The Hlabisas have running water complete with a functioning toilet and bathtub (in my homestay we used an outhouse and bathed in a bucket with water that I heated on the stove). The last night that we were there, the Hlabisas held a braai for us. A braai is a traditional Afrikaans (white Dutch South African) barbeque that Zulus have adopted. The feast was amazing, and we ate steak, chicken, fish, and my favorite, impala (an antelope found in South Africa). They did some Zulu dancing for us, and they sang Zulu choruses. They were incredibly thankful to us for coming to South Africa, and I loved getting to meet them.

My eighth week I did a second rotation at St. Mary's Hospital, which is a semi-private hospital founded by monks in the nineteenth century. I did a rotation there in June during the strike, and it was amazing how much better the experience was after the strike ended. In June, it was extremely difficult for me to find doctors to shadow, and the doctors we did find did not seem eager to have American med students following them around. In July, I saw how much the strike had impacted the functioning of the hospital. There were many more doctors (although still not enough for a hospital that size), and for the most part they seemed happy to teach us. Unlike at Hlabisa, most of the doctors at St. Mary's are South African. I got to help the midwives deliver two babies. At primary-level hospitals like St. Mary's, women cannot be given epidurals because doctors are only present if there is a complication. I also went to the ARV clinic, called Ithemba, which means "hope" in Zulu. Ithemba was completely filled with people every time I saw it, and the two doctors see 70-80 patients every day. One day I had the opportunity to sit in on a meeting about psychospiritual care for HIV patients. The hospital is starting a series of motivational sessions designed to provide hope and inspiration to the patients as well as the healthcare providers. It was wonderful for me to see that there are doctors and nurses who recognize the importance of caring for the spiritual and psychological needs of patients, especially those with HIV.

On Thursday I went to a hospice about 30 minutes outside of Durban. The hospice is an NGO that gets funding from private individuals, companies, charities, and international health organizations. The hospice is not a traditional hospice where terminally ill patients go. Instead, it only provides out-patient care and home-based care. Although I was only there for one day, I was very impressed by the enthusiasm and compassion of the staff. The hospice employs two professional nurses, several counselors, and a psychologist. Most of the 200 patients have HIV, but they also care for cancer patients. Patients are transported to the hospice weekly, bimonthly, or monthly depending on the severity of their illness. They are seen by the nurse and if the patient has a problem that she cannot deal with, the patient is referred to the hospital. A doctor comes to the hospice once a month for half a day. Because the hospice does not have the funding to provide medication, the nurse's main role is to ensure that the patients are doing well and taking their ARVs, etc. They also have numerous support groups, and once a month they take the patients on an excursion to the park or the beach. Every Thursday they have a "day-care" program in which a small group of patients spends the day at the clinic receiving counseling and psychological or spiritual care. Every week they do a different activity like basketweaving, cooking or painting. This week they had a Catholic priest talk to them about spirituality and HIV. It was absolutely amazing to hear them discuss questions like "Do I blame God for my disease" and "What are my responsibilites in this world" and "How is my relationship with God?" I sat next to a 21 year named Paradise. She looks very healthy, and if she had not been at the meeting for HIV patients, I would have never guessed that she is HIV-positive. She was very nice and seemed very intelligent. She went to a white high school and grew up with a white family because her mom was the family's housekeeper. Her mom work three hours away in Johannesburg and only comes home on weekends. So Paradise basically lives alone with her four year old brother. When I told her that I am interested in pediatrics, she told me that she really loves her brother, and he gives her "so much joy." It was encouraging to see that Paradise is optimistic about the future. As soon as she has the money, she wants to go to college in Durban to study tourism. It was so great to be able to talk to Paradise about her life, and I wish that I could have spent more time with her before she had to leave. I wish that I could have talked with her about her HIV status. Is she scared about getting sick? Is she afraid of death? When did she test positive? I realized after I left the hospice that I was afraid to ask Paradise those questions. Although people in South Africa talk about removing the stigma of HIV, the stigma is still very present. I realized that I had let the stigma of HIV keep me from talking to Paradise directly about her status. Even in the clinics, where the stigma should be completely discouraged, the doctors hesitate to use the word "HIV." Instead, they say that a patient is "RVD-reactive" (RVD means retroviral disease). Although the stigma is not as bad as it used to be, there is a long way to go before people speak openly about their status.

I am happy to be home, but I am also really sad to have left South Africa. I miss my host family, the sound of Zulu, the beautiful weather, the hills of Durban, the ocean, and the beautiful people of South Africa. I am going to spend the next few days reflecting on my experience, and I hope to share my thoughts with you in the near future. I will also share my pictures with you as soon as I can get them uploaded. Thanks to all of you for you encouragement, prayers, and support. I could not have done this without you.

AIDS research in SA

The last couple of weeks have been busy but amazing. I spent my fourth week in South Africa at a government-run health clinic called Kwadabeka. The six female doctors there see 80-100 patients every single day. They have "little to no job satisfaction," but they couldn't imagine leaving South Africa or doing anything besides medicine. Because of the continuing strike, the clinic wasn't that busy, and we got to spend a lot of time talking to the young doctors. Last weekend all the other American CFHI students returned to the US because they are only doing the four week program instead of the 8 week program. Fortunately, another batch of 20 students arrived yesterday. I also have a new roommate who arrived last week. She is very nice, and I am thankful that she came a week early for her July program.

I spent last week at a privately funded research clinic called CAPRISA (Center for the AIDS Programme of Research in South Africa). It is almost entirely funded by US sources, including the NIH and PEFAR (The Presidential Emergency Fund for AIDS Relief). It is by far the nicest health facility that I have seen here. It is extremely well staffed, and unlike the burned out doctors that I see in the public sector, the doctors at Caprisa are excited about their work. They are doing several clinical trials at the clinic, including a HIV vaccine, a microbicide, and a study of acute HIV infection. We spent most of our time with doctors who are involved in a study aimed at determining the best time to start ARVs (antiretrovirals) in patients who are coinfected with tuberculosis and HIV. It was extremely interesting, and it was encouraging to know that there are people who are diligently working to find solutions to the AIDS pandemic. The CAPRISA center has received international attention, and representatives from the US government may be coming to visit the research clinic.



Thankfully, the strike officially ended on Friday after 28 days. Unfortunately it will take time for the health care system to get back to normal, and many of the city's biggest hospitals are struggling to provide adequate care to patients. This week I am rotating at a home-based care center that provides health care for patients who cannot travel to clinics. The site is in a large black township called Kwamashu. It has been really interesting to see where the patients live.



On Saturday I had the amazing opportunity to go to a membeso, which is a traditional ceremony for a couple that is getting married soon. The groom's family gives gifts to the each member of the bride's family. It was absolutely fascinating, and I am very thankful that I was able to experience traditional Zulu culture.

I can't believe that I will only be here for two and a half more weeks. The last five weeks have gone by so quickly, and it will definitely be hard to leave.

Drakensberg

I spent last week at a semi-private Catholic hospital called St. Mary's. In general, the doctors there seemed apathetic, frustrated, and tired. Even before the strike started, several doctors quit in the middle of the week because they were frustrated with the lack of resources. Even in the private sector, resources are limited and doctors must work under extremely difficult conditions. The hospital appeared to be running as normal even with the strike. The nurses and doctors were told by the hospital management that they would be fired if they went on strike. However, it seems that some of the staff may have been working more slowly out of sympathy for the strikers. On Wednesday we didn't go to work at all because the taxis and buses went on strike. Basically the entire city was shut down, and people struggled to find rides to work. Despite the frustrating conditions at St. Mary's, I did have some really good experiences with the staff there. I got a good tour of the laboratory, where they do microbiology, blood tests, and 100 HIV tests every week. The laboratory technicians were extremely knowledgeable and showed us slides of tuberbulosis and a fungus called cryptococcus. They do intensive HIV counseling at the clinic there, and 72.5% of the HIV tests that they run are positive.

The strike continues, and negotiations seem to be reaching some end. The government has increased its offer to 7.25%, but the union is demanding a 10% increase. It is still unclear when the strike will be resolved, and until then patients will continue to suffer. Please continue to pray for a quick resolution of the strike and our continued safety.

Last weekend I went to the Drakensberg mountains with six other students in my program. We hiked about ten miles on Friday and 6 miles on Saturday. It was absolutely gorgeous, and I am hoping to visit the mountains again in July.

Healthcare in Africa

I finally had a chance today to come to the internet cafe. The last two weeks have been amazing, fascinating, and exhausting. I am not sure how to begin to tell you about all of my experiences, but I will do my best to give you a good idea of what it is like here. This is going to be a long update, so feel free to skim it. The first week I was here I went to a government-run clinic called Cato Manor. The nurses (called sisters) basically act as doctors because there aren't enough doctors in South Africa. Nurses can prescribe meds, make some diagnoses, and distribute meds. The healthcare situation in South Africa is actually worse than I expected. Patients who cannot afford to go to a private clinic go to the government-run clinics, where they usually wait all day to be seen. We got to talk to several doctors who specialize in HIV/AIDS, and the clinic has a strong program for the prevention of mother-to-child-transmission of HIV. We saw hundreds of young pregnant women, some as young as 15. About half of the patients that I saw are HIV-positive.

Last week ten students in my program travelled to a rural hospital called Hlabisa. It provides care for about 85,000 people. It was absolutely amazing. It is a fairly large hospital, but they only have about 15 doctors. Most of the doctors come from Britain, Sweden, and Scotland. They come to Hlabisa for a year or two and then return to their native countries. Even the doctors from South Africa usually only stay at Hlabisa for a year because the conditions are so difficult. The hospital is located in a little town that has a supermarket, a couple liquor stores, and of course KFC (everyone seems to love KFC here). Given the isolated conditions of the hospital, the doctors at Hlabisa are here because they really want to provide adequate healthcare for South Africans. They were amazing teachers, and they were eager to help us to understand how the hospital operates. I saw more in that one week than I would ever be able to see in the States. I learned how to take a patient history, how to look for pleural effusion (fluid build-up) in a chest X-ray, and how to listen for evidence of tuberculosis in the lungs. My favorite day was the day I spent in maternity. I watched a doctor remove a retained placenta, and I learned how to determine the gestational period by measuring the height of the fundus. That afternoon I watched two caesarian sections, and two of my peers got to actually assist in the surgery. It was amazing to watch the surgeon deliver the baby, and I am hoping that I will be able to assist in a C-section soon.

The healthcare system in South Africa is at its breaking point right now. On June 1 the public servants of South Africa went on strike. This includes nurses, teachers, and doctors who work in the public sector. The rate of inflation is 6.3%, but the government was only offering a 6% raise to the public servants. To make matters worse, the members of parliament gave themselves raises from 37-50%. The unions are demanding a 12% increase. Thankfully, we were not really affected by the strike at Hlabisa because it is partly funded by private sources. However, conditions in Durban are worsening as the government hospitals are nearly completely shut down. Several people have already died as a direct result of the strike, including a woman who died of an asthma attack because her ambulance was not allowed to enter the hospital. This week I am working at St. Mary's in Durban, which is also semi-private and is still operating as usual. On Wednesday other workers will be participating in secondary strikes. The situation will most likely get worse before it gets better.

I have had an amazing experience so far, and I am looking forward to the next six weeks. Last weekend we got to go to a game reserve, and this weekend I am going to the Drakensburg mountains. This country is absolutely beautiful, and I feel privileged to have the opportunity to know the people of South Africa. I could go on and on about all that I have seen here, but my internet time is running out. I love you all, and I really appreciate all of your prayers. I will try to update again soon.

Prayer requests:
Safety as the public servants strike worsens
Resolution of the strike
That God will continue to give me strength, and that he will continue to remind me that despite all of the suffering that I see here, He is present.

Greetings from Africa

I just wanted to let all of you know that I finally arrived safely in Durban at 11 am on Sunday. I spent all day today at a clinic in a poor area of town. I love love love my host family. They are so kind, hospitable, and loving. They are members of the African Gospel Church, and they pray together every night. I am looking forward to going to church with them. They call me their daughter, and my "mom" and "dad" are already making me feel at home. They really love hearing me try to speak Zulu. Their 2 year old girl, Sisi, doesn't speak English, but that doesn't stop her from coming into my room and talking to me nonstop in Zulu. Thanks for all your prayers. I will update again soon.

New prayer request

I have time (eleven hours!) to kill in London, so I thought that I might update you all. My flight from Dallas to NYC got diverted to North Carolina for a couple of hours because for some unknown reason the air traffic going into JFK was too high. I missed my connecting flight to South Africa, and the only flight I could get was the next day. So I spent all day yesterday at JFK, and I am now in London. Unfortunately I have an eleven hour layover in London, and I am too tired and jet lagged to gather enough energy to go explore the city. If all goes well with my next two flights, I will finally get to Durban on Sunday morning. God has been teaching me a lot about patience and solitude over the last couple of days, and I have to say that I am thankful for technology like Ipods. Please pray that I make it safely to Durban after four days of exhausting travelling, and that I quickly recover so that I can begin orientation .

Leaving on a jet plane

My bags are packed, I am completely immunized, and I am ready to embark on this journey to Africa. I found out that I will be living with a nurse, Mrs. Shezi, and her husband. They have two daughters who are 22 and 24 years old and go to the university. They also have two grandchildren who are 2 and 8 years old. I am really excited to get to know the family, and I am thankful that I will have the opportunity to live with some South Africans who are my own age.

My flight leaves at 10:50 am tomorrow (Thursday). Coincidentally, tomorrow is my 21st birthday. Flying to Africa is not quite the way that most people celebrate turning 21, but thanks to Carrie I will be eating Kahlua-filled chocolate on the plane. In case you were wondering, I will spend a total of 20 hours flying 9677 miles. I fly from Dallas to New York, New York to Senegal, Senegal to Johannesburg, and Johannesburg to Durban. If everything goes according to plan, I will be picked up by my coordinator at 8 pm on Friday. Hopefully I will be able to update again some time in the next week.

Thanks to all of you who have given me love, prayers, and encouragement over the last couple of weeks. And thanks to my Trinity friends (you know who you are) for the amazing care package full of chocolate.

Prayer requests:

• That my flight will go smoothly, with minimal stress. (As you could imagine, I am a bit nervous about flying almost 10,000 miles by myself.)
• That God would give comfort and peace to my parents.
• That I would completely rely on God's strength and power as I adjust to life in South Africa.
• That God's peace would fill my anxious heart, and that I may "Be joyful in hope, patient in affliction, faithful in prayer" (Romans 12:12).

I am so excited about the next two months, and I am so thankful to have so many friends and family in the States who are praying for me. I love you all, and I will see you in two months!

South Africa here I come!

I leave for South Africa in less than two weeks. I will begin my two day plane trip on May 24, which coincidentally is my 21st birthday. I am so excited about going, but I am also getting pretty nervous. I have a lot to do before I leave: get a typhoid shot, buy a tuberculosis mask, get scrubs, buy a webcam, and pack. A couple of weeks ago I got the list of the other students who will be participating in the program. They are from all over the country: Hawaii, Duke, Boston University, Maryland, UC Berkeley, and even Canada. I am really thankful that I have two weeks to recover from finals, rest, and prepare for my two months abroad!