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.