Home again

Its been almost a full week since I've come back home and after handing in my final assignments and realizing that this will probably be my last blog post I worry more and more that with every day I spend away from Rustenburg I will lose the feelings within myself that had been changed so much by this ISA. Coming home has been like going to a different world and even though I had left Rustenburg wanting to continue some sort of HIV related service work during my summer vacation, that plan seems more and more elusive as the days pass by and I laze around the house "enjoying my vacation." I couldn't have prepared myself for my homecoming and even though I knew what to expect and I tried to plan accordingly so as to counteract the obstacles I knew I would face it has still taken me by surprise. All I have now are the memories of what has been and the dreams that have developed as a result of my time in Rustenburg. Everyday I try to keep those dreams alive and continue on the journey I began 3 months ago when I first arrived. Thank you to everybody who has made this experience what it has been, you have changed my life. Peace and Love :)

Rise and Fall

The second morning at the In-Patient Unit and we walked in to find two of the nurses trying very dismally to insert an IV catheter into one of the patient’s arms. They constantly complained about how tough his skin was to break through and that his veins had collapsed, making it even more difficult to get fluids into his failing body. I looked at the thin frame that lay in the bed, the contours of his bones clearly defined under his skin. He lay there with his eyes shifting across the room not moving any other part of his body, what caught my attention though was his heavy and laborious breathing. I stood and watched as his chest, outlined by the bones of his ribs, rose up and down and up and down with each breath that he struggled for. The rhythmic rise and fall of his chest was the last remnants of life within him and after each breath he seemed to wait for a few moments before taking the next one. Lily and I would glance at each other and then back at his chest, hoping to see it rise, but expecting it not to. This man could no longer eat solid foods and even struggled to ingest the soft porridge that the nursing staff had prepared for him. He could not speak and struggled to breath and all that persisted was the rise and fall of his chest, pausing for a long while before rising and falling again. Many times while Sister Francinah tried to insert the catheter, we saw him drift in and out of consciousness and she would tap his head and loudly call his name to try and bring him back to life. After many attempts by a few of the nursing staff, they finally gave up inserting the IV and tried once again to orally feed his weak frame....I stood there and stared intently at the rise and fall of his chest, hoping but not expectant.
We spent the day doing whatever we could to help Bernard; as the morning progressed we fed some of those patients that could not feed themselves and after breakfast, we helped get them out of bed and into the sun for a while. Bernard explained that a lot of them often spend about 2 weeks in the wards and never go outside so any sun that they could get would be good for them. Making hospital beds seemed a more challenging job that I thought it would be especially after Bernard explained exactly what we should do and after realising that some of the linen had fluid from the patients and so we had to use extra precaution when changing those sheets. We changed all of the beds in both wards and even went to those in the TB ward where a newly admitted patient joined the three women we had seen there the previous day. As we were changing the beds, Bernard told us that another patient had passed away in the female ward. Lily looked at him inquisitively and we asked if we could see how they prepare patients for the mortuary and without hesitation he said yes, but only if we were sure. We walked into the female ward, changing each one of the beds and choosing not to pay attention to the corner bed that was kept secluded behind two curtains, that was where she lay. She has passed away only minutes before while we were in the male ward and with every bed change we came closer and closer to that corner. I tried to psych myself up to the experience, I have never seen a dead body before, except for open casket viewings at funerals and for some reason I thought that if I could stomach this then I would be ready for a career in the health professions. We finished changing the other beds, helped the patients back into the empty beds and nodded at Bernard as he asked if we were ready to see the body. He pulled back the white curtain and we huddled around the bed and waited for him to pull back the white sheet that lay over what appeared to be a frail female body. As he pulled it back, I watched and waited...her body lay perfectly straight with her arms lying by her side, the nursing staff had placed wet cotton balls over her eye lids to help them close and they had wrapped a bandage around her bead from her chin around the top of her head to help close her open mouth. Bernard went on to place a small pillow under her chin as well because he explained that if they didn’t do that then the mouth would stay wide open which is not how most family members wish to see the body of their loved one after death. I watched her feeble and motionless body, half expecting to see that familiar rise and fall of her chest but knowing that it would not come. Bernard replaced the white sheet over her head and as we left the ward I noticed that I was surprisingly a lot calmer than I thought I would be and we continued on with our day as if nothing had changed. While sitting down for a tea break I began paying closer attention to by own chest, I felt it rise and expand forward and later contract and fall again, breathing seemed so easy for me at that point but I began to appreciate this steady rise and fall that gives and takes life.

IPU

We walked into the In-Patient Unit, not knowing what to expect yet at the same time looking around in eager anticipation. Today was the day we would have direct contact with those people most affected by the AIDS pandemic in and around Rustenburg, those people that were at their lowest points and thus needed the most help. Tapologo’s IPU is essentially made up of three wards, a ward for male patients which lies adjacent to the female ward in the main IPU building. A stone’s throw away is the TB ward where patients with tuberculosis are quarantined to prevent TB infection of the other patients.
After a brief introduction given by Bernard, one of the nurses on duty for the day, we began our day just talking to the patients and as Bernard says, trying to establish if there are any social disorders they should address. We walked into the male ward where 4 patients all turned and glanced over at us as we stood awkwardly waiting for a cue or direction from Bernard. “Bo ausi ba ba tlo bua le lona ba le bolelele gore ke bone bo mang” he said (these ladies are just here to chat with you and tell you who they are and find out how you’re doing). I immediately felt the same anxiety that I felt that third week of march when we first arrived and were told to talk to the patients at Freedom Park. In my mind I wondered what exactly I would say to the 4 men in the IPU without being intrusive and asking them about their condition. My ability to speak Setswana put me at an advantage so I sat next to the bed closest to the door. The patient in the bed lay tilted up with his thin frame straight down the middle of his bed. The lower half of his legs were as thin as my arms but what startled me the most was the colour of his finger nails, the nail bed was a dark grey colour that I had never seen before but was told by Bernard that it was very common among HIV positive patients. I sat and listened as the male patient told me about where he was from and how he hoped to get better soon so he could go back to working in the mine. In the back of my mind I wondered if he would ever be strong enough to return to work, especially the tedious and laborious tasks required in the mines but I realised that for him it was something to look forward to. He spoke so passionately about how he studied engineering and what he did at the mines that I realised that looking forward to his work was the only hope he had of claiming back his old life, the only thing that would signify recovery and strength. I sat and listen to the zeal in his voice as he spoke about the future and watched the glow in his eyes as he said how he hoped to be discharged today, in the back of my mind, wondering if it was all going to be possible but hopeful for him.
We moved on to the TB ward, only after getting face masks from Bernard that resembled the beak of a duck when we put them on. Despite the mask fitting tightly around my nose and mouth I could still smell the faint scent of disinfectant that always lingers around in hospital settings, there again we spoke to the two female patients that were alone in the TB ward. Treatment for tuberculosis is taken for 9 months and because many of the patients are said to be ‘defaulters’ meaning that they stop taking medication once they see signs of recovery, Tapologo requests that the patients stay for the entire 9 month period to ensure that they take all of their medication as is required. One patient had not been taking her ARV’s or her TB medication and as a result her belly had swollen up so much that it resembled that of a pregnant woman at 9 months gestation. She explained to us that when the resident doctor at the IPU comes in he usually drains the fluid from her swollen abdomen and that just a few days ago he had drained 10 litres of fluid. She pulled back the sheets from her bed to show us her belly and explained the excruciating pain that comes with the fluid drainage. She later got up from her bed to watch TV in the other room and we went and sat down with some off the support staff at Tapologo for a cup of tea.
It had already felt like a long morning, not because of the time that we had spent there but mainly because of the things we had seen and the conversations we had had. When we approached Bernard again after tea he told us that he had to deliver some bad news to a family because a patient had just died. The patient was HIV positive, had had TB AND had cancer as well, way too much for one person to handle I thought. I listened in as Bernard make the call, “ausi, ke le tshwaretse dikgang tse di botlhoko” (I have some terrible news for you) he continued in Setswana as Lily and I stood behind the counter watching him closely. He explained that the patient had died and that because Tapologo did not have a morgue on site, the family needed to confirm which funeral home they should call to come and collect the body. We had not seen this particular patient because they were kept in seclusion due to their weaker condition in comparison to the other patients, I could not put a face to the name but in my mind I kept thinking that ‘someone had died today.’
By lunch time I felt weak myself, physically and mentally and Bernard looked at us and declared that we could help with feeding the patients and then should go home until tomorrow. We obliged and after feeding, as we washed the dishes before heading out for the day, I started talking to the nurse that had walked in to find the patient that had passed away. She explained how she closed the patient’s eyes and mouth and changed them out of the hospice clothes into their own clothes. She explained how she cleans the patient and covers them as they wait for the funeral home to come and take them away. “Maybe I should have called you to come and help me clean the patient” she said, I replied that she should have but still am not sure how I would have reacted to that experience, “you get used to it,” she said.

Almost up

The weeks run by and time draws closer and closer to the end of our experience here in Rustenburg. Tommorrow marks the beginning of our last full week of work yet it seems like we arrived just yesterday. I can see how this experience has changed me and wonder if other people will see the changes, especially because, unlike Lily who has had an uninterrupted time here, I have been back and forth between here and home since we came. We'll be working at the In-Patient Unit tommorrow! Like a reward, Stephen declared that since we had a few days left in Rustenburg we should do some work in the IPU and the other HIV/AIDS clinics that they have at their various sites. I remember the very first day that we arrived at Tapologo and how all we wanted was to work in the IPU, it seems like a fitting task to have during these last few days as we get ready to pack up and head out. The last assignments are being written and final tasks being done, we'll try and take in as much as we can of whats left of our experience here to add to the many storys that we already have to tell.

Day of Freedom

Today marks the day that South Africa had its first democratic elections. The first day that the people of South Africa, both black and white were able to vote, a day that marked the end of apartheid. It seems ironic that Freedom day 2010 has come at a time where the racial tension within South Africa has reached a high point, both with the actions of Julius Malema and the murder of Eugene Terreblanche. The 2010 FIFA world cup is looming closer and closer and despite where the country is headed, it is without a doubt that 16 years ago, today, marked a day that has forever changed the history of South Africa.

A day in the life of a child-care worker

With very little to do today, we asked one of the child-care workers at Boitekong if we could accompany her on her home visits for the day. She readily agreed and after setting a place and a time to meet I began wondering what exactly we were going to see and do today?! The sun shone down as groups of school kids, all clad in blue, flew past out parked car, with ice-lollies in hand to cool their sun-struck bodies. The expressions on their faces as they walked past us asked who we were and why we were blocking their walk-way. A few smiled and waved and after a few minutes, Angie, the child-care worker came and we went on our way to the local kindergarten to pick up Gift, who was one of 4 children in the first family we would visit.
The first family was made up of 4 children and Angie had come to teach Tsholo, the 8 year old about being a good friend.
“Who is your best friend Tsholo?” Angie asked
“Ermm, Siphiwe,” she answered
“What would you do if Siphiwe was HIV positive?” Angie asked
Tsholo looked down at her tiny hands and answered, “I would cry!”
It was then that I understood the importance of these weekly lessons. Tsholo stated that she would no longer play with her friend out of fear of contracting HIV, a fear that has alienated many children from the community and created fear and restlessness as well. What the care-givers do is teach children about how HIV is contacted and how infection can be prevented, through their teachings they remove stigma and isolation for those children that are HIV positive and teach preventative measures for those that are negative.
The second family we visited was made up of 7 children from 2 different mothers, both of which had passed away and left the children to all live with their paternal grandmother. None of the children had birth certificates or ID documents and so they had no access to public funds and were all in the 2nd grade despite the fact that they ranged in age from 6 to 15. Their grandmother worked menial and temporary jobs to try and feed the family. She arrived at the end of the lesson and immediately settled into her chair complaining about her aching feet, she walks for many miles to and from work daily. This is probably the worst of situations we’ve seen since we’ve been here but today we have asked to go on more visits with Didimalang, another care-worker from Freedom Park. Freedom Park seems to be the worst of all the OVC areas so I wonder how the circumstances will differ there.

Special kind of person

It takes a special kind of person to take in a newborn baby that had been abandoned by its parents and care for the child for almost a year as if they were their own. The type of person who has founded an organization to meet community need and even goes as far as paying the volunteers for transport costs and other business associated payments out of her own pocket. Someone who always gives and has not recieved a cent for those efforts and would not have it any other way. Marie van Schalkwyk is this person and as the founder and director of NeoBirth, her selfless generosity can be seen throughout the organization and its subsidaries. We arrived at NeoBirth this morning to find that a week old baby had been left their by her mother the day before who simply said that she could not cope and handed the baby to the NeoBirth staff. Angela took the starving child home with her, much like how Marie herself took in a baby who was born to a drug addict father and prostitute mother almost a year ago and has been taking care of the child amidst the long going court case to determine whether custody should be given back to the parents or if the child should be placed in the foster care or adoption system.
The humility and selflessness of the caregivers as well is highlighted by the fact that these women take care of about 20 children each. They hand-wash the childrens laundry, clean the households for those that a child-led, they help the children with their homework and even sometimes feed the children at their own homes and out of their own pockets. It takes a special kind of person to do the work that all of these women do daily.

Extension 13

Today the wild African sun beat down like a Zulu dancer’s drum. My head was spinning from the sudden onset of a migraine brought about by the heat, I took some pills and watched as we snaked our way through Boitekong’s Extension 13 accompanying the child-care providers on one of their weekly home visits. The area was filled with tiny convenience stores at every corner as residents tried to make a living by selling various fruits and vegetables. Almost all of the houses were small; mainly one or two rooms while others were the same shacks that we had seen before.
We made our way into the first household, headed by an old woman whose daughter had passed away and left behind her two children for her mother to look after. The child-care worker who had been visiting with the family had decided to leave the position, Angela had told us last week that many of the woman had about 10 households to care for and the work that they did impinged a lot on their own family lives so that might be the reason why she left. Lebo, the OVC co-ordinator reassured the old lady over and over again that they had not forgotten about her household and would continue to send over as many people as they could until they found someone to take over the position permanently. “We have not forgotten about you,” she said over and over again in Setswana to try and lift the spirits of the old woman who said that she was disappointed by the departure of their previous child-care worker. It became evident, the extent to which Boitekong’s child-care workers are respected and needed in the community as Lebo reassured her that they would still go and check on how the kids are doing in school and would still walk them back from school when they could.
There must be thousands of families living in each settlement but the households visited are chosen according to the criteria of the OVC (Orphaned and Vulnerable Children) programme. Mainly those households where children are orphaned and have lost both of their parents or those children who have one or both of their parents infected with HIV fit the criteria and are included in the programme. From the other families we visited it became clear that a lot of the households were headed by grandparents, many of which were old and had their own debilitating illnesses. I also found that many of the college aged children stayed at home because they either had not done well enough in their high school leaving exams to secure a place in university or could not afford to go and so they ended up staying at home because there were no other alternatives. That alone could lead to increased prostitution and HIV infection as they may not see any other ways of making money for finding employment. Hopefully the government will find way for this never-ending cycle to end.

NeoBirth

I'm sitting outside feeling the moist sand underneath my bare feet and listening attentively to the distant call of the birds up in the mountains. The past few days have been filled with rain so the feel of the warm South African sunshine is much welcomed and was sorely missed.
We spent the day with Angela from the NeoBirth Care Center and even though it has been 7 days since we started working there, today I finally understood the scope of the work that they do. As a Christian organization (shown by the various biblical readings all around the office as well as the Christian messages that accompany their food parcels) NeoBirth works mainly to provide and instill basic life skills, HIV/AIDS Awareness, Pre-abortion counselling, support for abused and neglected children as well as foster-care and help with facilitating adoptions. In the previous days that we have been at NeoBirth we were mainly helping them organizationally but today we went back to both Freedom Park and Boitekong with Angela to deliver food parcels and sit in on a training session with the care-givers at both centers.

The previous days rain had turned the barren roads of Freedom Park into mud-filled tracks that we maneuvered through, arms filled with food donated by local churches to those families that needed them the most. We made our way through the neighbourhoods of corrugated iron shacks, among the multitudes of goats and pigs, to the first family. A mother with three children who did not receive any form of support from the government. She seemed a little awe-struck by these 6 strangers (accompanied by one of the care-workers) who suddenly came, seemingly out of nowhere, with food. It was the most eye opening experience of my time here because it is impossible to imagine how people can live in a 10 X 10 square corrugated iron shack, today I saw the inside for myself. Everything was neatly packed away and the inside spotless, It was easy to see that the family took pride in the little that they had.

On we went to another four families, giving each as much food as we could for the number of children in each family. One household was headed by a seventeen year old girl who took care of her three younger siblings while also holding a temporary job at the local convenience store. I've begun to appreciate what I have so much more now because of what I have seen and putting myself in the shoes of the grandmother who has 3 grandchildren to feed without government support or the teenager who has lost both of her parents and has younger siblings to take care of has opened my eyes to the luxuries I take for granted.

At Boitekong we sat in on a training session for the Child-care workers on the various social, and physical developmental mile stones that children normally reach at various year groups. I'll be writing my final report on the difference between HIV/AIDS preventative measures taken in South Africa and in Botswana and from the training session I realised that many of the initiatives taken to combat HIV in South Africa are run mainly by NGO's while the Botswana government plays a key role back at home with a lesser part taken by the NGO's. Tapologo, in partnership with NeoBirth works not only to address the issue of HIV but to combat social issues as well, such as education, poverty and basic social well being. The care-givers each visit with about 10 families (an average of 20 children) to find out how the children are doing in school, the problems faced by the family and how they can be helped. They address issues of teen pregnancy as well as transmission of HIV from a mother to her unborn fetus and look at preventative measures for both.

It is incredible to see how each woman took such pride in the families that she visited with and to hear of how appreciative the children are as well. The work that they do and the diligence with which they do it is unparalleled and Lily and I will be lucky enough to accompany them on one of their home visits this coming Tuesday. This is exactly what I came here for, this is what I've longed to do.

Home again home again

For the first time in 4 years I was home for the easter weekend!! I took Lily along with me and amongst the church ceremonies and quiet Botswana landscape she continualy said how she enjoyed meeting people and more especially the late afternoon BBQ we had on Saturday with a group of my friends...lol. I never really pay attention to specific details when I'm home so it was really refreshing to understand the wonderful simplicity of a game park filled with animals as a the perfect place for a few friends to have a 'braai'. It felt like a lifetime had passed since I'd been back, I had begun to forget how peaceful and refreshing Botswana was and how familiar it has always been to me. From the broad smiles of friends that I hadn't seen in ages to the comfort of my own bed that I had taken for granted. It seems ironic for me to feel homesick from a place 2 hours away when I spend three quaters of the year thousands of miles away!!

Take your shoes off and step on the scale please...

Today we spent the day helping the nursing staff from Tapologo do medical assessments on about 60 children. It was by far the most enjoyable day I have had here thus far yet also the most tiring. Out of the door by 7am we headed to Boitekong, an out of town residential area that is also built around a Platinum mine. The lady who runs the centre there, Lebo had her daughter with her and it was hilarious watching her sneakily wipe her boogers off her moms shirt while she was turned away...lol. Many of the children that are registered into the OVC Programme at Boitekong are HIV positive and those that had yet to be tested had their blood drawn today as a 'Rapid (HIV) Test' was performed. Among the beaming faces of those children that had come out early to get their physicals, there were those that cried at the very site of any type of medical equipment and those that would do anything to have us take a photograph of them. Lily and I were in charge of weight and height measurements to make sure that the children were developing normally, after the initial assessment we did, they were then sent on to the professional nursing staff who examined their reflexes, lymph nodes, blood pressure and all that other good stuff.
Although to many of the children, the only words we exchanged were "could you take your shoes off and step on the scale please" (in setswana of course) this is the one day that we have had the most interaction with the people of Rustenburg, both young and old. After a week of being in a back room cleaning out the closet or organizing books, today felt like a breath of something new, people...finally!
We took many pictures of both us and the children, and while trying to put on our most professional looking 'medical poses' we couldn't help but laugh at the little boy who came up every so often to ask us to take a picture of him, and would still hold the same pose he did for the last 5. It was a very tiring day but I hold on to the hope that we'll have many more just like this one.

One week on..

It seems like we have been here for a lot longer than the 7 days that it has been, Rustenburg has begun to etch itself into our brains as we learn to find our way around after being lost everyday this last week. It has been a busy days work at Neobirth and after having cleaned out their outlet store and organized the clothes donated for pregnant mothers, I began to think about why I decided to take up this venture. This past week Lily and I have spent organizing books for the childrens library at Freedom Park, a mining residential area of low cost housing and corrugated iron shacks. With the tasks few and far between we have taken to doing routine and laborious work like washing dishes and mopping the floor just to have something to do. So after 4 days spent at Freedom Park and the days work at Neobirth, with the load weighing heavy on my shoulders and spreading its ache across my muscles I began to think back to why Lily and I decided to come to Rustenburg, South Africa in the first place.
With a fire in our hearts and a will to do some good in the world we left the comforts of Schenectady and crossed the Atlantic. With rose-coloured glasses I told myself I wanted to make some sort of change in the lives of the people I'd be working with. I wasn't as ambitious as to say I wanted to the change the world (I'll do that later) but change one persons world atleast. The first day we arrived at Tapologo we were given a tour of the center, the In-Patient Unit and Lab. We met the staff and the familiar excitement that had been diluted by the hard work of planning this independent study began to return. We went to Freedom Park that very first day, met the amazing women at the center who run the after-school care programme for the children and went home eagerly awaiting the next day.
We began sorting through hundreds of books that were gathering dust in the store-room and even had some children come in to help us transport them into the newly formed library. We tried setting up computers that had been donated to the center as well, probably the oldest computer models known to man-kind, but were set to fail, not only because of how old they were but because of the many missing parts as well.
I may not feel like I am changing any lives but I've seen the joy in the faces of those children that ran into their new library, grabbed a book and all gathered around it to read together. I've seen appreciation in the face of the old man who told me about his long struggle with TB, how he wishes to get better so he can get back to working in the mine and who insisted that after every sentence, I reiterate his story to Lily in english. I may not feel like I am changing any lives but I am making some sort of difference...we'll see what this week has to offer.