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South Africa: Journal of a Public Health Student
by Brett Mayfield | July 2008
Brett traveled to South Africa during July and August of 2008 for hands-on experience in public health, one of his concentrations at NYU's Gallatin School of Individualized Study.
Wed July 2
so if delta didn't make mistakes, there wouldn't a business class. im happy to be their mistake! i got upgraded to business class for that intense flite, yo. amazing.
anywho, i have to pay for internet here, what?! so things mite be concise but i hope the pictures look ok!
well it looks like at the moment im having trouble uploading photos here, so you can go to my flickr i think its flickr.com/people/brettmayfield but im not entirely sure my user name is brett.mayfield so maybe you can look or search for that
i went grocery shopping, read tons about abortions and hiv, am getting geared up for out 5am start tomorrow to hike up table mountain, we are planning a shark dive, and people are pretty much cool. god i love so many public health nerds. people are from texas, las vegas, new york, and some random elsewheres.
um...its cool here, but not too cold, flannel and a hoody makes me happy and fine
i like my lodge, the freeland lodge and listening to people is awesome. lots of codeswitching between languages.
um i think thats all...?
guess ill talk ith yall soon ciaooooo
Thursday July 3
So a few of us (Drew my roommate, Shashana and Jaushna) went to take a train. First we hit the strip mall area to buy little things for daily life. We got train tickets, R5,50, which is about $.80 maybe? It's been raining all day, so we stood in the rain and waited for the train and then left Observatory and went to the main area of Cape Town. About 20 minutes of training it.
Oh, yesterday we drove by smaller versions of favellas. It's kinda...I dunno. I dunno how I feel about it. I do know I don't like it.
We wound up in Cape Town, and we went to the First National Bank, swapped money (the rate is somewhere between R7,5 and R7,9 for US$1) and then got lunch. I got pumpkin stew, which was served on buns and not at all like a soup as you'd expect, and that chicken curry which was mad good. I wanted to compare the SA version to the Amer'n version and definitely some similarities. But SA uses less chicken, at least thus far, and adds green beans.
We walked and walked and I found a photo shop! Then went to the Company Gardens and like whoa lots of ducks. They were vicious too. But we hit the South African History Museum. I know a lot about rocks with scratches on them.
Um...My TA from Epidemiology is here which is pretty cool.
We are thinking about going shark diving. We didn't go to Table Mountain because of the rain.
Also, this may or may not be a place where I synthesize thoughts and write deeply about things. It's hard for me to write out some of these things eloquently, especially when we go to Durban and I do a homestay with some rural villagers. That's why I turn to pictures I guess. Don't be disappointed. But ask. If you want more let me know. I'm not being shallow about the trip. I just can't figure out how to talk about it.
Ciao per adesso.
Friday July 4
So we had orientation a few hours ago and I got my NGO assignment. I will be working with ARK-Absolute return For Kidz. Myself and one other girl will be working with them. This is their Mission on their website:
ARK is an international charity whose purpose is to transform children's lives.
ARK was founded in 2002 by a group of senior figures in the alternative investment industry, pooling their skills and resources to improve the life chances of children. With a shared vision of collective philanthropy, ARK delivers high social returns on philanthropic investment.
ARK brings together passionate experts with the best talent from business. It has developed a strong results-driven model to identify, create and deliver innovative programmes addressing critical issues in the areas of HIV/AIDS (South Africa, Mozambique), Education (UK, Asia) and Children in Care (Eastern Europe) that are transformative, scalable and sustainable. ARK applies the same principles and disciplines to managing the charity as it would to running a business, focusing on the transformation of children's lives through rigorous research, monitoring and evaluation. ARK's work meets high standards of efficiency and effectiveness.
ARK's Board of Trustees and Patrons ensures that the central administrative costs of ARK are met. 100% of donations are then used to deliver ARK's programmes. The Board acts as a catalyst for others to give and leverages additional funding and significant resources for ARK's work.
I am excited for this. Hopefully we will be working on projects and/or with people directly that are being helped by the organization. The good thing is that they also work in Eastern Europe, so maybe this will turn into something that I can pursue there in the coming years.
We are having dinner in the Bangkop(?) area tonite at an Islamic restaurant.
So during apartheid there were different sections of people, White Black Colored and Asian. Apparently now Chinese are considered Black. I dunno. But whats interesting is that saying colored here is totally chill. People will often identify as that, and apparently Colord people make up the majority of the population of either South Africa or Cape Town. Though apartheid is over, people still identify with some of the terms because they actually semi-accurately denote cultural practices and understandings.
I haven't bought a cell phone and wont be. And Im happy about that. Its cool to not be attached like that. Besides the fact that it will allow me to spend less on stuff I don't need and invest more in the food and experience. Ive been eating a lot of food and good stuff. The pizza is mad good here. I just ate one with chicken, brie, basil and cranberry jelly.
Um... oh ya. We got our syllabus. When I have it in my hand ill type it up. But in two Mondays we have a guy coming in who runs the archival documentary something or other at the University of Cape Town and is a well known documentary photographer and hell be doing a lecture for us so im stoked!
I dunno what else now. Well, weve been hearing consistently about how crime ridden SA is. They said travel in more than pairs. And it has been reiterated over and over. Its mostly petty, like theft, burglary. So weve been rather good at watching out. Our mentality hasn't changed and we aren't really changing our behavior other than being in groups. A few of us just had coffee and the owner of the café called the police maybe to report or talk about a mugging she just watched for the second time this week. Oh well. Apparently this has a lot to do with how severe the economic gap is and also how on top of each other the rich and impoverished are.
Saturday July 6
We visited a townships and informal settlement yesterday (Gugulethu) and I took pictures and had a hard time and got uber messed up and unsure about photography as a medium and don't know how to compromise. How do I take pictures?
But while in the 3 bedrooms of about 9 families I took photos of the room, because one guy asked me to come in and look and would point things out for me to shoot, or so I assumed. So I got interesting photos that way, and then when I got out of the house, the kids saw my two cameras as well as the cameras of my peers already outside and they started posing on the stairs for me and asking to see them. I also randomly had Trident Jaclyn gave and some Doublemint, so I gave them pieces of gum which created a tidal wave of children.
Soon after we drove out of the settlement (which is what my issue was with, we could have taken a fifteen minute walk out of there instead and we should have been split up into smaller groups) we were taken to a place that the driver, who lives rite next to the townships, owns. She has turned her home into a bit of a cigar lounge and sports bar to create revenue. About 8 locals were there, so we got to eat some of the random pastas they had prepared. We were there and one guy was HIV+ and who's viral load, he just found out, is undetectable, which is great, except that if one is above a CD4 count of 200, then one is no longer eligible for the federal grant of R850 that is given when below 200. So it can be bittersweet. Fasi, the HIV+ guy, was open about his status, which is pretty unusual. Though people often know, individuals are not open, especially men, about their status. He spoke to us, and we talked with him, and it was interesting because he seemed shy and softspoken, but was very emphatic about his message of door to door education and this and that and the other.
I'm not giving the tour credit and am being rather straightforward about it because I feel like it's impossible to try to convey the unease that I felt and how much more conflicted I am about photography. To the point that it is much more of a convoluted love-hate relationship than ever.
We got back home, chilled for a spot, then me Sarah and Annie asked other people to come to Long Market st with us, but people were going to Waterkant (the Waterfront, commercial area with more international branding, etc.), so we went on our own and picked up blander normal food, like margherita pizza and a chicken and avocado sandwich. after the pastas it was a must. i downed a bunch of coffee and then we walked and got to a place called Mojito which was a Carribean rest/bar.
We got back to the house around nine and then played 30 Seconds, which is like Taboo but with a board and references a lot more English and South African things than we could deal with.
Today I'm going to go to the green market and i want to pick you up some textiles. There are fabrics and everything made by people in the townships.
Thursday July 10
Class class class
So that you know, I am actually taking classes here.
We have been all over the place, and it's all rooted in public health. We have been talking about the economic implications of malaria, how public health has changed from the Apartheid, all this crazy stuff.
Today I went to a provincial clinic that treats trauma and HIV patients in an area of informal settling in Gugulethu. A few of us sat with the coordinator for about an hour and just launched questions and she just gave us comprehensive answers. It helped to better understand the conditions that the doctors and nurses have to work within in order to treat those around them. The clinic we visited is called the Hanaan ___ Clinic (woops, forgot the middle word, oh well). The treatment here is specifically for those that are HIV+ and the main purpose is to roll out first and second line ARV's (antiretro virals). But what is interesting is that the patients who choose to utilize the clinic must disclose their status to a certain number of members of their community, even the adolescents to their parents. This helps to battle the stigma associated with HIV, as well as indirectly holding the patient accountable for their treatment. They have a phenomenal adherence rate to drugs, sitting at about 98% and they attribute this to their counselors and the methods that they use. The program has been so successful that the coordinator, with whom we spoke, has been asked to start up the creation and management of another facility. Desmond Tutu is the overseer of the Hanaan facility, as well as some neighboring ones. Tutu has started a mobile testing and treatment campaign called TutuTesting.
I saw a surf movie this week called Zulu Surf Riders. It was a documentary. Actually I'm ot gunna talk about it. It kinda sucked.
Um...I'm hiking Table Mountain on Saturday.
Um...I have really liked the classes, because each lecture is by a different person from a different field. It has been really good to view so many of these public health issues from such a wide range of perspectives; sociological, economic, medical, etc. And we have seen the real application of policies as we go into clinics and townships.
It's an unusual place to be, in that when you study abroad you think that you'll get bombarded with culture shock or so many new things, but it's like being in suburban areas that have swapped demographics and just has less money. Everything is in English, as the 3 languages here are English, Afrikaans, and Xhosa. I like Xhosa because we have to make clicking sounds to say a bunch of the words.
Tonite for dinner I had this ridiculously good grilled calamari and then prawn wantons. I was at a restaurant called the Green Dolphin at the Waterkant. I meant to see a movie, Iron Women (?) about the Liberian president and her entirely female cabinet. But apparently my ticket is for tomorrow...hmm...
The food hasn't been too surprising or crazy. Some things are a little different. We eat ostrich a bunch, beef bacon is macon, and chicken liver isn't exclusive; actually it's really easy to get and cheap.
I had to pull out some money today to pay for the safari we'll be going on, and how I wished the R3,000 I pulled out was actually dollars.
Picture taking has been slow because we've been in classes, but the clouds here still have unbelievable structure. Ugh clouds! It rains every day! Actually, today it didn't, but it was the first day without any. Whateva. But it's cold. Africa is cold. I think it's also kinda cool that I'm at just about the farthest point south on the map save for Antarctica. As if that place even existed...
Tuesday July 15
We have finished the proper classes and are into our shadowing/internships. The classes ended with two lectures. The first was given by a well-known South African documentary photographer, Paul Weinberg. He is most well-known for his collections on Bushmen. I am really interested in some of the stuff that he does because he situates himself in the rural areas for several months at a time, understanding the culture and style and everything as he shoots. It is pretty streamline with the work I would like to do in Romania.
The following lecture was from representatives of Sonke, a local NGO that is doing a lot of work towards gender equality, but especially in terms of men. They are addressing the domestic and sexual violence issues, trying to make sure that men are good partners. I think this is good, because the marginalized (women and children) always have overwhelming support systems, to the point that services are marginalized for men. I think this is true across the world. Straight men in the states are marginalized in terms sexual and reproductive health services. Let's take that position for just a moment and throw in a twist. The twist is called HPV.
Over half of women in the US, and likely around the world, will have HPV by the time they are 40 years old. It's pretty much a given at this point. Where are they getting it? From men. Straight men. 500,000 women a year die of cervical cancer. 100% of those cervical cancer deaths are linked to the few strains of HPV that can cause cervical cancer (in the US those strains are mainly 16 and 18, whereas here in South Africa I believe it 16 and 32). As you may know HPV also manifests itself with the unsightly but mostly harmless warts. This has become rampant in gay men in the US. Penile and anal cancer incidence and prevalence have both risen due to HPV, as well. In gay males, at least, because that's the only people that studies have really been looking at. What this means is that there is probably an overlap between MSM and MSW. This is how many STI's are transferred between genders, sexes, what have you. If so many women are getting HPV, why are we treating and vaccinating women, and not men? In South Africa Gardasil has not yet even been placed into the public market. Privately it may be possible to get, but certainly not in the public facilities. But why is it that I cannot be "ONE LESS?" Am I left to be "ONE MORE," that will be left to the wayside? Though I have never intentionally used them to my advantage, I have seen the white, anglosaxon, protestant, male and straight traits to be of benefit. But I still cannot get a vaccine against HPV? Mexico and Australia say I can.
Bottom-line: when one group is marginalized, we are all marginalized.
My above sequence may not work for everyone's mind, but in my ADD head, it works out just fine. And that's cool with me.
Anyways, I started my shadowing at ARK (Absolute Return for Kidz) today. It has very little to do with kidz. It is a British organization, and I'm sure in the beginning it was geared towards kidz and their caregivers, but while talking with Dr Peter Bock, whom I shadowed today, he simply said it would be too unethical to focus only on caregivers and children. The mission statement is for the stakeholders and for money. What is cool, though, is that ARK is responsible for a huge amount of the ARV rollout in South Africa, something like 12% of those on ARV's are on therapy due to ARK's facilitation. ARK is best at resources, it seems. They supply clinics with things they need, be it a desk or drugs. They do much of the hiring of nurses and doctors for clinics, they create exit strategies and sustainable practices for NGO's to transfer clinics to the DOH, and they are facilitating several studies. Today we went to a provincial clinic in a township to check on how the growing PMTCT program is going. PMTCT is Prevent Mother To Child Transmission. In case you aren't aware, not all babies are guaranteed to have HIV if they are born to an HIV+ mother. PMTCT has become one of the hottest prevention programs in the country, especially with regards to breast feeding. There is a lot of data showing that exclusive breast feeding does not transfer HIV to the baby, which I think is good because it means that the formula companies can start to step off! They are giving way too much formula to these people that can't effectively use it. If a mother is HIV+ and is supplied with formula and doesn't have clean water, what is she going to do? She needs to breast feed then. But if the next week she has clean water for the formula, what will she do? Not breastfeed and she will use formula. Then if she breastfeeds again, what happens? The baby will be HIV+, almost guaranteed. But 98% of women, whether they need it or not, are opting for breastfeeding, because it's a free handout! It's like those tampons that they are giving to girls in Africa; IT DOESN'T WORK! STOP!
The inability for companies or organizations to have any foresight is severely damaging the lives of people in places like South Africa, Russia, Iraq, all of these places. Understand the culture and the lives before you give money or resources, or before you rent an office in the city to take a car into the village. These unsustainable practices like formula, like democracy, like trying to outlaw FGM; these are bad things! College kids that have just graduated with a degree in economics and want to start a random NGO in another country and have smiling kids in pixilated pictures on their shitty pamphlets talking about how they have started a community knitting club and donated cotton machines in Ethiopia need to understand what they are actually doing! The same is with FGM, female circumcision, or however you like to phrase it. This practice cannot be outlawed, nor should it be! Enforcing and ENDORSING these policies does two things: shows a fundamental lack of understanding or regard for a culture and its practices that have been deeply embedded in the culture for longer than many countries have existed, and secondly completely uproots the existing structure of society. I am all for humanism, equal treatment for everyone regardless of blah blah blah, but no way will I walk into the Bush trying to instate that notion. Let them understand the safety issues, then teach them about how to either continue the practice safely, or better yet, how to substitute the practice with another ritual. At the extreme I could even say mild scarification. Yes there is some pain involved, but it isn't sexist, and that's all we need.
Anyways, that might be all I have for today.
I took tons of pictures of real penguins a few days ago.
Friday July 18
There is a bit of an uprising. Some of the class are voicing their opinions on actions taken at a dinner a few nites ago. Honestly, I think most of this is ridiculous. But it's not really important.
I saw a play a few nites ago. Cissie, about Cissie Gool, an activist during the Apartheid, specifically held situated in District Six. It was good, but I forgot how I don't really like plays. Musicals maybe, plays, not so much. Unless they are skilfully executed and done in a unique manner, like The Laramie Project, or Waiting for Godot. Or Vagina Monologues.
I have finished my shadowing for the week. Again, I was with ARK, Absolute Return for Kidz, and I shadowed Dr Peter Bock and Thuthu. I didn't get Thuthu's last names, but with Thuthu being the condensed version of her name, I wasn't going to butcher the whole thing.
Each day I went to a different township; Nyanga, Phillipi, and I think Gugulethu again. Jaughna and I went to maybe five clinics and three NGO's. ARK provides personnel, financial, and all sorts of other resources to clinics via other NGO's. ARK works with Ma Afrika Tikkun and S.A.C.L.A. to provide training for Patient Advocates who work in the townships, directly with HIV/AIDS, TB, diabetes, and other patients. ARK trains, though, specifically for HIV/AIDS PA's. The PA's go to the homes to check in on the patients/clients and makes sure that they are adhering to the ARV and DOTS plans. The ARV's should be taken according to their regimen, because failure to do so can result in the development of a drug-resistant strain of HIV. Africa is privy only to two lines of drugs that help the body decrease the viral load. The US has plenty more.
I was especially happy to see that there are a few gardens that have been started at Ma Afrika Tikkun and SACLA. The gardens are teaching tools for those that work in them, and they also supply the kitchens with loads of different vegetables. The gardens are not very small, either. The kitchens, in turn, are forums for some of the people in the township to come together to cook or learn cooking, as you'd assume. But the kitchens also turn to the community to provide food about four nites a week.
ARK is doing a particularly good job at working within the boundaries of the government, as they are setting up these clinics and other facilities for the government to takeover after 1-3 years of ARK's system implementation. But ARK moves beyond much of the government's abilities. They have been instrumental in working out ways to pull apart the vertical health system and rebuild new ways of combining health services. In SA patients can't go to one clinic to get multiple things fixed up or checked out. Everything is divided and they have to have referrals from one location to the other. With people living in shacks and unemployment around something like 40-60% in some of the townships, health and referrals and treatment start to move to the backburner. It's unfortunate that this is the situation, and I really cannot express the kind of dire circumstances that people are put into as just a result of the system's setup. It's not that the services aren't available, but they aren't accessible. Accessibility issues are killing me. But they are really killing other people.
The stigma of HIV/AIDS here is ridiculous, too. People avoid testing, avoid disclosing, are beaten, are killed, are all sorts of things because they are HIV+. There are a number of other NGO's working on destigmatizing and trying to get at the roots of gender-based violence (GBV).
There is just a lot to take in. And no way to get across the kind of things that need to change. The people living in the townships aren't looking for handouts, but they are looking for a way to move out of tin shacks and just everything.
Anyways, let's figure something out.
Sunday July 20
Everyone has left the lodge and headed to Robben Island, where Nelson Mandela was imprisoned for 27 years. Yesterday was his 90th birthday. There were quite the celebrations.
I didn't really feel like going so I am still at the lodge. I went to Cocoa Chachi, a gnarly good coffee shop on Lower Main Rd, for coffee and to write. I am sposed to be keeping up with a log that has my thought about the class, public health, etc. It's hard to keep it focused on PH, because I want to talk about my reactions, but I think that the professor who will be reading these isn't very interested in the way that we synthesize our experience other than what has to do with PH or the implications and environment surrounding it.
I think I'm gunna go walk around and photograph stuff. But I don't know what to shoot. I spose I'll just find things. It's finally hot out. It was sunny yesterday and is again today and it's mad good out.
Oh, I put up a few new photos on flickr. Soon more to come. It's just expensive to put them up because I am charged by every MB that I upload. Anyone that wants to see the full collection should let me know when I am back.
Anywho, ciao for now.
Tuesday July 29
So I just got back from Durban in KwaZulu Natal, one of the other 8 provinces in South Africa. We spent our time doing a ton of stuff.
The first is that we drove for a few hours and arrived at Hlabisa Hospital, a pretty comprehensive medical facility, but it is still lacking in a lot of resources. We sat with the hospital manager and the head nurse for pediatrics and maternity. We then walked around to some of the wards, specifically the children's surgery ward. Apparently one of the patients there was also there last year. It has become a bit more of a facility for housing kids that are chronically ill or have been orphaned. The whole hospital has maybe 8 doctors. Clinical Nurse Practitioners are really heading a lot of the efforts there. One little boy was asking us in Zulu to gather around and put our hands in a pile and then he started chanting and praying. He felt like he needed to pray for us. We slowly moved out of the hospital. It was a weird circumstance to be there and not be able to put in any effort towards helping or facilitating or anything.
We drove directly to a rural township in Hlabisa and hung out for about two or three hours with a bunch of kids from the village. They were ranging in age from 3 to 18 and then there were a handful of grandmothers and some older men around, as well. After some performances, some greetings, some minispeeches, and more, we sat down to this killer dinner. They had cooked some meats, some sausages, these unbelievable beans, fried pap, ah so good! We wound up he meals, and followed a few family members up this big-ass hill, crazy dark out, and wandered onto the families' respective compounds. Since 18 year-old males cannot live in the house proper, two-bedroom huts are built for them and usually their brother(s). That is where Drew and I stayed. We walked around with 3 of the guys in the family we were staying with, who were all in high school. Eventually Drew and I were off to bed and tried to sleep through the squaking geese. The rooster started crowing around 5:00 or 5:30, so we got up and wandered into the main house. There, two of the older women had prepared our baths: two wide buckets, shallowly filled with about two inches of hot water. They handed us each a buckets and bar of soap. So we headed back to out rooms and did our thing.
We brought back the buckets and were handed glasses of water for brushing our teeth, so we did and again came back to the house. Then breakfast. The women sat us down in the livingroom, and one said, here is some porridge, and sugar, and here's some warm milk. So we took the porridge (Corn Flakes), and poured the warm milk over it. So good, yo. Add sugar, and that's something special. Then they brought out glasses of hot water and instant coffee (basically instant is that standard in South Africa, and filter is only occasionally found) and then the main breakfast. They had cooked fried eggs, bacon (which is usually cooked less here than in the states and is a lot thicker) and some cooked tomatoes. They gave us a bunch of buttered bread, and we started eating. I was so full by the end, but it was delicious! It really was clear that they had gone above and beyond their usually means for us and we are unbelievably grateful for thir generosity. We stuck around, talked with these three grandmothers (as the guys and gurl had left for school around 6:00) and had some pictures. We then walked down to the area where we had been dropped off the day before and met with our classmates and other people from the village. I handed over my cameras to a gurl who was maybe 3 and she just tooled around with my film and digital cameras. She figured out how to view, shoot, and display the images without me doing anything.
We left for the school where the 5th, 6th, and 7th graders performed traditional Zulu dances and songs. They were unbelievable. I was sure that I didn't have Jaclyn's voice recorder with me, and I was wrong, I found out yesterday, but I did get some pretty good pictures. We then went into the classrooms and we asked them questions, they asked us, apparently one ground even held a miniclass on volume and area, etc. When we were getting drilled with questions, I was consistently asked if I was a rock star. Then asked about all of my peircings. But the best was when a boy asked about my tattoos and I explained them to him and the class, and then he raised his hand again and said that God doesn't like it when we "write on our bodies." To which I had no other explanation than, "I know..." Do Cooper followed up with a concise and PC explanation of the differences in beliefs.
I was given a Polaroid camera by the professors and went to every table to get their pictures and class pictures of each of the grades (it was a 4 room school house with about 40-60 students in each of the 3 classrooms). For a bunch of them, this may be the only picture that they have of themself. They went apeshit for pictures. They loved seeing them in the digital cameras and they were always grabbing at them and it almost become violent the way they kids were trying to cram in front of the lens. The process was hard as we slowly pulled ourselves out of the mix and into the cars. We drove to St. Lucia, a suburb of Durban, and headed immediately for a croc and hippo tour. We saw crocs and hippos and birds and tons of vegetation and were on a boat and the skipper spoke about five languages. We were exhausted so it was like, Whateva.
Then for the next few days it was safari. Ill follow up with a safari post and pictures in a little while. but it was two days in a game park and one day in a wetland. We then flew back to Cape Town yesterday, and here I am. So much stuff. It was unreal. The pictures are the only way to get across some of the weight of what we were seeing and doing. Ill try to have them on here but flickr might be the thing to check.
Anyways, that be it. Ciao for now.
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