Day-to-Day in South Africa

I thought for this blog I would update people on the day to day for me. Most days I spend time with an HIV consoler named Makhosi. She is pivotal in making sure that patients are seen in the Siyaphila program. So Tuesday-Thursday I am in her office helping her and seeing patients with her. 

On Monday mornings I work with Dr. Sunpath, who is an HIV and TB specialist physician. While with him, we see patients who are failing on HIV treatment. Most of these patients are quite complex. We decide which regimen of antiretroviral (ARV) drugs the patient should be switched to and we also determine if the patient needs to be seen by any other medical support staff for treatment adherence or support. In the afternoon on Monday’s I spend time doing research. Currently I am helping create two databases, the first is for patients that have failed treatment and are being switched to a more advanced therapy and the second is made up of patients that are on TB treatment and HIV treatment concurrently noting the interactions and side effects.

On Tuesdays, while most of my time is with Makhosi, I also follow around the rest of the Siyaphila team, which includes a dietician, psychologist, pastor, and social worker. From my time with each of them, I am working on a report on how to fine tune the program so that patients are seen in a timely manner and so work isn’t being over done or under done.

On Wednesdays, I get to see Medical Clinic patients with Dr. Edwin. The majority of patients are patients from the hospital that have been started on ARVs through the Siyaphila program are coming back for follow-up visits. Then in the afternoons I spend time with Makhosi.

Thursdays are normally the busiest days. In the morning, I go to continuing medical education (CME) meetings with all of the medical doctors and medical students. Most of the time these sessions only last an hour to an hour and half. The topics are both HIV and TB associated topics. Along with Durban being the HIV capital of the world, I have heard it is also the TB capital of the world. Following the CME meeting, I go on ward rounds with Dr. Sunpath and the medical team. Following the ward round the Siyaphila multidisciplinary team meets in the hospital and we round on the Siyaphila patients to discuss their treatment and care. We then meet to discuss each patient needs and when the patient will be ready to start ARV treatment and factors impacting adherence to treatment.

On a side note, apart of this discussion is whither or not the patient has disclosed their status to someone. Which may not seem important, but research shows that if a patient discloses his or her status, they are more successful at adhering to treatment. A majority of patients disclose their status to loved ones, but due to stigma around HIV many new diagnosed patients are scared to disclose their status. There is a saying around McCord that HIV doesn’t kill people, stigma kills people. Some patients don’t want to take life saving medication just because they are terrified of what others might think or say about them. What is ridiculous is that over forty percent of the population has HIV, which to me means that there should be no stigma. One of Makhosi’s many jobs in the Siyaphila program is to help dispel the stigma around HIV for the patients and family.

Fridays, in the morning I work with Dr. Edwin. The majority of our time is spent starting patients on HIV treatment or following-up patients that have been initiated on treatment. It is extremely important that each patient is followed-up closely, due the side effects of the ARV drugs.

Within the past few weeks I have been able to see patients almost independently of the Dr. Sunpath and Dr. Edwin. Which has been rather exciting and challenging. In any free time that I have, I do research and work on a standard operating procedure that will be used to get medical aid (similar to medical insurance companies in the states) companies invested in sending their patients into the Siyaphila program. Which will in turn help even out the costs for patients that can’t afford the Siyaphila program. I have to say though, that if patients can’t afford to stay and get the treatment through Siyaphila, Loving South Africa pays for their stay so the patient can get the much-needed treatment.

I hope this has given you an idea of what I do during the week. At times it can be very painful emotionally, at other times it can be mundane, and at other times it can be encouraging and inspiring.

There are a few things that I would appreciate prayer for. Within the next few months I am wanting to help the hospital with training for the nurses and other medical staff- most of it has to do with patient satisfaction (this is a new standard the national health program is looking at for hospitals) and practicing excellence. I will be approaching the nursing supervisor and HR staff to talk about training staff on this. I am hoping to work with them to put together a program or an educational piece to teach practical ways of applying this. I would also appreciate prayer for clarity on how to proceed with the standard operating procedure for the Siyaphila program and the steps that the program needs to take to continue to provide the much-needed care to the Durban area. 

Compassion, Not Pity

Blog Post: Compassion, not Pity

Walking around Durban, it is hard to not see poverty on every street corner. For instance, once a week I go to an internet café to have a cappuccino and fast internet. It’s about a fifteen-minute walk from the hospital to the café called Peg. On the way at nearly every corner there is at least one person walking amongst the cars begging for money. Cynically, I think that most of these people are putting on a show- faking a limp, crippled hand, have a down trout look on their face, etc. Or maybe it is my way of trying to cope with the need in front of me. That being said, I do believe that most are in need- whether it be financial, food, resources, spiritual healing, or something else.

            At times, I wonder if people driving by or walking by notice these individuals, do they fade into the background of the cityscape? Or maybe people are so struck by the poverty around them they feel powerless to do anything about it. Whatever the situation maybe there is something wrong about this.

            Which has made me ask myself, how should I respond? Not just to poverty here Durban, but poverty in general. The easy response would be to throw money at the situation. Which in the short run works, but how is the person receiving money valued or impacted by that. They are receiving something that they need correct, but is that truly what they need? Another solution would be to change the system, but in reality that is a lengthy process which takes tons of experience and insight to change. Although this should be worked on, it doesn’t solve the immediate need. So one thing that I have come up with is compassion, not pity.

Pity, to me means seeing a person in need feeling sorry for them and their situation and that is only response. Compassion to me means feeling for someone, seeing the situation he or she is in, and responding to that need accurately. It seems to me that most people don’t need money, although that may be what they are asking for. If a person comes to ask me for money, I normally tell them that I don’t give out money, but I would like to buy them groceries if that is what they are truly in need of. That also gives me a chance to actually speak with the person and get to know them. Although it is hard here in South Africa, most of the time in the States I try and refer the person to resources that are better equipped to help their situation.

            I’m not saying this is what everyone is called to do. But, I think it addresses a bigger issue of valuing people. In Matthew 14:14-21, Jesus is filled compassion for the people that are following him. He heals their sick and decides that the people must be feed. So he takes five loaves of bread and two fish and feeds five thousand people with food left over. If Christ had compassion are five thousand, what is one person asking for food.

            This is not to say that, every single person I come across I go and buy groceries for. But, I do try and stop and talk with person at least. Who knows whom one will run into?

            That being said, thank you for reading my blog. All I write is meant to be an encouragement. This current situation I have been processing since I have gotten here to South Africa, although in Indy is was something I thought about. Here it is a reality one can’t get away from so easily. Things here continue to be in full motion. Hopefully in my next few posts I will be able to give you a day to day of what I have been doing. 

Easter Weekend with Light Providers

Pictures from my time with the Light Providers Crew. It was such a blessed time of fellowship. I was able to get away from the city and out to the township. The food was great, but the fellowship was better. In case you are wondering about the chess game that I am playing with Sabelo, I lost horribly. He is a bit of a ringer when it comes to playing chess apparently. No one told me that until I had played two games with him. He was undefeated the whole day.

Above: Vuzi and I, giving the thumbs up.

Above: Vuzi and I, just having a good time in fellowship together

Above: Following the guys around the building to check-out the hillside.

Above: Playing Sabelo in chess, he wiped the board with me.

Above: Mural on the one of the buildings at Light Providers.

Experiences in March

Sorry it’s been a while since my last post. Things here have been in full swing and quiet busy over the past few weeks. Let me share the wonderful experiences that I have had over the past few weeks.

Two weekends ago, I had the honor to go with one of my housemates (Lebby) to a counselor’s house in a township. Sizile was quiet nice in opening her house to us, she even came into town (a 45 minute ride by a mini taxi bus) to fetch us. We spent the whole day helping her with errands and then took the mini taxi bus out to her house. While at her house she entertained us and taught us how to make traditional Zulu bread, which tastes wonderful!! While at her house we got to play with her son, who was 1 ½ years old. At first her son wasn’t quiet sure of me, he didn’t even want to touch me. But, by the end of the time he let me hold and play airplane with him. It was such a treat.

Sunday, I was able to hang out with Siyanda and the Light Provider crew after church. We went downtown and grabbed lunch at a shop. We then hung out in a park for the afternoon. Enjoying each other’s company.

Sunday evening, I was able to go to Sizwe’s house (who is the leader of the church I attend Sunday mornings). Sizwe and his family were very generous in providing dinner and great fellowship. Sizwe showed me video of how traditional Zulu churches worshipped and why he did church differently then other churches. We talked about family and issues facing many people in the townships around Durban. He asked me about healthy diets for families and asked me to come to couples meetings to teach about healthy cooking and eating habits.

On Thursday of this past week, I was able to go to my supervisor, Claire’s house with my housemate Lebby (who is an intern here from Union college) for a braai. It was a wonderful break from the city, to go out into the Valley of a Thousand Hills (which is one of the most beautiful places one could ever see). The picture to the right doesn't do the scenery justice. We had a wonderful time talking about the hospital and life before South Africa. We were joined by Oliva (who previously held Claire’s position at McCord) and her husband, as well as Mark’s (Claire’s husband) best friend grow

ing up Chris and his wife. I was able to convince Mark to take me to go snake hunting with him and his friend Chris (who collects snakes). Hopefully soon, I will be able to get together with him to find some snakes.

Thursday night, I was able to stay at Makaphutu. Which is where I stayed for the two weeks that I came with LSA on my first trip here. It was such a blessing to be able to spend time with Nic (the director of Makaphutu) and hear how life was going at the children’s village. (Below are pictures of the view from Makaphutu, its what I woke-up too Friday morning)

The next morning we (Lebby and I) rose early to go to the Hillcrest AIDS Center. Which was one of the many highlights of the past few weeks. Hillcrest AIDS Center is only 21 years old, yet the impact that the organization is having on the community is monumental. As an organization Hillcrest AIDS Center wants to impact the HIV/AIDS pandemic by unconditionally loving those infected and affected by HIV/AIDS. The organization loves people through many programs: HIV counseling and testing, feeding scheme, clothing scheme, Othandweni Respite unit (hospice), clinic and nursing services, HIV/AIDS awareness and education, craft revenue, support of grandmothers in the community, and plant nursery and gardening scheme. The Hillcrest AIDS Center is holistic and practical in the way that they are impacting HIV/AIDS in the community around them. In my opinion, Hillcrest AIDS Center is one of the best examples of how local people in an area of need can impact the lives of those around them.

Again, sorry it has been such a long time since I have updated my blog. I promise I will be update more regularly. Thank you to everyone who actually reads this. I hope you are enjoy hearing of my experiences and thoughts.

Retreat Weekend for Sinikithemba Kids

Every second weekend of the month, McCord's Sinikithemba (treatment center) program has a support group for kids and teens. The support group run by the counselors (the counselors don't get paid for the time they spend on Saturdays with the kids) at Sinikithemba because they found that as the kids in the program were growing older, they were struggling with continuing on treatment because they felt different from their other friends. So the kids and teens come to support group so that they can spend time with HIV positive kids and teens and get support from each other.

This past weekend was the second Saturday of the month. But, instead of the kids and teens getting together to discuss issues, the counselors decided to have a fun month. So they took all the kids and teens to the pool (picture to the left is of the pool). Fortunately for me, I got invited to come along. In total there were about 60+ kids and teens that showed up. The kids swam and talked and just hung out. We had a braai (in the states it's called grilling or bbq) and plenty of fruit drinks to go around. It was a wonderful way to spend a bright sunny Saturday.

The whole time I was at the pool I was thinking about one kid in particular who I had met a week prior in the hospital wards. I meet him because he had been admitted due to a secondary infection and the doctors found out that he had stopped taking his ARV medication (anti-retro viral or HIV meds). The counselor that I work with was called to come and see the patient and to talk with him about why he had stopped taking his medications. The patients stay in the hospital was funded by Loving South Africa, because he doesn't have anyone who was able to pay for his treatment. In talking with the patient, we (Makhosi and I) found out this is the third time that he has stopped taking his medication. When we asked him why, he just said that he couldn't do it any more. He just wants to be normal. Shortly after stopping his medicine he got sick and was admitted to the hospital. We asked him if he was interested in starting the medication again and he said yes (we won't start treatment if the individual is not ready to start). We asked him if he meant it, because he has stopped taking the medication three times. He stated yes. We asked him is he understood that he would have to take the medication for the rest of his life, and he stated he understood. We asked him why he wanted to start back on the medication. His response was because he doesn't want to be sick any more.

This young man was 16, yet he looked 12 years old. This is why, the support groups at McCord are so important. This young man is not a special case. I personally can't imagine at the age of 16, adjusting to an ever changing body, emotions, and world, having take a handful of pills daily knowing that they are the only thing keeping me alive and well. This young man, is fortunate that he is at a hospital and in a program that is focused on holistically providing care to their patients. It would be easy to provide just medical care for the patient and tell him that he needs to get his priorities in place and start taking his medications again. It takes a lot more to organize support for a teen or child, knowing that it is difficult to live in a world were, even though nearly 50% of people have HIV, you are ostracize because you have HIV and it's not cool to take medications that are keeping you alive and well.

On Saturday, the young man came up to me and we talked for a few minutes. It had been a week since his hospital stay and he looked much better. With a fedora on, fo-Ray Bans (apparently I'm pretty cool with my $10 fo-Ray Bans as well), and blaring music from his cell phone, he committed in a soft voice that he liked that I had trimmed my beard (apparently the mountain man look isn't in right now). I imagined a kid in the States in a youth group coming up to me and saying the same thing. Just wanting to be normal and accepted.

Below is a picture for the Doctor's Consultation Room on Friday afternoon. What a beautiful picture of the coast and Durban.

View from my office with Makhosi. You may be able to see me in the reflection of the windows. Things have been going very well with the internship here. If you could lift up McCord hospital as they are going through a lot of transition. It seems as though there has been a lot of bad news about budget cuts within the hospital, due to recession and so forth. McCord just recently celebrated it's 100th year of service to the Durban area. Historically McCord was one of the only hospitals that provided medical care to the Zulu and Indian people during Apartheid. And still is committed to serving those who cannot pay for treatment. Pray for wisdom and vision, as the hospital continue to serve those in need.

Rainbow Nation

Sorry it's been a minute since my post. Time got away from these past few weeks. I will be working at making a more concerted effort to post once a week.

This past weekend I was at the coast with friends and we were approached by a British South African who was very excited. He stated that, “we were a wonderful picture of the new South Africa.” He was referring to the fact that each of us was a different color of skin: Caucasian, African, and Indian. A rainbow of color and culture, the sad part being that none of us were South African. We were American, Botswanan, and Australian/Indian. This experience has made me think a lot about how the world should be, and the present state that the world is in right now.

I have had a hard time trying to figure out how to present this topic in a blog. However, I think the best way to do it is give a little history. In South Africa, people of color (black, mixed, yellow- basically anyone who was not pasty white) before 1994 were not allowed to have any say on who governed over them. That means that 90% of the population in South Africa was powerless to have control of where they lived and the types of jobs they could get. This was known as Apartheid. Fortunately in 1994, Apartheid ended with the election of Nelson Mandela as the first black African president of South Africa. If you have seen any movie about South Africa recently (such as Invictus ), you know the huge impact the election of Mandela to the presidency made for the people of South Africa and really the world. Unfortunately, despite the political changes in South Africa, the segregation didn’t necessarily end in the mental or social sense. Just because there are changes in the law, doesn’t mean that people suddenly change their habits and attitudes – at least right away.

Martin Luther King, Jr. once said that eleven o’clock on Sunday mornings is the most segregated hour of the week.

This bothers me. The Church should be the most integrated and diverse group in the world. Instead, we seem to seek the comfort of being with people who are the same as we are. I am not just talking about segregation in the ethnic sense; I am talking economically and culturally. Let me explain a little. When I read the Bible I see Jesus inviting all to come to him, I see him breaking down ethnic, economic, and cultural barriers to bring people to Him. I see the Church of Acts creating a new culture where no one is in need (Acts 2:42-47), I see Paul being all things to all people so they might know Christ (1 Corinthians 9).

One of my favorite stories in the Bible is about Jesus flipping cultural, economical, and ethnic norms upside down. In John 4 we are told of Jesus’ interaction with a Samaritan women. Jesus goes through Samaria; exhausted he sits at a well where he meets a Samaritan woman. Speaking to the woman, he asks for a drink. The woman knowing the history of her people addresses the fact that He is Jewish and she is Samaritan (Jews didn’t associate with Samaritans). Not to mention, if a man were alone, culturally he would not have addressed a women. Furthermore, it is sixth hour of the day. Normally, people draw water early in the day or late in the afternoon due to the heat of the day. The sixth hour of the day is noon, where the first hour of the day would be about 6 a.m. The Samaritan woman was coming to the well at the hottest time of the day, knowing or maybe hoping that she wasn’t going to run into anyone. Further along in the story, we understand why she was coming around at noon, she was getting around. She has had five husbands and is with a guy that isn’t her husband. Socially, Jesus would have had every reason to write her off, condemn her, and send her out of his presence. Yet, he doesn’t. Jesus does the exact opposite. He sees the women for who she is, a child of God. Very aware of all the reasons that he shouldn’t talk with her due to cultural norms, he speaks into her life. How does the women respond to all of this? She goes around telling everyone she knows of Jesus, a Jewish man who told her everything about her life. When Jesus’ disciples return to him after getting food, they are puzzled to see him with a woman, let alone a Samaritan.

Jesus went against the cultural norm of his time when speaking with the Samaritan women. He spent two days in Samaria teaching people and gathered people around him. Jesus didn’t see the woman and say, She is a Samaritan, as a Jew I don’t get along with a Samaritan by principle so I’m not going to talk with her.” He addressed and called her into a new way of living. I can’t help but think this is how the Church should be. Instead of segregating ourselves because of cultural, ethnic, and economical differences, shouldn’t we be creating a new culture? I see a culture like the Church of Acts, where people were devoted to the teaching of the apostles and breaking bread and praying with each other. On the first Saturday of every month there is a Christian Medical Fellowship meeting at McCord Hospital. This past Saturday before we started our meeting, everyone introduced themselves and told of their Church background. It was such an encouragement to be with people from different countries and denominations all coming together to worship God.

I understand that is not always comfortable to be in community with someone who is different. For instance, what if you invited a homeless person or drug addict to church with you? There might be some social norms that the person might not pick-up on and that person may embarrass you or dare I say make your friends uncomfortable. Or maybe, some one visits your church from say, Africa or the Middle East, would you be the one to go an introduce yourself to them, invite them over for dinner, learn about how they came to where you are? Jesus had a vision that was far past his generation or the next. Where all people devoid of ethnic, economical, or cultural differences share life together creating a new standard of how to live.