Moretele

So the big question is what I am actually doing at work?  Well, last week I really got to find out!  It was my first "implementation week."  Basically South to South is working with the departments of health in the different provinces to help them improve their pediatric HIV care.  Since things in the Western Cape (the province that Cape Town is in) are already decent, most of our work is in other provinces (there are 9 in the country - sort of a similar concept to states in the US).  Right now we are working in the Northwest Province in a sub-district called Moretele (it is blue thumbtack below - you may have to zoom out a lot to get prospective, if it doesn't stay zoomed out)


View Moretele in a larger map

Moretele is about 1-2 hours from Pretoria depending on where in the area you are going and how much rain there has been (since many of the roads are dirt roads, when it rains a lot there is a bit of a problem getting around.  Luckily it is dry season right now ;) There are 26 clinics in the area and we are focusing on 10 (as requested by the department of health).  Only 4 of them currently supply ARVs to patients (and 2 just started this month) the rest of the patients who are HIV positive must travel to one of those clinics to get care, which is an improvement since they used to have to travel to the nearest hospital which is not even in their district.  The clinics are pretty far apart considering most people do not have cars, bikes, or donkey carts and public transportation is limited to minibuses....Many of the clinics do not have running water.  Most of the clinics have a severe chair shortage so meetings are held either standing up or on the beds in the labor room (when there are no patients in labor).  So what we are doing is helping the nurses, lay counselors, and the few doctors and pharmacists develop their skills and comfort in treating pediatric HIV.  We are also focusing heavily on PMTCT (Prevention of Mother to Child Transmission) since that is really the only way to stop pediatric HIV.  Some of the time is spent mentoring individual health care workers and the other part is helping the clinics put systems in place to improve care.

A typical sign listing the services at the clinic - though most are supplied by nurses only and many patients have to be referred to the hospital for further management which is hours away.  There is an ambulance in the area most of the time for emergencies though it can take a long time to arrive (and if it is not a life threatening emergency they have find their own transport, which many of them cannot afford)

On Tuesday, I got to attend the second meeting of the Teen Club in one of the clinics.  There were 11 teens (a stark contrast to the 200 who attend Teen Club in Botswana every last Sat of the month).  But this is the beginning. The teens got to know each other, elected members to do different tasks, and discussed the importance of confidentiality.  I am looking forward to working with the social worker at the clinic to help her develop the Teen Club even further, but it is off to a great start.  The kids were really engaged and clearly appreciated being able to attend.

The road to one of the clinics

South to South (S2S) has created registers (basically like patient logs, where healthcare workers enter information about the patients and columns like "mother on HAART y/n" prompt the healthcare worker to ask certain questions and send certain tests).  These have helped to improve the numbers of women who are receiving ARVs when they are pregnant and in labor.  But we realized that some of the health care workers do not really understand why they are doing certain things - they are just following protocols.  This is generally good except that without understanding the reasoning behind the protocols, they are often missing things.  So on Wednesday one of the S2S nurses and I sat with all the nurses in one of the clinics and explained the reasoning behind some of the protocols to them.  It was so nice seeing the lightbulbs go on in many of their heads.

I will be going to this district 1-2 weeks each month for the next 6 months and then we may expand to other districts depending on how things are going in Moretele.  In between traveling weeks, I will work on projects identified while there (this week, improving their adherence sheets, collecting resources for the teen club, and improving the registers).  And also conducting week long trainings at Tygerberg Hospital at the University of Stellenbosch (first one for me is Sept 5-9).

One of the clinics we visited is trying to make the outside look nice so all the workers at the clinic each brought a plant and they were planting and watering when we arrived.

On one of the days we visited a business of local women called the Heartfelt Project during the lunch break.  It was started by a woman named Martha after her son was wrongly accused, imprisoned and died in prison.  She lost all of her money to a corrupt lawyer who had promised to get him out.  She had worked for 20 years for a family in Pretoria and their daughter, Julie, helped her start the business.  Now they have 10 employees and create all sorts of hand sewn felt designs.  If anyone is getting married (or having another occasion to party) and needs nice party favors, consider ordering some from them they are great and the profits go to the women and also to support a local community health project.  .....www.theheartfeltproject.com is where you can read more about them and place orders.
They will even ship all over the world with enough time ;)

Here are some of the designs before being sewn and stuffed.

Hope everyone reading this on the East Coast is managing to stay dry and get back your power!  Stay Safe!

Larry Joe

A few days ago I was invited to hear a guy called Larry Joe perform at a local synagogue.  I had never heard of him and so I googled him before going and thought he sounded good.  Also I thought he must have an interesting story since the songs online were recorded in prison!  But beyond that, I had no idea what to expect and I was truly inspired by him and his story.

He was introduced by Aron Turset-Swartz (a founding and now former member of the band Freshlyground.  Aron said that on World AIDS Day (Dec 1) in 2008 Freshlyground was asked to perform at a small concert in Douglas, South Africa (in the middle of the country).  As the sound equipment was being set up a man came on stage and performed two songs which both got a great reception from the audience. Aron remembered being struck by how great the guy sounded and he asked him who he was and where he was from.  "I'm Larry Joe from the Douglas Correctional Center," he said pointing to the side of the stage where 4 armed guards were waiting to take him back to prison.  To make a long story short, after the concert Aron developed a relationship with Larry and eventually ended up becoming his producer and helping him to record his first CD.  

Then Larry took the stage and began to play his guitar and sing his original songs in 5 different languages!  I thought he was really good. In between songs he told his story.  Basically, when he was in his early 20s he broke into a few houses in Kimberley, South Africa.  When he heard the police were looking for him, he ran away to Cape Town.  He had learned how to play a few chords of guitar from his father and liked to sing.  He begged for money until he had enough to buy a guitar and then began to sing on street corners around Cape Town.  He did this for 7 years and got better as he went, always singing covers.  One day he had a dream that he was playing in Madison Square Garden and he decided that he could not really pursue a music career until he served time for what he did.  So he returned to Kimberley and turned himself into the police.  He was sentenced to 5 years in prison.  While in prison he used the time to improve his musical skills. He began to write his own music for the first time and wrote over 40 songs in 5 different languages.  He only really speaks English and Afrikaans, but he had guards and other inmates translate some songs into Xhosa, Spanish, and Portuguese for him.  In addition, he says he read every book in the prison library and used those to inspire his songs in other languages.

Here he is playing with Aron backing him up on a wooden box as a drum

The prison was incredibly accommodating of his desire to practice and play music, allowing him to play in his cell, asking him to perform at that World AIDS Day Concert, and eventually letting Aron bring in recording equipment so that he could record his first CD from inside a cell in the prison.  They were apparently so accommodating because they want to aid prisoner rehabilitation and they saw this as a great opportunity for Larry.
He was released on parole on December 13, 2010 and his CD was released that day as well.  Now he goes around to schools, prisons, and other community organizations to sing and tell his story in the hopes that he can inspire young people to follow their dreams.  Definitely an inspirational story!  
Here is a link to a video about him so you can hear him sing
http://www.youtube.com/watch?v=EQgXj1s1sQ4&feature=related.
If it doesn't work just go to youtube and search for Larry Joe.

On a totally unrelated note, for your entertainment purposes, I am going to include the following picture of me and my bosses.

Elke (Pediatric Unit Manager), Liezl (South to South Clinical Director) and Me

What is so great about being in pediatrics is that pediatricians are generally fun.  Elke and I are both new to South to South (though Elke started 2 months ago).  So at our staff meeting, Liezl welcomed us into the organization by giving us each a pair of eyeglasses made from wire.  This is because now we are joining South to South and their vision for better pediatric care for children.  Each previous staff member has also gotten to go through this ritual.  We then got to decorate them with ribbon and beads (you can't really see the beads which form the side of the glasses, but trust me they are there ;)

Slideshow reposted

Apparently there were problems viewing the slideshow on the last post.  I hope this one will work better....



If still not working, click on this link to view https://picasaweb.google.com/109170280186909692299/August142011?authkey=Gv1sRgCIP3oJeSv6LB2gE

Settling in

Now that I have been in Cape Town for 2.5 weeks, I am beginning to feel a bit more settled.  I am working in Bellville which is one of the Northern Suburbs of Cape Town (30 km and about a 30 min drive from the city center).  It felt too suburban and too segregated for me to live there, so I decided to live in Cape Town itself. But since choosing an apartment over the internet is hard anywhere, and esp difficult when you don't really know the city very well, I decided to wait until I arrived to find a place.  For the first two weeks, my work arranged for me to stay in Bellville in a self-catering apartment which was a 10 min walk to work and 10 min walk (in the other direction) to a shopping center.   So after a 36 hour trip (through Dubai), I was met at the airport by my super nice co-worker who took me to the local Pick and Pay (grocery store) and to the apartment.  The next day I rented a car (my first time driving a manual alone, more on that later) and began apartment hunting.  In 2 days I must have looked at 20 apartments (some in Blouberg - along the beach and the rest in the city).  I decided on a place in center city right across from Company Gardens. The big blue thumb tack below marks the spot of my building (this map is in my grandfather's honor), if you click on the map you can zoom in and out to get a better sense of where it is....


View St. Martini Gardens in a larger map

It is completely furnished which saves me a lot of hassle.  Parking is under the building and it is walking distance to tons of great restaurants, shopping, a lovely public garden, etc.  I got a 2 bedroom apartment so there is plenty of room for visitors ;)

A slideshow of the first 2 weeks (if you are reading this on email you have to go to the blog to see the slideshow)....



Which brings me to the car!  I did not know how to drive a stick shift before I got to Botswana but last year I learned under the tutelage of Gelane and Bri on our many trips for our outreach evaluation.  And after our trip to Swazi/St. Lucia, I was feeling pretty okay with stick.  Only a few small problems here: HILLS (and very steep ones), lots more people, stop and go traffic.....all these things make driving a stick shift much harder, esp when you learned in a flat, sparsely populated country.  So let's just say that driving stick when I rented a car was interesting and I was thinking that my life would be simpler with an automatic car.  However those are hard to come by, more expensive, harder to get fixed and harder to sell.  As a result I ended up with a Nisaan Micra (ever hear of that one?)  I think it looks like a bug, but it is nice and small (good for parking around here), supposedly light on fuel (it better be considering it cost me the equivalent of $45 for 3/4 of a tank!!!!), and relatively peppy on the highway considering it only has a 1.4L engine!  So far so good, I am getting better on the hills and each day feel slightly more comfortable driving stick....though I still don't understand the appeal when automatics are so easy.

So far work has been a lot of logistics as well.  Familiarizing myself with guidelines, protocols, training manuals etc.  They have developed a great pediatric toolkit to help healthcare providers when they are treating children with HIV.  It was developed for South Africa but now is being changed to be more generally based on the WHO guidelines so it can be used in many other countries, so I helped with that process.  All my colleagues are very nice and friendly and it seems we will make a good team. My first mentoring trip is next week, so I will have a much better sense of things by the end of the month.

One thing I have seen here are the incredible disparities, which I am sure I will see even more of when we go up to the Northwest Province where we are doing the mentoring.  The city is very modern, has good infrastructure, plenty of pretty buildings, and tourist attractions.  However, though apartheid ended 17 years ago, there are many lasting effects still present today.  Residential areas are still incredibly segregated.  In fact, when I called real estate people looking for houses, I talked to one agent, over the phone, who told me "that area is not for you."  I asked him what he meant by that and he said "Trust me, I try to match the right people with the right houses."  I had never met the guy, but I am guessing that he could tell I was American by my accent and probably just assumed I was white based on that.  I never met him, so I was unable to investigate his reasoning any further.

The inequities are everywhere if you pay even a little bit of attention.  When I was moving into my apartment, I had several boxes of things shipped from Botswana to Cape Town.  They arrived bundled together in a giant cardboard box.  As we were unpacking the giant box in the truck in front of my building, the guard for the building was keeping watch.  When we had all the smaller boxes in the apartment, he asked me if he could have the giant cardboard box.  Of course, I said yes and then just because I was curious I asked what he planned to do with it.  "Take it to Khayelitsha [the largest township in Cape Town] and use it to cover my shack since it is so cold," he told me.  Here I was unloading boxes of clothes, blankets, knick knacks, etc and this guy was trying to get some extra insulation for his shack.  Having driven past Khayelitsha and other townships, I have seen the condition of housing there, but I naively assumed that most of the people living in shacks were some of the 25% of the population who are unemployed (a shocking number that I read in the paper this morning).  In fact here was the guy who is working 12 hours a day, 6 days a week as a guard of a big apartment complex and he too is living in a shack.  The disparities here are even greater than in Botswana where, though there is definitely extreme poverty, people who are working can generally afford something more substantial than a shack.  Highlights once again how far there is to go to overcome decades of forced segregation and oppression and how fortunate I am.

Flashback: Bushfire and St. Lucia

Enjoying the music at Bushfire 

Bushfire is an annual music festival in May Swaziland - 3 days of live performances from all over the world (though most performers were from Africa).  Gelane, Premal and I missed it in 2010 so we had been planning to attend in 2011 for some time.  Then realizing that there was a Botswana holiday the same week, we decided to make a week of it and explore the Eastern coast of South Africa with Bri joining us there.  We got off on a bit of a bad start.  We drove from Gaborone to Pretoria in Gelane's car and then realized that the radiator was leaking.  We took the car to a Honda dealer and they said the radiator needed to be completely replaced.....We spent several hours in the Honda dealer (during which I finished the handwarmers I had been making for Gelane)...

Gelane testing out the new hand warmers and praying that they would be able to find a radiator in the area!

Unfortunately they were not able to find the radiator in the area and told us that the car could not be fixed until Tuesday (it was Friday and bushfire was Friday-Sunday in Swaziland which was still a 5 hour drive away!) So we went into planning mode and to make a long story short - headed off in a rented Nissan Hardbody truck (with manual transmission)!  We needed such a big car since we had so much stuff (below is Premal in the rental agency with all our stuff....)

We finally arrived in Swaziland at night and managed to put up our tent in the dark (Premal got really into hammering in the stakes - below) before heading out to experience the music. 

For 3 nights and 2 days, we were treated to some amazing performances.  We camped right next to the area where the stages were and it was great to be able to come and go as we pleased.  

Here is Gelane in the midst of the crowd in front of the stage

It was gorgeous during the days and pretty darn cold at night, but thanks to Liz and Jon's awesome tent and camping equipment we managed to stay pretty warm.  

Oliver Mtukudzi was definitely our favorite.  He is in his 60s and still was jumping around the stage and has an amazing voice!

There was one artist from Botswana, Shanti-Lo, who we also really enjoyed.

When the concert finished we drove through Swaziland (it is a tiny land locked country surrounded by South Africa). We stopped at the Swazi Candle factory where we saw intricate candles of all kinds (from elephants to birds to larger circular creations - these people were talented with wax) being made.

We watched this entire rhino be created and it only took about 10 minutes!

Next stop was St. Lucia - no not the island in the Caribbean!  There is a beach town along the Eastern Coast of South Africa called St. Lucia.  It was a very sleepy beach town (esp. because it was not high season).  Which meant we had a gorgeous beach to ourselves and plenty of room for the requisite jump shots ;)

We even went snorkeling one day though the water was extremely cold and the waves were pretty rough. After freezing a bit and getting bashed by the waves, Gelane and Premal spotted a small tidal pool and decided to try it....

The town is basically in the iSimangaliso Wetlands Park which provided for some amazing views and landscapes as well as excellent animal spotting on our self-drive safaris.  We saw rhino, buffalo, giant kudu, and then on a boat cruise we were super close to Crocs and hippos!

 Here are some photos from the boat cruise

Bri, Gelane, and I even got to go scuba diving in Sodwana Bay which is bit further North of St. Lucia and as extremely clear waters with tons of beautiful fish.

All in all an amazing last trip from Bots!

Flashback: My Last Teen Club :(

When teens are asked what topics they want to learn about at Teen Club, sexual issues are often first on the list.  There are numerous myths and misconceptions all over the world when it comes to sex.  This is especially true in a conservative country like Botswana where teachers, caregivers, and even some healthcare workers are reluctant to talk openly with teenagers, deeming this topic inappropriate and unnecessary for adolescents. I was asked to play an active role in planning a Teen Club about sex so that the Teen Club staff could make sure that all the information which was presented was medically correct.  The planning sessions became a bit tense in the weeks leading up to the event, as some of the clinic staff did not feel that it was appropriate to have such a discussion with the teens.  However, after much debate it was acknowledged that this is a critical subject for all teens and that Teen Club is probably they only place they are going to get to have their questions answered in an open, honest and medically correct way.

In preparation for this discussion/forum, teens were notified a month earlier that the June Teen Club would be about sex, giving them enough time and opportunity to prepare questions. The team placed a visible box in the clinic for them to write down anonymous questions about sex and sexual health.

On the day of the event, teens were divided into the usual two groups (13-15 and 16-19 year olds).  For the younger teens we had 3 stations: playing games; dispelling myths (as you can see me explaining above); and a short discussion on puberty and importance of abstinence.   The teens rotated from station to station every 40 minutes.  There was concern that that some might not be mature enough for the topics, but once again they surprised us with their maturity, concentration, and engagement with the subject.

During the short discussion on puberty we taught them about the normal changes that the body goes through, as they get older, the importance of abstinence and the need for protection when abstinence is impossible. We also answered many of the questions they had about sexual issues and puberty.  During the myths/facts session the teens were given a myth and asked to go to the area of the courtyard corresponding to their feelings about the myth (true, false, or don’t know).   We then discussed the answers in detail, dispelling such myths as “two condoms are better than one” (two condoms are NOT better than one!) and “a girl cannot get pregnant if she has sex standing up” (She CAN!)  which are two common myths in Botswana.

The older teens had male and female condom demonstrations led by three wonderful volunteers from the Ministry of Health (MOH), who volunteered their time and expertise on a Saturday. Their experience is extensive – they have conducted demonstrations all over Botswana in many different settings from schools to community centers to other public gatherings.  

Teens were divided based on gender, in an effort to encourage more open discussion and stimulate questions. Most were eager to share what they thought to be correct information about condoms and their use. The demonstrations certainly stimulated questions ranging from myths of pregnancy and changes the body goes through during puberty to more complex issues such as age of sexual debut and perceived ideas about the roles of a man and a woman in a relationship.

Then all the older teens were brought together and their questions were answered (both those they had placed in the question box and those which they came up with on the spot).  Once encouraged these young men and women were eager to take the opportunity to ask and demystify concepts about sex and sexual health. Due to time constraints we were unable to answer every single question and will definitely have to have more sessions on this topic in the future.

All in all, the event went better than the team expected.  The teens were serious and mature about discussing the subject, even more so than many adults when placed in similar situations. We felt their appreciation through their enthusiastic participation, eager concentration, and mature disposition.  

At the end of the event, the teens surprised us with a dance number and kind words to say goodbye to me and Gelane as it was our last teen club.  We both expressed to them how much we had learned from them and how their strength and resilience are truly an inspiration to all. 

Transitions

Gelane, Bri, Premal and I were super sad to say good bye to each other!
 I know we will keep in touch, but after 2 years of living, working, traveling together it was really hard to part.

It has been forever since I posted, I know, but I am going to try to get back into it.  You might have noticed that the description of my blog has changed (it is now "tales of my life as a pediatrician in Botswana and beyond....") I figured that was easier than setting up a new blog.  That is because I have moved to Cape Town, South Africa!  The Pediatric AIDS Corps program had 5 years of funding which ended in July 2011.  Other sources of funding were sought and the program transitioned to the Global Health Corps this July.  It will be very similar to the PAC program, but smaller and will focus on more than just HIV/AIDS.  Though it was quite hard to leave Botswana, all the patients at the clinic there, and the friends I have made in the last 2 years, it was time to move on.

I also had to say good bye to Gizmo our cat.  He clearly wanted to come along, but loves to be outdoors and I don't think he would have done well in a Cape Town flat.
Luckily Bilen moved in next door and Gizmo moved in with her.
They are both very happy now ;)

I have taken a job with an organization called South to South.  It is an NGO that is funded by USAID and is housed at the University of Stellenbosch in Cape Town.  The goal is to help South Africa expand their pediatric HIV program.  Many healthcare providers are comfortable treating adults with HIV but not children, so our goal is to help them feel comfortable treating children.  In addition, the goal is to increase the number of clinics that provide ARVs (medications to treat HIV) so that patients do not have to travel as far to reach the clinics or wait all day to be seen (do to overcrowding at the centers which exist).  You can read more about it here if interested www.sun.ac.za/southtosouth.I am the Pediatric Clinical Advisor which means I will be doing training and mentoring of healthcare workers (nurses, doctors, lay counselors, etc).  A lot of my time (about 40%) will be spent traveling around the country. Right now we are focusing on a district called Moretele which is in the Northwest Province of South Africa (about 2 hours north of Johannesburg), more on that in a few weeks after I have actual been.

Almost half of my residency class managed to make it to Sonia's wedding!

Sonia and Elliott are officially married

Before moving to South Africa, I was lucky enough to get to spend almost three weeks back in the States with family and friends.  I was really lucky that Sonia decided to get married during that time and so I got to attend her beautiful wedding and see a lot of my friends from residency (as well as two delightful new additions to our St. Chris family - Josie and Walter ;)

Josie, beautiful daughter of Meredith and Trevor

Walter, adorable son of Ruth and Robert

I spent lots of quality time with my parents, grandmother, aunts, uncles, and cousins.  Definitely the thing I miss the most about being "this side" is time with family and friends who are "that side" but luckily the technological age (skype, internet phones, etc) helps with that a lot.

I will try to post a few flashbacks of my last months in Bots and then will move on to giving you a sense of life in Cape Town.  Right now it is a lot of logistics, finding an apartment, buying a car, opening a bank account, etc but photos and details of all those things to come!