And now, something completely different!!

Well, Chapter 1 and 2 (my two different overland trips) were now over. It was time for Chapter 3. I must say, that my expectations of this healthcare volunteer experience were a little hazy. Not much info is given about exactly what you are going to see and do. Part of this was also impacted by the fact that I had talked to one of my buddies at work right before heading out, and she told me she had also volunteered outside of Capetown at a hospital. Wow, I thought, "what place?". She then told me the name was Rondelbosch or something like that. I thought, hey, I think that's my place because I remember that it started with an R. She then went on to say how modern it was, state of the art. She actually worked in their ICU and was so impressed with what they had. This certainly was a little different then I was expecting. I thought maybe it might be a small clinic or something, but then again, maybe I will have an opportunity to work at a clinic while I was there. Well, let's just say, it was not the same place. It turns out that my place was in Rocklands a neighborhood in an area called Mitchells Plains. During Apartheid, sometime in mid 20th century, huge numbers of nonwhites were essentially kicked out of Capetown proper and redistributed in an area called Capetown flats where Mitchells Plains is located. Most of them were housed in shanty towns, shacks made of plywood and other stuff, literally on top of one another. Many of these still remain, but others were small houses crammed together with the poorest of the poor. This was my neighborhood. It wasn't exactly the slums, in fact it was relatively clean, but everyone had a gate, and every window had bars on it. And I was expressly forbidden/warned by my host family to not walk around without one of them, knowing that as a "whitey", obviously not from this "hood", that I would be a definite victim. My host family was amazing. "Auntie" Pearl is a 60year old widow who is a saint. All of them were very religious and Andrew, her son in law, had become a born again Christian just months before. He picked me up from the airport with his 2 year old son Isiah. I was originally supposed to be picked up by Marina, the coordinator, but instead was met by this man who was about my height but at least twice my size. He is though, at least now, a gentle giant. Most of the trip from the airport involved him telling me his story. About 36 years old, he grew up in a city known for extensive gang activity and many many casualties from such activity. He himself was one of the leaders in a gang coincidentally known as the Americans, one of the most well known gangs in all of South Africa. He went on to say that America is respected and worshipped for it's gang life. They emulate rappers and gangsters from America (to be so proud!!). He also told stories of his life, the women, the drugs, the drinking, the killings and I listened in shocked disbelief. This was my host family. "Holy shit!!!" But what contrast to the man he has become, he left all of that behind years ago, but continued most of the excessive drinking until finding God. Now he has become an instrument of Christ and has dedicated his life to spreading the word. Just amazing stuff. His wife Sanchiline is incredible. She has the patience of Job, works like a madwoman (currently supporting the family. Unemployment is rampant in South Africa) and also takes care of her son and teenage daughter with the help of Andrew and Pearl. Kaylin is her 15year old daughter from another father, who is a witty, quick talking and fun teenager. Quick to give me crap, teach me a card game and then in good teenage style, beat me severely at the game and let me know it. She's a good sister to her younger brother, Isiah. This kid is amazing. He smiles and laughs like no other, he's mesmerized by tv (stopped in his tracks anytime he walks by) and is into anything that anybody else is doing. He also is somewhat of a nudist, and is quick to shed clothes at a moments notice. I loved that kid and look forward to see what he becomes. Much of my time there entailed meeting the friends and family of these guys and I cherish those moments the most. I really got to know a lot about the culture through those many special interactions. All of them were incredibly wonderful people. I even got to drink boxed wine with some of his old drinking buddies in a small shack in what Andrew referred to as "the slums". As we drank away, they told me that if I were to walk one block down, there was a good chance I would come upon some meth heads who would at the very least rob me, and possibly even kill me if I were alone. Refreshing thoughts. With them, they said, I was safe, nobody would dare mess with me while I hung out with them. Strangely enough I treasured those moments. Scared, yet exhilarated. Admittedly, having Andrew, a man twice my size (at least) who had been a major gang member, at my side, was always reassuring. I also went to a braii which is essentially a South African bbq with in this case large sausages (the name I forget) over a small grill. I then listened as they played guitar and sang songs. That was the second night I was there. This was amazing. Now no discussion of South Africa would be complete without the discussion of race. It is everything here. It started hundreds of years ago with the Dutch coming in, progressed with the Boers who were essentially offshoots of that but mostly farmers and culminated with the establishment of apartheid. Now, this is a country of lots of white immigrants from hundreds of years ago, former slaves that are a mix of europeans/indians/arabs who are mixed in with the native "blacks". When I say mixed, I mean, their has been a lot of offspring from these combinations. So essentially during apartheid people were classified into whites, blacks who are what one would think of as Africans, and the coloureds who are the mix of those other groups, and then there are also the pure immigrants who are classified as Asians that includes Indians. Confused yet. I am. Now the strange thing to me as an American is that many of the coloured group would in fact in America be categorized as black, but it's more than just a color thing, it's a cultural thing. Most of the blacks speak the native african dialects, where as the coloureds favor Afrikaans which is a language essentially created by the early immigrants and is a combination of Dutch, German, English, etc. Most coloureds also speak English but favor the Afrikaans, most blacks speak their own dialects but also speak English and most whities speak both but favor Afrikaans, and all of this changes depending on what part of the country you are in. Now I know you are confused. So the bottom line is, South Africa in many ways is a messed up country because you have all of these languages and cultures, etc and to top it off, you had a bunch of idiot whities that decided years ago to separate everybody and treat them like crap and then try to rule the country even though they were a huge minority. Recipe for disaster. Now fast forward to Mandela, who comes out of prison and now ends Apartheid with lots of help and now everything is switched all around, but now all the blacks are in power and a reverse discrimination has occured where most of the jobs now go to them, and now, and this is a slanted version, because I lived the coloured experience, the coloured who were once second class citizens to the "whiteys" are now second class citizens to the blacks. The tension in this country is incredible. Each day there is a battle to keep order. It's a tenuous situation, which is far better than the time of Mandela's election, but things are brewing and there is definite fear and trepidation within this country. Not to mention, I have never seen so much barbed wire, gates, electric fences in my life. Everything here revolves around protecting those things that you have. All the cars have code keys to start the engine, stereos which are removed, not just faceplates but the whole stereo. Forgetting to lock your car is a present to the thieves. Now I have seen one side of the country, and my guess is that there exists many wonderful places here, safe and secure, but that is indeed a minority. I hope for the best for this country, but they have far to go, but then again, looking back, they have also come a far way. Gone are the days of carrying id cards with your vital info including your race status, but the distrust is still ingrained. Ok, that just lets you know a little of the situation that exists here. My volunteer position was at Mitchells Plain Community Hospital which is essentially a day hospital monday to friday 8-4 unless there is an extreme emergency which stays open 24hours a day. It also has clinics for babies/children and mothers. Another clinic focused on diabetics and hypertensive patients and another clinic called the ARV (antiretroviral) clinic which deals with HIV patients in the area. The 24 hr area would be called our emergency room, but is referred to as Trauma which is actually a great name for it. The hospital is only one level, but receives an amazing amount of patients that are all low or no income patients. These are the poorest of the poor. My first introduction as I passed through the walled in/barbed wired complex was to get frisked by the security guard. Everybody must be checked for weapons, and this was a daily drill as was the searching of cars for bombs as they entered the gate. I then was introduced to many of the "sisters", the designation for nurses here in South Africa. They all were epaulets on their shoulders which indicate which areas of training they have completed, for example, "general", "psych", "trauma", etc. I would say that all of them seem very well trained and I was impressed by their abilities. My first day involved working in the ARV Clinic (HIV) shadowing the counselers who are kind of like social workers, but not quite. They see all the HIV patients on a regular basis, depending on their point of treatment and counsel them on how to take the medicines, side effects of drugs and the disease and helping them with home issues like money, alcohol, abuse, drugs, etc. There is a huge HIV population in South Africa, the highest percentage in the world, and there is a huge focus on testing, prevention and treatment, because of that. It took many years to get to this point but they are really trying to get a hold of the disease. I don't want to get too much into details of the program because it would take forever. I am however left with the overwhelming feeling of how big a problem this is and how it affects the country. I continued my experience working with the physicians who were all excellent, the head of the clinic actually is from Nigeria, and was truly amazing and funny too. One of my days also involved going to a few of the clubs and dropping off boxes of condoms (6,000 condoms each) which are given out free to customers. They were a little surprised when I told them that we pay for such things. Oh, another hilarious thing I read in the informational booklets about HIV was that as they described the types of people that can have HIV, they said that "even Homosexuals" are known to contract HIV. Suffice to say, it is hugely the heterosexual population that carries the disease here, and not vice versa. After more than a week in the ARV clinic, I spent my last few days in the Trauma unit. Now this place is busy. They are severely understaffed and have very little room for the patients that come in. It's essentially 3 beds with the triaging occuring in the same room. Meanwhile, with all this overcrowding, you have lots of people coughing, coming in with measles (now an evolving problem) and TB. Infection control is . . . well, interesting. You have a sink, that sometimes has soap, but rarely has paper towels. Alcohol rub is relatively non existent. Gloves are present but rarely used, especially with IV insertion. I also assisted in putting a couple of urinary catheters which involved cleansing with normal saline and that's all and using regular gloves. In America, everything is sterile smeared with lots of iodine. Wow!! What a trip. The first day was not too bad, the next involved showing up at 8am with them inserting a chest tube into a 30 ish old woman who had a collapsed lung secondary to TB. Not sure if I mentionned it, but I saw more TB in 1 day than in 12 years of nursing. All total, I saw probably about 100 people who either had had TB in the past, just contracted TB or were on their 3rd of 4th bout of TB. And they have a lot of the multi drug resistant TB here. THat being said, my time in Trauma involved wearing a mask the whole time, because the doctors, thankfully, did not want me to bring some weird strain of TB back to America to infect the masses. The days commonly involved the presence of police who brought patient/prisoners in with stab wounds or minor/major lacerations. There was a lot of suturing going on. My last day involved coming in with the doctors treating a major head wound, meaning much of the back of the head was missing, secondary to a fall or some other tragedy. The patient was unresponsive, but ironically had great vital signs. That place was indeed crazy, and they stated this was actually minor compared to Friday and Saturday nights when the place fills with gunshot and stab wounds. All I got to say is I definitely received an amazing experience filled with all the complexities that South Africa has to offer. Next stop, my safari volunteer experience. Later