Take the stats I just posted and compare them with this...
24% of the world population lives in Sub-Sahara Africa
1% or less of health professionals are serving in this area.
Hlabisa (the HL is pronounced by pushing air into your cheeks. Think of Eeek The Cat's lisp...) is the name of the 300 bed hospital where we have spent the last two weeks. It is the only hospital for hours in any direction, and there are about 20 clinics scattered throughout the countryside that feed into it. It is in the province KwaZulu-Natal, which is considered the global epicenter of HIV/AIDS. Statistically, the most reliable source of HIV infection rates has come from antenatal clinics, where there is now compulsory testing for mothers - 56% of them are testing positive here.
The doctors that work at Hlabisa are either South Africans who are obligated to one year of community service after completing med school, or young doctors from European countries wanting a year of experience with infectious disease before returning home. The doctor who had been there the longest had been there barely 18 months (and had also just adopted an orphaned infant).
While there, we were able to tag along with the doctors through all of the many workings of Hlabisa. We observed rounds in the medical, surgical, tb, pediatric, icu, and neo natal wards. We were able to assist in surgeries and deliveries. I sat in on counseling sessions for patients being initiated onto ARV's. The out patient department was always busy and understaffed. People would wait all day, sometimes having to stay the night on the benches, in hopes of being seen in the morning.
As I think of Hlabisa, a few stories come to mind:
*Almost every night we were there, we were either without water or electricity. It made for a fun game of resource roulette as we made dinner plans.
*The women here are insanely quiet while giving birth. One afternoon, two other girls and I were in the labor and delivery, hoping to observe a few deliveries. We were reading books while we waited, and on the other side of a CURTAIN was a woman in labor. There was no nurse or midwife in the large room that had capacity to hold 4-7 laboring women. We looked up when we heard the woman calmly call, "nurse", then jumped to our feet when we heard the baby wail. She had delivered on her own, without making a sound. We laughed, thinking of how we would have been screaming for help, and expressed gladness for the baby not shooting off the end of the bed.
*I have been fortunate in life to have very limited contact with death. At Hlabisa, it is a daily occurence. A morning priority many days is filling out death certificates for patients who did not make it through the night. One day we were doing a lumbar puncture for a man in order to confirm the suspicion of meningitis. He was clearly in the final stages of AIDS, with skin stretched over his once tall and probably lanky frame and eyes receding back in preparation for his final sleep. The doctor inserted the needle, and I stood, hands on his back, collecting his cerebrospinal fluid. During this simple procedure, he slipped away. The profoundness of being the last touch this man encountered has spun through my head for a week now. What other sensation should he have been encountering at this moment. Bouncing a child on his knee, smelling his wife's simmering curry and rice, calloused hands holding a garden tool...
We have spent a good part of our time here trying to unravel the complex nature of disease in South Africa. The struggle is not just against illness though. It is so much more. I am hoping to write about all that I am learning in an attempt to process through it better myself. That will be another day though, I'm out of cafe minutes! Hope all is well in the west. Love.
Monday, November 26, 2007
Find the Good News
November 07 UNAIDS Fact Sheet
Global Overview
Global HIV prevalence (the proportion of people living with the virus) appears to have levelled off. However, the number of people living with HIV has risen to 33.2 million in 2007 from 29.0 million in 2001.
Some 2.5 million people were newly infected with the virus in 2007 and 2.1 million people died of AIDS-related illnesses.
Sub-Saharan Africa
Sub-Saharan Africa remains the most affected region. Some 1.7 million people were newly infected with HIV in 2007, bringing to 22.5 million the total number of people living with the virus. Unlike other regions, the majority of people (61%) living with HIV in sub-Saharan Africa are women.
More than two-thirds (68%) of all people infected with HIV live in sub-Saharan Africa where more than three quarters (76%) of all AIDS-related deaths in 2007 occurred.
Within the region, Southern Africa is worst-affected – national adult HIV prevalence exceeded 15% in eight Southern African countries in 2005.
South Africa is the country in the world with the most HIV infections, but like most of the countries in Southern, East and West Africa adult HIV prevalence is either stable or has started to decline. The latter trend is most evident in Kenya and Zimbabwe, and signs of declining HIV prevalence are also being seen in Côte d’Ivoire, Mali and urban Burkina Faso. In these countries there is also evidence of a shift towards safer behaviour.
Global Overview
Global HIV prevalence (the proportion of people living with the virus) appears to have levelled off. However, the number of people living with HIV has risen to 33.2 million in 2007 from 29.0 million in 2001.
Some 2.5 million people were newly infected with the virus in 2007 and 2.1 million people died of AIDS-related illnesses.
Sub-Saharan Africa
Sub-Saharan Africa remains the most affected region. Some 1.7 million people were newly infected with HIV in 2007, bringing to 22.5 million the total number of people living with the virus. Unlike other regions, the majority of people (61%) living with HIV in sub-Saharan Africa are women.
More than two-thirds (68%) of all people infected with HIV live in sub-Saharan Africa where more than three quarters (76%) of all AIDS-related deaths in 2007 occurred.
Within the region, Southern Africa is worst-affected – national adult HIV prevalence exceeded 15% in eight Southern African countries in 2005.
South Africa is the country in the world with the most HIV infections, but like most of the countries in Southern, East and West Africa adult HIV prevalence is either stable or has started to decline. The latter trend is most evident in Kenya and Zimbabwe, and signs of declining HIV prevalence are also being seen in Côte d’Ivoire, Mali and urban Burkina Faso. In these countries there is also evidence of a shift towards safer behaviour.
Thursday, November 8, 2007
St. Mary's
The hospital of the week was St. Mary's. A super old, semi-subsidized hospital which seems to be run by extremely compassionate, well organized individuals who are doing great things with the limited resources available. The first day I spent in the HIV ward where the halls were exploding with people waiting for care. A fellow CFHIer, Chris, and I spent the day bouncing between two doctors, seeing HIV+ patients mostly in stages 1-3 (out of a possible 4). They were in the hospital to be treated for the opportunistic diseases/infections that jump in once the immune system is weakened. I had my first look at tuburculosis, oral thrush (a rash in the mouth), severe cases of herpes, and genital warts.
The medical information was absolutely fascinating, and as I overlooked the crowd it swirled in my head along with the thought that these people have been handed their death sentence. Unless something random jumps in, they know how they will die, and have more than likely seen very vividly the process in full. A granny came into the office. She had nursed her son until his death and in so doing, had incurred the disease. Now his children would nurse their granny to her death. The doctor turned to us and repeatedly said, 'this woman is not supposed to be a statistic.'
There is so much ignorance here about the disease - and at all levels. It was only a few years ago that the department of health acknowledged that it was HIV that caused AIDS. It is especially within the Zulu culture that there is much misunderstanding about the disease, and they are very resistant to attempts to educate them. They would rather hold to their cultural beliefs and traditional healer's remedies, even though they are dying. This didn't make much sense to me until one of the CFHI doctors reminded me that only 20 years ago, these beliefs were all that they had. Apartheid really screwed things up.
Anyway, the second day I was in a unit called PMTCT (preventing mother to child transmission). It was nuts it was so gripping. Seeing babies all day, some positive, some not. Most not thriving, but some doing okay. I worked with a 62 year old white woman who had gone to school at a black college and had recently adopted 2 black children. She had 44 years of nursing exerience and talked my ear off all day. I took pages of notes. Then today we did home visits in the Valley of 1000 Hills. It was a gorgeous area, and we walked all day through a hillside village that had a mix of huts and small houses made of stone, mud, cinderblock, sticks, etc. We were checking on the HIV+ patients of St. Mary's in this particular village to make sure they were taking their ARV's and were doing okay. One woman told us that she couldn't take her meds because she had no food. Another had no money to get back to the hospital to get her son tested. I guess it was pretty typical, but still sad.
For the next two weeks we will be in rural clinics, so there will be no internet. We have heard though that they are very understaffed and we will be put to work, not just observing. So here we go... it should be interesting!
The medical information was absolutely fascinating, and as I overlooked the crowd it swirled in my head along with the thought that these people have been handed their death sentence. Unless something random jumps in, they know how they will die, and have more than likely seen very vividly the process in full. A granny came into the office. She had nursed her son until his death and in so doing, had incurred the disease. Now his children would nurse their granny to her death. The doctor turned to us and repeatedly said, 'this woman is not supposed to be a statistic.'
There is so much ignorance here about the disease - and at all levels. It was only a few years ago that the department of health acknowledged that it was HIV that caused AIDS. It is especially within the Zulu culture that there is much misunderstanding about the disease, and they are very resistant to attempts to educate them. They would rather hold to their cultural beliefs and traditional healer's remedies, even though they are dying. This didn't make much sense to me until one of the CFHI doctors reminded me that only 20 years ago, these beliefs were all that they had. Apartheid really screwed things up.
Anyway, the second day I was in a unit called PMTCT (preventing mother to child transmission). It was nuts it was so gripping. Seeing babies all day, some positive, some not. Most not thriving, but some doing okay. I worked with a 62 year old white woman who had gone to school at a black college and had recently adopted 2 black children. She had 44 years of nursing exerience and talked my ear off all day. I took pages of notes. Then today we did home visits in the Valley of 1000 Hills. It was a gorgeous area, and we walked all day through a hillside village that had a mix of huts and small houses made of stone, mud, cinderblock, sticks, etc. We were checking on the HIV+ patients of St. Mary's in this particular village to make sure they were taking their ARV's and were doing okay. One woman told us that she couldn't take her meds because she had no food. Another had no money to get back to the hospital to get her son tested. I guess it was pretty typical, but still sad.
For the next two weeks we will be in rural clinics, so there will be no internet. We have heard though that they are very understaffed and we will be put to work, not just observing. So here we go... it should be interesting!
Sunday, November 4, 2007
Welcome to Durban
Made it! It is beautiful here. The family I'm staying with is fantastic. They live in a small house in a neighborhood stacked on a hill that overlooks the suburbs, which I'm guessing is slightly south of the downtown area. From the front door you can see a few miles out, all the way to the 'sea' as they call it here. They have two boys, who enjoy greatly the Colts football I brought along. :o)
The other girl in the program that I'm staying with is named Lisa, and she came in last night. She is from Michigan and has spent the past few weeks touring SA with her brother. I like her a lot already.
The younger of the boys is teaching me Zulu. He was really excited when I could pronounce almost correctly a few words that have clicks in the middle of them. (I was too!) He is a very patient teacher, much like his parents, who are both school teachers.
My timer here in the Internet Cafe is running out, so I'm out! Take care, hope to hear from you as well! Love.
The other girl in the program that I'm staying with is named Lisa, and she came in last night. She is from Michigan and has spent the past few weeks touring SA with her brother. I like her a lot already.
The younger of the boys is teaching me Zulu. He was really excited when I could pronounce almost correctly a few words that have clicks in the middle of them. (I was too!) He is a very patient teacher, much like his parents, who are both school teachers.
My timer here in the Internet Cafe is running out, so I'm out! Take care, hope to hear from you as well! Love.
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