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The
Journal Travel Journal Africa Day 134: Siyabuswa and Mmametlake Hospital Austin had heard from the UK of a potential job interview (it's remarkable how difficult the NHS makes getting a job if you're not in the UK) so spent the morning on the phone trying to organise a phone interview. That left Andy, Duncan and Giles to head off with Sam for a visit to Mmametlake Hospital, forty minutes drive from Siyabuswa. Mmametlake is not quite as big as Philadelphia Hospital but having been built more recently feels more modern. The sister in charge of the HIV/AIDS programme kindly took a few hours out to explain all the work they are doing there at the moment and their plans for the future. At present they offer voluntary counselling and HIV testing and clinics which allow the treatment of opportunistic infections but do no yet have ARV therapy for their patients (they are available for post-exposure prophylaxis in, for example, needle stick injuries, or for victims of rape). We were told they have had the first of their two accreditation visits required before during which they must show that they have adequate facilities to run a complete HIV service before they are provided with ARVs. It's easy to not see beyond the need for ARVs in countries like South Africa but this hospital demonstrated very clearly to us the huge investment in staff and infrastructure that is required in order to ensure the drugs are as successful as they can be. From Mmametlake, we headed on to two health clinics, first Phake Clinic and then to Nokaneng Health Centres. Both are reasonably newly built centres that operate 24 hours a day, providing basic health care in rural settings. As with the centres we'd seen in Siyabuswa and Watervaal, the doctor only visits once a week and the remainder of the time patients are seen by the ever hardworking nurses. They seem capable of dealing with all aspects of medical treatment from family planning and sexual health through orthopaedics and trauma - quite amazing. It's
been hugely pleasing to hear that HFA are very excited to have the
tents on top of the Land Rovers, as accommodation is a little hard
to come by in some of the areas they will be put to work. Therefore,
once back at Hendrick's house we set about returning Bert to his
former tented glory (Ernie will have to wait until there are more
people to give us a hand with his incredibly heavy roof rack) and
generally doing a few of the small adjustments we'd talked to Hendrick
about at the weekend. Sunday is the traditional day of rest and worship and, never ones to buck the trend, this was the plan. In the morning Andy, Duncan, and Giles went off for another dose of church, Africa style. Meanwhile Austin set about the DVD collection, anxious to fulfil the rest part of the plan. After a short 4 hour service the boys returned to an afternoon of Scrabble, duly put to shame by Carole's more extensive vocabulary. A cup of hot cocoa and early to bed rounded off the day, our penultimate weekend in Africa, with the nagging suspicion that next weekend may be a little less sedate. With the bright sun shining upon the intrepid quartet we nervously drove to the local church, anxious about what would await us. On this occasion there were 25 eager students packed into one of the church's rooms. The teaching session began; comprising three 40 min blocks where we attempted to cover all that they had requested from the previous week. This included more detail about anti-retrovirals, tying in with the planned program to supply them from the 1st July at Philadelphia, as well as expanding upon the themes of opportunistic infections of which they had a great deal of first hand experience. It was very much a two way session, with us learning as much as we taught (hopefully). At the end of the session it was decided to try and put together an extended handout covering all the topics from the two days as well as more detail on the subject of ARV's. The afternoon was spent with Hendrick, the Hope for Africa director, discussing the inventory lists and the final vehicle specifications. Thanks to the generous support of a great number of people and organisations it has been possible to provide Hope for Africa with additional funds for maintenance and upkeep of the two vehicles, allowing this to be a sustainable donation and provide usefulness long into the future. Whilst
Duncan & Giles made a start on the teaching plan for Saturday,
Austin & Andy accompanied Alfred to the weigh-bridge, for Bert
and Ernie's big day. Having stripped as much unnecessary equipment
off, fingers were crossed that they would make the weight requirement.
As with all things in Africa, the exact location of the weigh-bridge
was a matter for much discussion amongst the various traffic officials.
The first weigh-in happened some distance out of town at an official
government weigh-bridge. This was staffed by 7 officials who were
somewhat surprised to see two British Land Rovers limbering up.
It turned out that this was not the right place at all. The
rest of the day was spent putting together the teaching session
ready for tomorrow, and completing an up to date inventory of all
remaining equipment. Day 130 - Siyabuswa & Philadelphia Hospital The ever enthusiastic Sam had organised a morning visit for us to Philadelphia Hospital, a secondary referral (roughly equivalent to a large DGH) centre about 20km from Siyabuswa. After having experienced a little of the front-line at the Health Centres on Tuesday, we were keen to see the level of healthcare available to the population at a larger centre. Philadelphia Hospital serves a population of between 750,000 and 1 million people; it's difficult to give accurate figures and this is probably an underestimation as people from outside their 'catchment area' regularly present to clinic. On an average day approximately 600 people present to clinic and the (medical) doctors see all cases from general medicine, through TB and HIV, to psychiatry. They also run surgical clinics and theatres, a dentistry service, an A&E (all two beds of it) and are currently in the process of initiating the provision of Anti-Retroviral (ARV) treatment for HIV patients. Sadly the doctors were a bit snowed under (not terribly surprising) but we were lucky enough to be given a tour of the hospital by Mrs Pretorius, one of the matrons. She told us about all aspects of the working of the hospital as well as the up-coming start of their ARV program. At present they are pre-counselling 10 HIV patients who will start the ARVs on the 1st July. Although this seems like a tiny number compared to the high rate of HIV infection in this part of the world, they feel it is important to ensure that patients are properly counselled before starting the therapy and that any small problems are quickly identified and sorted out early. This will be easier with an initially small treatment group and the plan is to increase the number of people on the programme by 30 per month. The hospital has high hopes that by showing people that there is an effective treatment to help stop the progression of HIV/AIDS the population will see a real benefit in getting HIV tested and starting treatment, as at present there are a disappointingly low number of people willing to come forward for testing. Thus it is hoped the benefits of the ARVs will be seen on both an individual and population level. Mrs. Pretorius suggested it might be of interest to come back the next week to join in the doctors rounds, and we agreed we would try and speak to the CEO when he returned from his holiday and organise something. With
Bert & Ernie due to be weighed the next day (and it being important
that they come in at under 3500kg - as you need a special licence
to drive a vehicle heavier than this) we spent the afternoon removing
all of our boxes of equipment and taking off the two roof tents.
We gradually came to appreciate why Ernie has been a little slower
than Bert as we carried out the four boxes of spares and took off
his mostly steel (as opposed to aluminium) roof rack. It's really
quite heavy. With all our equipment stacked in the guest house and
the tents on the drive, Bert & Ernie were riding a good deal
higher on their springs and looking a little emaciated - we might
have to refit everything after the weighing just to make them look
rugged again! Our
earliest start for quite sometime, in fact darkness still prevailed.
The plan today was a journey to Pretoria to complete the vehicle
formalities, plus a few other outstanding jobs. Taking Edward and
family as well as the ever helpful Carole along to assist us as
well as get them Mozambique visas. To facilitate this, the team
split into two, with Giles and Austin taking Ernie, the rest of
the gang in Bert. Meanwhile the Bert team were attempting to make a start with all the formalities required of importing vehicles into South Africa. Fortunately Carole had already done much of the soul-destroying chasing of paperwork and so we were left with the job of heading to the main Customs building in Pretoria to have the vehicles inspected and cleared. Obviously this proved to be slightly more laborious and long winded than we'd hoped, but after a little running around town searching for someone to fill out our forms for us (only the agents have the book with all the right codes in it…..) and a slightly longer wait than normal due to a power cut we were ready to have Bert & Ernie inspected. All we had to do was get hold of Austin and Giles. The Ernie team were naturally in constant radio communication so were able to respond instantly to the call and swiftly make their way to the custom's office. There is simply no truth in the rumour that the Sushi bar conveyor belt noise affected the audibility of the phone ring. With
both vehicles checked and all chassis and engine numbers matching
(not that we'd checked until then) the relevant paperwork and inevitable
stamps were issued. All that remained was the weigh-in (hmmm 3500kg
max), road worthiness (surely a breeze for the lads), and registration,
all of which can be accomplished locally. Bert looked after the
Hope for Africa team as they picked up visas and headed home whilst
MobileMedics reunited in Ernie to return to the mall for a few last
jobs. Amongst other important things, this entailed a haircut involving
a splendid tea tree head massage for Austin (the big girl's blouse);
imagine abandoning the Slippy Saloon. Day 128 Siybuswa - Siyabuswa and Wasterfaal Health Clinics Today we were taken to the two local government run health clinics we had seen the previous day. These clinics serve the local community and are funded by the central health department and staffed by nurses. The first clinic in Siyabuswa has approximately 600 patients attending it each day. These are dealt with by 25 nurses with two doctors visiting once a week (where possible). In South Africa the doctors study for 6 years, followed by a year's internship and then followed by a compulsory year working in the community. The two doctors were currently completing their community requirements. The nurses decide each week which new patients the doctors should review, in addition there are the doctors' own follow ups and at least 20 patients with disability grant forms to be completed. This amounts to approximately 40 patients in any given session. On that particular day the doctor was also on-call for the local hospital! The sorts of patients we saw included a great deal of hypertension, diabetes, tuberculosis, epilepsy as well as some psychiatry and inevitably HIV/AIDS. It was a strange feeling that despite the distance we had travelled the same health problems were being tackled and the same problems of compliance and understanding remained. The clinic itself has a dispensary giving access to most basic medications and the local hospital is available for specialist referrals. They also have the capacity for basic blood tests, although they then have to be sent to the hospital for analysis. By lunchtime we were already struggling to maintain the pace and were kindly discharged for lunch and our next health post. The second health post is located in the next town of Watervaal, divided into A, B, and C districts (catchy names). This health post is smaller and hasn't had a doctor attend for a number of months. In fact it only had four trained nurses on the day we visited, covering the clinics themselves as well as the dispensary, reception and delivery rooms. No small feat and, as if to add insult to injury, they also had no phone connection making summoning an ambulance only possible if there was a mobile phone around. With introductions completed the larger-than-life matron put us to work in the dispensary and clinics. The order of the day was family planning and before long Andrew was given IM injections of contraceptive. Mind you he was soon moved on, coated in concentrated female hormone: nice injection technique. The number of patients the nurses deal with each day was staggering; 200 on average, over a twelve hour shift. Most of the problems we saw that day related to family planning and gynaecology. Frighteningly the number of sexually transmitted diseases they treated was very high, and aggressive antibiotic therapy is the protocol, somewhat different from back home. With
the sun setting it was time to bid a farewell to the health posts
and retire back to the mission base Day 127 Siyabuswa - Official Welcome To Hope For Africa Although we'd arrived on the Friday, our constant delaying had meant that Hendrick thought it wisest to postpone the official welcome and briefing until today. Just before leaving for the Place of Safety, we were told we they would like us to give a small talk about our project - ah more hurried preparation.
Heading to the Place of Safety, we weren't quite sure what to expect and on arriving discovered that many of the care givers as well as most of the managers of the various HFA projects were there looking expectantly at us. The day started with hymns, a devotion and prayers; HFA is very much a faith led organisation and it is through their incredible faith that they find the strength to do their great work. They were aware that we are not all religiously minded but seemed happy that we were willing to work with them and share in trying to help in very difficult circumstances. We heard from each of the project managers in turn and were fascinated and held in awe by the sheer scale and breadth of the projects that HFA is running. Besides their involvement in the running of the church and school in Siyabuswa, HFA also run the agricultural and medical projects we had seen in Southern Mozambique, as well as projects in Southern Malawi, Zimbabwe and are planning to use one of the Land Rovers to initiate mobile health in Northern Mozambique, Malawi and Zimbabwe. We couldn't quite match some of the public speaking on show, but gave a brief summary of the Mobile Medics project from its inception to our plans for the future and then guided everyone outside for a thorough inspection of the vehicles. There was much excitement and more singing as we showed off Bert & Ernie to all. Pastor Edward became the first person other than the four of us to drive either of the Land Rovers since we'd left the UK and it wonderfully symbolised for us the handing over of them to HFA. In between showing people around Bert & Ernie, Giles and Austin produced a football they'd bought for the children at the Place of Safety - hugely appreciated by all - and entertained us with their footballing skills. We thought the two footed tackle on the five year old was a little harsh though. In the afternoon, Sam (the Care Awareness & Training Co-ordinator) had organised us to briefly visit two of the health clinics we were scheduled spend some time at over the next week. It was instantly apparent that there is a huge demand on these places and that we would see a side of medicine that doctors in the UK don't. Sunday
as a day of rest is taken pretty seriously at Hendrick's house and
we were more than happy to tow the line. After breakfast Giles,
Duncan and Andy set off to attend Hope for Africa's church in Siyabuswa.
Hendrick had warned us that we were unlikely to return for 3-4 hours
at the earliest and that service would be loud, very loud and in
Zulu... We were fortunate that the service that Sunday was led by
the youth of the congregation. They kindly conducted more of the
service than normal in English and much of the rest was translated
for us. It was also shorter than usual, only lasting a little over
two hours. Day 125 Siyabuswa - Teaching session with care givers 1 We started the day we another fine meal and headed up to the 'Place of Safety' for the teaching session we were due to give. The Place of Safety is a building that is financially supported by HFA and houses vulnerable or orphaned children, often as a result of HIV/AIDS. It also seems to double as the HFA conference centre and today it was to double as our classroom; our teaching session being due to start at nine o'clock. It being Africa, we arrived at nine-twenty and were totally unsurprised to find that no-one else had yet made it there. It gave us some time to look around and for Carole to give us an overview of a few of the projects that HFA are currently running. Sadly, the Place of Safety is due to be taken over by another organisation and so HFA are currently in the process of building an accommodation block next to the HFA-run school, Grace Chirstian School. This means that all resources are being channelled towards the building and so the Place of Safety is a little short on furniture and toys for the children. By ten o'clock, around fifteen of the care givers had arrived and we made a start. We'd been told that some of the people present would know very little about the medical details of HIV/AIDS and accordingly had planned a basic teaching session. Unfortunately, those that turned up actually had a quite advanced knowledge of the disease and so we had to do some ad-libbing (six years at Medical School is the perfect training). We hoped we hadn't bored them too much and promised that we would talk about the disease in more detail at the next planned session and the care givers were able to tell us exactly what they wanted teaching on. Next time we hoped to target our material to their level a little better. The afternoon was spent making a start planning the next week's teaching session (the internet is a marvellous thing), checking e-mail and trying in vain to help Carole download some photos from her camera onto her computer. We
had another excellent breakfast at The Pretoria Backbackers before
calling Rolf at Independent 4x4. The vehicles were going to be finished
by lunch-time so we called a little taxi into which we shoehorned
ourselves and bags and set off. We got up with high hopes that Bert & Ernie would be finished and we could be on our way to the ever patient Hope For Africa. Sadly a phone call to Rolf at Independent 4x4 revealed he hadn't yet been able to get a few of the parts he needed and so they wouldn't be ready until two o'clock the following day. Disappointed but happy that it sounded like both Land Rovers would be fully sorted in no too long we rang Hendrick at HFA and explained the situation. Hendrick told us not to worry and to head up once we had both Bert & Ernie back again. Feeling slightly better we spent the rest of the day enjoying the civilised surroundings of Pretoria - an environment we were confident would be a great deal removed from that we would see in Siyabuswa. The
following morning we checked in with the garage and they told us
that they had managed to get the majority of the work done and,
despite it being a public holiday today, may even be finished by
the following day. With this in mind we spoke again to Carole at
HFA and decided that we could come on the following day with the
cars rather than renting another vehicle and driving up there for
a few days. In
an attempt to save time we decided to take Bert & Ernie to the
nearest garage in Pretoria to fix the last few problems before handing
them over so that we wouldn't have to return before going to the
health posts. Taking the advice of the very helpful owner of the
backpackers we headed out to a garage on the outskirts of town.
After some entertaining navigation we eventually found ourselves
in the yard of the Independent 4x4 garage. |
