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Archive for October 2011

Jonesy gets the horn

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Just as I was starting to worry that my work here was settling into a too-comfortable routine, the whirlwind that is our area manager roared through Camdeboo lifting entire HIV teams into the air before depositing them, reconfigured, in unfamiliar places. Welcome George was dapper in black and white ankle-height brogues, the cuffs and collar of his white shirt chic-ly patterned beneath a deep red, velvety jacket: dandy. His mind is as sharp as his wardrobe, fizzing with creativity and expectation: it can be thrilling to be around him.

The entire Graaff-Reinet FPD (Foundation for Professional Development) team was reminded that its work will cease in September 2012 – don’y worry Angela: end of November for me. Concentrating then on one of my guiding principals, leaving behind a self-sustaining public HIV service, I’m to reduce the time spent one-to-one with Maryna in Camdeboo clinics. Throughout November I’ll be mentoring two or three more FPD NIM-ART mentors in further flung towns: Klipplaat (107 km) and Steytlerville (147 km). Klipplaat is a railway town whose last train pulled away ten years ago, presumably leaving the clippies of Klipplaat to exchange their ticket punches for sheep clippers. With Steytlerville I’ll be adding the Baviaanskloof Wilderness to the Valley of Desolation. (Baviaanskloof means baboons’ ravine.)

Saturday cricket – last week’s narrow defeat to Somerset East followed by Ruspe’s eight-wicket victory – was topped off at the spanking new sports club behind the Botanical Ground with big screen broadcast of the Currie Cup final. It’s like FA Cup final day but with the wrong-shaped ball and too many players on the park. No detail is too trivial in pre-match build-up: the arrival of team buses at Johannesburg’s Coca-Cola Stadium, interviews with team-colours face-painted Sharks (Durban) or Lions (Jo’burg) fans, a stats-fest… For the sports club this was launch night. For Graaff-Reinet cricketers it was time for their “number one supporter” – some weeks you might say “only” – to kneel for the kudu horn of ale challenge. Well, I’d had a big breakfast but only a coffee and two rusks at lunchtime; then a couple of Amstel lagers already… You’ll be proud to read that British honour was upheld with not a drop spilled as gravity and gulping formed a fluid combination and I rose from my knees to cricketers’ handshakes and backslaps. While Angela’s head recovered from Friday evening at Eastbourne’s eighth Beer Festival mine spun sympathetically in the southern hemisphere.

Curious coincidence: there’s a comment on the ‘Culture and sensitivity’ blog from Candy Duggan, a nurse I first met at St George’s Hospital, Tooting, let’s discretely say some years ago. Having exchanged emails it turns out that she’s been visiting the Eastern Cape with CHIVA (the Children’s HIV Association) and even spent three days at Graaff-Reinet, including Ithemba (HIV) Clinic, my base. We’re hoping to compare notes via Skype.

Nature watch: I saw plenty of lizards in the Valley of Desolation today and have had a companion on my bathroom ceiling for three days (photo below). It’s jacaranda season too, Graaff-Reinet’s avenues gorgeously blue from street level and viewed from the Mountain Drive. For any students reading this, it’s considered lucky if a jacaranda blossom falls on you whilst revising for exams. Finally I was delighted to identify the pretty, crested, long-tailed bird that has skimmed away so many times at my approach when a pair of red faced mousebirds sat stock still in a bush beside my path, obviously in awe of the UK cricket fan who drained a kudu hornful of ale.

 

 

 

The lizard on the ceiling, jacaranda in Graaff-Reinet, with Maryna in Umasizakhe Clinic AND with cricketers and kudu horn (extreme right)

Written by martinjones183

October 30, 2011 at 5:38 pm

Culture and sensitivity

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What makes you think you have something to say that people want to read?

Redi Tlhabi in ‘The darling of the media’, Mail & Guardian October 21 to 27 2011

A humbling thought and one that has crossed my mind as I blog. So if you’re still reading ‘UK HIV nurse in South Africa’ I hope that I’m saying something that you want to read. (So why am I starting with a metaphor that you may well not want to read?)

Any TB suspect who spat into a specimen pot at around the time that I was being disgorged from passenger planes onto South African soil should by now be receiving reports of culture and sensitivity. Angela has teased me for listening to northern soul via the BBC iPlayer, which has prompted a reflection on my experience of and sensitivity to South African culture – whatever that is. Black / white / coloured? Johannesburg / Port Elizabeth / Graaff-Reinet? Central Graaff-Reinet (white area during apartheid) / Umasizakhe (black) / Kroonvale (coloured)? Urban / rural? Rich / poor? It’s a fascinating country of differences.

In response to the tease I’m streaming Yfm as I type which, according to the SouthAfrica.info website plays a mix of Kwaito (a South African form of house music) and music for the Y Generation (born 1975 to 1995). Your blogger falls fractionally outside the target demographic but I’m drawn by the reported 50% local music quota. So far it’s a pleasant contrast to ubiquitous Algoa FM which features a repetitive playlist of international pop that I might hear anywhere on the globe. As a station favourite by mid-seventies UK dullards Smokie so appropriately puts it, ‘Don’t play your rock’n’roll to me’.

This week’s other musical occasion featured a legacy of the British Empire: drifting down the town hall corridor into Horseshoe Clinic came school-assembly-styled piano accompanying sweet young voices belting out ‘Que sera sera’, ‘Big ship sails on the ally ally oh’, ‘There was an old man named Michael Finnegan’, etc. Songs pre-dating the Y Generation and even your blogger…

Other South African cultural experiences? I’ve read and can recommend – as something (else?) you might want to read:

Hilary Mantel, ‘A Change Of Climate’ set in childhood-holiday Norfolk and apartheid South Africa.

Fred Khumalo, ‘Bitches’ Brew’ evoking jazz and shebeens in Durban’s underworld.

Maya Fowler, ‘The Elephant in the Room’, a powerful contemporary study of eating disorder written by a Graaff-Reineter.

Gillian Slovo, ‘Red Dust’ set hereabouts during the post-1994 period of truth and reconciliation hearings. The movie was filmed in Graaff-Reinet.

Troy Blacklaws, ‘Karoo Boy’ and ‘Blood Orange’ both coming of age novels vividly describing the South African landscape both physical and apartheid. If Steve and Chris (Jones) read books I’d buy them one each. Coldplay’s Chris Martin, no less, describes Karoo Boy as ‘the most colourful book I’ve ever read’.

The South African Sunday Independent replied to my email about its absence from Graaff-Reinet newsstands explaining that the town is beyond their distribution network so I read Mail & Guardian and (with less enjoyment) The Sunday Times. However the most arresting newspaper advertisement of my stay will have been missed by most South Africans despite its front page prominence… in this week’s Graaff-Reinet Advertiser:

 

That sent me straight round the corner to further broaden my cultural experience. Disappointing to relate, the bodge job implied by Bosch looks just like… a painted church roof.

Then there’s the Springboks’ ubiquitous green jerseys, my ‘getting into’ the rugby world cup – without ever developing symptoms of RWC fever – and my enjoyment of the start of the southern hemisphere’s cricket season. Proteas have just thrashed Australia in the second one-day international, the crowd at Port Elizabeth taking up the informal brass band’s ‘Bye, bye blackbird’ with ‘Bye, bye Aussies, let’s hope we’ll meet again!’ And let’s not forget local cricket action at the Botanical Ground – an exciting 18-run defeat to Somerset East on Saturday.

Finally, there are the accidentally comical things that catch my eye (see second example below). I’m sensitive to the fact that my cultural experience of South Africa – and Graaff-Reinet – is biased. At work I’ve yet to meet a white person with HIV; my workmates are drawn from all sections of ‘the rainbow nation’; however my cultural experiences have been broadly with and within the white community…

Notice at Horseshoe Clinic

Written by martinjones183

October 24, 2011 at 7:06 pm

Building it ourselves

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Today, Monday I reach day 46 of my assignment in South Africa and will thereafter be closer to Arrivals than Departures at Heathrow Airport. Chatting on Skype last week, Angela and I agreed that, despite some weekend longueurs the time has truly flown.

Having been counted in the South African census I Googled Graaff-Reinet’s data from 2001. In the 2001 census, 32,464 Graaff-Reineters were recorded. The population has grown rapidly as an estimated  62,896 were living here by January 2008, comparable to St Albans or Clermont-Ferrand where, a couple of years ago I enjoyed walking the surrounding puys with Michael & Russell.

To cope with this, on the road between Umasizakhe and Kroonvale clinics – respectively Graaff-Reinet’s former black & coloured areas during apartheid years – Camdeboo municipality has prepared a large area for building more low-cost township-style housing. Umasizakhe translates as ‘we built it ourselves’. It’s still 83.7% black with 16% coloured and 0.2% white. During clinic on Tuesday a large tent was erected outside, from which melodic, gospel-like singing periodically rose – a far lovelier accompaniment to working than Heart FM in Avenue House, Eastbourne. In a project named Siyazondla (‘we are feeding ourselves’) the Department of Rural Development and Agrarian Reform was promoting urban gardening by giving out free hosepipes, wheelbarrows and water butts. The latter, like South African beetles and crickets are jumbo-sized. By coincidence, Umasizakhe’s cricket XI was at the Botanical Ground on Saturday. Graaff-Reinet seconds posted 230 and sadly on this occasion their local rivals could not ‘build it themselves’, struggling to 76 all out, wides a significant scorer after the third wicket pair had sprayed a few boundaries.

Crouch. Touch. Pause. Engage.

Taking the instructions barked by world cup rugby referees every time the rhinocerous-like forwards form a scrum: at work we’ve been CROUCHing tigers – but not hidden dragons – gently establishing our presence and purpose in the clinics; we’ve TOUCHed every file of every HIV positive patient; having PAUSEd to form our plan we’ve ENGAGEd lay counsellors in recalling patients and practice nurses in mentoring. The nurses are a little anxious now that  push has turned to shove but we’re there to support through mentoring. It’s neither ruck nor maul – see how I’ve learnt the language. We know that the pebble that we’ve dropped has created more than mere ripples in local healthcare: a reasonable state of affairs midway through my assignment. We’re building a locally delivered HIV service – but not all by ourselves.

Away from work, a weekend that loomed emptily had barely a moment of boredom. Walking to Spar for the newspaper a splendid vintage Singer racing car pulled up alongside me. Brian, a friend of my hosts offered me a spin up to the dam as he was turning the engine over: wonderful. Later on the same road in the Chevy I had to stop for a pair of ostrich sauntering across. That proved more exotic than the game park where I started a walk at 05:30 on Sunday morning expecting to see fauna galore before the morning heat. The sum of it turned out to be half-a-dozen kudu galloping down the slope and a large rabbit that I’d startled. With park entry R60 for non-Africans that’s a (local) tenner-a-kudu. That afternoon, when I took a drive through the erroneously named ‘game viewing area’ I added 16-20 helmeted guineafowl and a tortoise. Even the hide – like hides everywhere in my experience – seemed to refer to the whereabouts of the animals: hidden. Still, I enjoyed a good walk ahead of the day’s heat and was back in time to join Pierre for the second rugby world cup semi-final. More exciting by far was South Africa’s unlikely T20 victory over Australia after their batsmen seemed to have left the tail in a hopeless losing position.

  

Views of township housing in Umasizakhe and Nieu Bethesda, taken from clinic windows

Written by martinjones183

October 17, 2011 at 5:16 pm

Honey, honey

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Happy birthday to you, happy birthday to you,

Happy birthday dear A-arch

Happy birthday to you

Leanne Manas and Vuyo Mbuli on SABC2’s Morning Live, 6th October

My last blog skipped mention of Desmond Tutu’s birthday. And yet this was a significant event with newspaper interviews, an authorised biography and, if it’s possible for a man of the cloth, an unholy row. Prior to the row, in the Mail & Guardian (30th September) he reflected on his more intemperate younger days:

My biggest mistake in life was being cocky because I was right. Had I remembered that you catch more flies with honey than with vinegar I might have been less self-righteous.

A few days later  honey was right off the Tutu menu as malt, wine, balsamic – every kind of righteous vinegar was deployed… without trapping his prey. Sad to report that the African National Congress (ANC) government hid behind bureaucracy and doublespeak, denying the Dalai Lama a slice of birthday cake on its soil. I hesitate to comment on my host country’s government after just a few weeks resident in South Africa – and clearly they are doing some great work as they grapple with many problems. However my take on the Dalai debacle, reflecting on recurrent media reportage and conversations with locals is this: with the guaranteed unswerving support of two-thirds of the electorate the ANC is mired in charges of abuse of power, corruption and in-fighting akin to untouchable single party states. Hence Tutu’s acid broadside.

And I mention Leanne and Vuyo’s singing ‘Happy Birthday’ since the last four mornings have begun with further disappointment. No, not that the Boks are back home, nor that Bafana Bafana will stay home when the African Cup of Nations kicks off next year; Leanne Manas is absent with laryngitis. Waking to the opening news bulletin just ain’t the same. I hope that she’s using plenty of honey for her sore thrort.

This week’s news focus has been the start of the decennial South African census… and on day one of twenty-one your blogger was counted. When the total is published in March 2013 – seems that’s how long it takes to count to 45 million – be sure to subtract one from the world’s soon-to-be seven billion: I was already counted in the United Kingdom six months ago.

Eating my own words (1) Back in early September Sally commented on a blog: “Hoping to be busy eh…be careful what you wish for!!” Boy, we’ve been busy this week. The lay counsellors, Dolly and Vicky have performed a wonderful job circulating in the local community recalling patients to the primary care clinics: people un-monitored for several years, many of them immunocompromised. When time permits, we’re mentoring the clinic nurses, showing them how to combine HIV management, TB screening & sexual health care. We’ve started all those eligible on TB preventive therapy – for the clinicians reading, that’s isoniazid and pyridoxine for six months – the health service is doing all it can to reduce the terribleness of ‘the terrible twins’, HIV & TB. It seems that the pebble that Maryna and I have dropped in the pond has created waves… more about the stormy waters next blog. We’re sticking with honey expecting that our flies will eventually stick to it.

Eating my own words (2) Who was the jumpered-up nurse blogging about cold consulting rooms so recently? The mercury has been rising in Graaff -Reinet and not just in sphygmomanometers cuffed to our elusive flies: 37°C the other day, though milder since. I’m not gloating to northern hemisphere readers but with evenings lengthening here, I’m walking later. Fresh sights include beetles the size of small mammals, large spiders with feathery displays – a honey trap for small birds? – mountains fading into shades of blue against the dimming sky and reflected gorgeously in the reservoir… against a backdrop of shrieking from hundreds of insects, squawking weaver birds, ‘har-de-har’ from hadeda ibis and more languages of birdsong than there are South African tongues.

If the dropped pebble hasn’t produced smiles all round, here’s hoping that Leanne is back in her seat at 6:00 tomorrow morning to spread a little breakfast joy as I spread honey on my toast.

 

Martin, Maryna, Dolly, Vicky, Henry                                Madiba and Leanne Manas

 My breakfast

Written by martinjones183

October 13, 2011 at 5:48 pm

Connecting dots; finding what I love; staying hungry and staying foolish

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You have to trust that the dots will somehow connect in your future. Believing that the dots will connect down the road will give you the confidence to follow your heart, even when it leads you off the well-worn path.

You’ve got to find what you love. And that is as true for work as it is for your lovers. [] And like any great relationship it just gets better and better as the years roll on.

Stay hungry. Stay foolish.

Steve Jobs, Commencement Speech to graduates at Stanford University, 2005

http://www.youtube.com/results?search_query=steve+jobs+stanford+commencement+speech+2005&aq=3&oq=steve+jobs

A week ago I posted two blogs, reflecting first on my month’s work in South Africa then about how I’ve been spending my spare time. Friday presented an occasion for further reflection, this time under the direction of the Foundation for Professional Development’s (FPD) David Cameron. I drove the Chevy to Port Elizabeth and back, a 572 km (355 miles) round journey with three colleagues on board. I’ve never driven so far in one day – not even to watch my beloved home town football team, Cambridge United. South Africa’s a big country. Whereas in the UK and especially the South-East we’d’ve been constantly passing cities, towns and villages, here we paused once: to obey the STOP junction in Jansenville (population <5,000), the only settlement on the entire route. I discovered what I’d missed on my first, dark drive north: kilometre after kilometre of semi-desert: the great Karoo (‘Pretoria to Graaff-Reinet’ blog, 9th September).

David addressed the gathering of Eastern Cape FPD mentors with an inspirational reflection on the life of Steve Jobs and its relevance to us in our work, using Jobs’ third point (above) as his focus and directing us to its source. I’ve watched it twice. It lasts for 15 minutes, barely two twelve-inch singles on the Chin Chin dancefloor. I urge you to watch it too.

It’s too early in my assignment to tell how dots will connect come 30th November – or indeed further down the road. In coming out to South Africa I’ve taken a major detour from the well-worn path of HIV nursing in East Sussex: I’ve followed my heart and am happy to trust that the dots will connect one day, maybe when I look back on my nursing career. However, thanks to David’s affirmative feedback, Maryna and I came away feeling that we’re on the right track.

I hesitate to draw any comparison between myself and Jobs but with due humility, like the co-founder of Apple, I dropped out of my degree… which turned out to be a good thing. At Addenbrooke’s Hospital I found two things that I love: Angela (née) Gadbury and HIV nursing. Despite the many years that have rolled on both get better and better.

Pausing in my flow: an aside about a different hunger from that which drove Steve Jobs. While I’ve been typing for you Graaff-Reinet’s mosquitos haven’t gone hungry this morning: the little buggers have bitten me all around my feet and ankles. Earlier this week I was reminded of an old joke: Question: What’s worse than biting into an apple and finding a maggot in it? Answer: biting into an apple and finding half a maggot in it. For work, I fill a 75 cl water bottle from the guesthouse tap. As I started to drain the last drop on Wednesday I noticed a mosquito larva flexing and springing like treponema pallidum (the causative agent of syphilis) under dark ground microscopy. Tongue in cheek, I reminded Pierre that I am vegetarian and he has introduced me to the tea strainer that acts as a filter beside the Aa-Qtansisi taps. Can I ingest malaria?

But back to Jobs via David and reflecting on my jobs here and at home: I can truthfully say that, whether in Graaff-Reinet or in Eastbourne my appetite for HIV nursing gnaws as it did twenty-five years ago. I’m lucky to have a job that makes me get out of bed each morning hungry for the day’s work. And if you ever catch me thinking that I know all about HIV, then I’ll be foolish in all the wrong ways. I’m committed to staying foolish – remaining inquisitive – so that I can deliver the best for people with HIV wherever in the world I am.

Stay hungry. Stay foolish.

[Photo removed at the request of one of its subjects]

Written by martinjones183

October 9, 2011 at 9:29 am

One month in the Valley of Desolation (2: play)

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Well, my first paragraph was planned last night to start with a review of items from my suitcase that remain unused. Waking this morning Graaff-Reinet is enclosed: not by dolomite mountains but by cloud and I’ve actually worn the previously redundant waterproof jacket. While Britain basks in a record-melting Indian summer, Brigid liberates factor-fifty from hibernation and Thursday’s Guardian featured a sunburnt beer belly in a deckchair on Eastbourne beach, AccuWeather.com on my desktop indicates a paltry 11° outside. It’s greyer than the Jones barnet and thunder renders this the ‘Valley of Detonation’ (er, boom boom!). It would have to be on the Sunday that I had planned to visit every newspaper vendor in town searching for the elusive SA Sunday Independent. Sticking with that resolution, three-quarters of an hour in drizzle seems to have confirmed that I’m stuck with the SA Sunday Times… I’ve emailed SASI about it’s not so sassy distribution.

Mentioning the Jones barnet (1) This week I had the unusual experience of a haircut without mention of Crystal Palace – first time in fourteen years. I had assured the Ministry of Barbers’ Graham that I’d return looking like Robinson Crusoe. However, after all those years under Graham’s clippers I have disloyally visited VIP (‘Victor in Person’) in the Spar Arcade. Half the price, too! He’s the first South African that I’ve met who has visited Eastbourne. He knows a barrister with a seafront house named Ball or Balls. It occurred to me much later that Ed Balls and Yvette Cooper were married in Eastbourne… I must ask when next in VIP.

Jones barnet (2) Prior to today my luxuriant thatch has proved a reliable indicator of the intensity of the Valley of Desolation’s sub-tropical sunshine… or am I getting a little thinner on top..? Either way, Chris’s cap has seen good service.

Returning to my suitcase the more-useful-than-expected item is the jumper that I threw in at the last minute. Diurnal variation in temperature has been considerable with the Chevrolet indicating 6-7° some mornings before hitting low to mid-30s by afternoon. Perhaps I’ll buy a Bokkies green rugby jersey… Having hated rugby at school and ignored it since the early seventies I’ve embraced South Africa’s national sport, watching England twice and all four of SA’s matches. Unlike Jonny Wilkinson I don’t plan to switch balls, at least not in the longterm. And I don’t envisage dwarf-throwing – Matty Crabb anyone? – on future Eastbourne Borough stadium tours. But I’ve enjoyed joining in.

Although the weekends have had their longueurs I can reflect on an enjoyable first month in the Valley of Desolation. Flora, fauna, cricket (next home match v Willowmore on Saturday), walking… As I completed yesterday’s leg-stretch I passed a bakkie blasting a gorgeous soul track into the picnic area where a group of locals were enjoying a few tinnies, so I stopped and asked them about it. On checking inside the cab they informed me it was The Dramatics’ ‘Thankful For Your Love’ which I’ll dedicate to Angela:

http://www.youtube.com/watch?v=sfBsgx4gSEc&feature=artist

The men and I had an enjoyable chat about soul music and I explained northern soul, parting on an African handshake. Only later – is this becoming a habit? – did I reflect that I should’ve asked them if there are local bars playing old soul…

And then there’s Pierre’s and Ria’s hospitality at Aa’Qtansisi guesthouse. Although a long way from home, I’ve felt very at-home thanks to their making me so welcome – and I include the staff: Mimi, Rachel and Sylvia indoors plus Shaun outside.

 

Pierre; Rachel, Miemie & Sylvia at Aa-Qtansisi guesthouse

 and, er… cricket

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October 2, 2011 at 10:18 am

One month in the Valley of Desolation (1: work)

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The first month of my assignment has passed more quickly than I had imagined it might when I contemplated a rather daunting three sans famille. If it continues like this I’ll be back home, back in my life and back at work before you know it. Next Friday I tackle the drive to Port Elizabeth for a day’s reflection on and evaluation of “progress made and challenges being faced” (David Cameron (the good one)). So, without stealing my own thunder and in the context of a public blog, how was it for me?

From the pre-departure guidance sent by Global Medical Force to the daily lurid news headlines here; in everyday cautionary conversation and in the Hilary Mantel novel that I just finished (more below), the notoriously violent side of South Africa never seems far away. Yet I seem to have landed in a small, old-fashioned town of comparative calm: ‘Eastbourne-by-desert’ you might say. That’s certainly contributed to the easy-going enjoyment of Graaff-Reinet, reported in my earlier blogs.

As September rolls into October work seems to be in about the right place too. The two-tiered nature of South African healthcare is another fact of everyday conversation. Those with Medical Aid dread the possibility of finding themselves in the long, long queues that appear to be normal in the comparatively under-resourced public health service should their insurance run dry. And as in the UK the private sector draws qualified staff from the public, attracted by better salaries and working conditions. The UK hasn’t been blameless as there’s been an exodus of South African nurses (and doctors) seeking overseas employment – although the bad David Cameron’s anti-immigration policies have disgracefully slowed this for non-European Union nationals. Then there’s the non-governmental organisations: on the one hand giving the public sector the leg-up it so desperately needs; on the other recruiting from it too. (If I’ve misperceived then will my NGO, sponsors FPD please put me right? – I have no intention to bite the hand that feeds me.) The South African government is working to address inequalities and improve things with its proposed National Health Insurance scheme. However:

The proposed National Health Insurance scheme will not have an impact on the demand for private health cover in South Africa if the quality of public healthcare remains dire, says a leading health economist. (Okore Okorafor, Mail & Guardian 30/09/2011)

The nurse that I’m mentoring, Maryna and I have a schedule for the clinics where we’re training practice nurses in HIV monitoring and the  initiation of antiretroviral therapy (NIM-ART). The staff make us welcome but with vacancies and absences they are understandably nervous of extra responsibility. We’ve adopted a softly-softly, supportive approach but, with their managers’ approval are clear with them that HIV care is now seen by the health service as an integral part of primary care. The NIM-ART nurses are all under our mentorship with the aim that each of them will have initiated antiretroviral therapy by the end of November when I must depart. Maryna will maintain momentum gathered during my remaining two months. We’ve identified 200-300 people with HIV who appear lost to primary care follow-up. The lay counsellors are briefed go out encouraging re-attendance so that there will be plenty of opportunity for the clinic nurses to have NIM-ART experience between now and then. We must strike a balance: drawing patients back into the clinics without flooding them or the nurses may feel that they are truly in the Valley of Desolation. Our task: to transform ‘the Valley of Desolation into a Valley of Hope’ (D Cameron, you know which one) for people with HIV.

Then there’s TB. If I come back spitting blood it’ll either be mycobacterium tuberculosis – whose spectre pervades every consultation – a consequence of having bitten the hand that feeds me or I’ll have featured in a lurid headline.

 He made a discovery, common to those who expatriate themselves and then return: that when he and Anna went abroad they had ceased to be regarded as real people. Out of sight, out of mind. Nobody [] wanted to hear anything about Africa.

Hilary Mantel, A Change of Climate

Well I hope that’s not the case for too many readers. Thankyou to those confounding Mantel’s central protagonists’ sad reflection: 1,769 hits in September (including an amazing 181 on the 4th) reassures me that I remain a ‘real person’ back home. Grateful thanks to Angela Jones & Michael Barber for being September’s numbers 1 & 2 respectively in the ‘top recent commenters’ chart. I’ve appreciated every comment and email from so many of you, helping to keep me connected to the life I rejoin come December. Until then I’ll be on this blog.

  

Maryna Stander standing outside Nieu Bethesda Clinic; view from NB clinic; clinic door.

Written by martinjones183

October 1, 2011 at 10:35 am