Archive for November 2011
As you set out for Ithaka
hope your road is a long one,
full of adventure, full of discovery.
angry Poseidon – don’t be afraid of them:
you’ll never find things like that on your way
as long as you keep your thoughts raised high,
as long as a rare excitement
stirs your spirit and your body.
wild Poseidon – you won’t encounter them
unless you bring them along inside your soul,
unless your soul sets them up in front of you.
Hope your road is a long one.
May there be many summer mornings when,
with what pleasure, what joy,
you enter harbours you’re seeing for the first time;
may you stop at Phoenician trading stations
to buy fine things,
mother of pearl and coral, amber and ebony,
sensual perfume of every kind –
as many sensual perfumes as you can;
and may you visit many Egyptian cities
to learn and go on learning from their scholars.
Keep Ithaka always in your mind.
Arriving there is what you’re destined for.
But don’t hurry the journey at all.
Better if it lasts for years,
so you’re old by the time you reach the island,
wealthy with all you’ve gained on the way,
not expecting Ithaka to make you rich.
Ithaka gave you the marvelous journey.
Without her you wouldn’t have set out.
She has nothing left to give you now.
And if you find her poor, Ithaka won’t have fooled you.
Wise as you will have become, so full of experience, you’ll have understood by then what these Ithakas mean.
Ithaka by C.P. Cavafy sent to me by Sally Hemmings before embarkation on my South African journey.
I’ve travelled a long road, full of adventure, full of discovery; with the submission of my twelfth weekly report I’m nearing the end of this marvellous, unhurried journey. Whilst South Africa has so much still to give, this assignment is all but over. My immersion in all things South African has embraced work, play, literature, media, sport township jazz* and more. I may have gone too far as I was caught on Skype telling Michael Barber, “we’ve set a target of 310″ as I discussed Proteas’ second test match v Australia…
* Click on the link – yes, you too Angela – for a blast of Sipho ‘Hotstix’ Mabuse and imagine me bouncing in the chevy along, straight, empty roads between clinics in the Karoo:
Preparing for re-entry I’ve returned my library books and thanked Graaff-Reinet’s librarians. I’ve picked up the new Nicci French, ‘Blue Monday’, the epitome of the airport novel purchased three months ago in Heathrow’s WH Smith and returning me to dark, English November by London’s River Fleet.
I continue to appreciate the pleasures, the joys, even in what’s commonplace here: Pierre trying to knock the vervet monkey from his apricot tree with fruits bitten once and thrown onto the lawn; rock pigeon, pied crow, ‘tick birds’ (cattle egret), masked weaver, ibis (‘har-dee-dar’ and sacred), beautiful blue crane, black winged stilt, red eyed bulbul, helmeted guinea fowl, red faced mousebirds, ostrich… It’s hard not to move around open-mouthed. On Saturday in Camdeboo National Park there were dozens of springbok, lollopping black wildebeeste, gemsbock, blesbock, kudu, meerkat and cape mountain zebra rolling in the dust.
The week contained a series of farewells. I invited the HIV team to an ‘English tea’. Ria from the guesthouse set a pretty table (photo below) in the new HIV clinic, an unfortunate symbol of bureaucracy that has stood unopened for a year as snagging jobs go back and forth between government inspectors and the contractor. Jones-made fridge chocolate cake was provided; as if I were retiring – and in a way I suppose I am – I was presented with a clock and I spoke on the theme of the HIV clinic’s name: ‘Ithemba’, place of hope. It didn’t strike me until now: Ithaka / Ithemba – ‘better to journey in hope than to arrive’? On this occasion not so.
I facilitated a first mentors’ supervision group on Friday, ironically in Jansenville’s identical but operational new HIV clinic. Their farewell was a braai including the astonishing baked bean and sliced banana salad: strangely it works. The weekend was a social whirl. A large party of Aa’Qtansisi guesthouse / Pioneers restaurant / associated good-timers gathered at the Botanics Sports Bar for Graaff-Reinet’s Mr Movember event. I considered deploying one of the licorice-like African black giant millipedes that have started to populate Mountain Drive. Tonight’s Pierre’s potjie filled the guesthouse with a dozen or more of the friends that I’ve made along the way including Maryna and Jaco.
Have I become wise? You’ll tell me when I’m home. Twenty-three blog posts attests to a full, full experience.
By curious coincidence the Pioneers girls plus three others are off to Ithaka next May.
Ithemba clinic, ‘English tea’, African black giant millipede, with Rolien & Almarie – the Pioneers girls – at Mr Movember
History will judge us on how we respond to the AIDS emergency in Africa….whether we stood around with watering cans and watched while a whole continent burst into flames… or not.
Masupetsela! We chart a new course, we write a new story:
Average male and female life expectancy at birth increased to seventy years as a consequence of progressive improvement in evidence based preventive and therapeutic interventions for HIV.
Target from South Africa’s newly published National Development Plan 2030
Not sure that I’d ever anticipated quoting the erstwhile Paul Hewson but I noticed what turned out to be his words on the cover of Monica, our HIV programme manager’s notebook, copied them down and googled. Monica and I were sitting on the stoep at Klipplaat Clinic discussing NIM-ART (Nurse Initiation and Monitoring of AntiRetroviral Therapy), what’s been achieved since my arrival in September and our vision for September 2012. Not wishing to blow my own vuvuzela too noisily – but anything to drown out U2 – I’m as confident as I reasonably can be that HIV care in the three Eastern Cape sub-districts of Camdeboo, Ikwezi and Baviaans where I’ve been mentoring has every chance of being in reasonably good shape in nine months time, forming a solid foundation for 2030 targets.
The lay counsellors, Dolly and Vicky have completed the amazing task of recalling more than two hundred people with HIV to the three Graaff-Reinet primary care clinics. Some have declined, moved or passed away but dozens have returned. Our great motivator, David Cameron in Pretoria regularly points out that we’re saving lives, preventing mother-to-child transmissions, enabling the South African health service to gain maximum benefit from its stretched resources. It’s marvelous for the nurses to see patients with perilously low CD4 counts back in care, being screened for TB, starting prophylaxis against HIV’s terrible twin and against pneumonia (PCP). Antiretrovirals are in the clinic pharmacies and starting to fly off the shelves; NIM-ART in primary care is under way.
Although we haven’t been standing around with watering cans, some seeds have fallen on stony ground. What we’ve interpreted as the stigma of HIV brought a complaint from a patient who worried about confidentiality and being recalled by lay counsellors living in her/his community. Well that’s the role of lay counsellors who know and work in their own neighbourhoods – we’ve organised local lay counsellors who are doing the same in Aberdeen and are about to start in Nieu Bethesda. Inevitably some people with HIV told Dolly and Vicky that they remain un-motivated to re-attend. We’ve agreed that they have nonetheless planted fertile seeds in the Karoo semi-desert that have the potential to germinate should conducive conditions prevail. World AIDS Day is only two weeks away, ready to sprinkle a little more water – and like the aftermath of rain in the desert, flowers may bloom.
It’s not only with patients that our efforts can sometimes fall on stony ground. One professional nurse remains openly hostile to the programme and a couple of others complain that they do not have the capacity for it. However NIM-ART is an unstoppable train, which is writing a new chapter in the story about HIV in South Africa. The mentors are well-established in the primary care clinics in Graaff-Reinet and beyond. Next week I’ll be facilitating their first mentor supervision group, bringing together government and NGO NIM-ART mentors. Then signing off.
Desert flowers; Sister Mabel Pieterse being mentored by Marlene; Martin blogging.
Blogging on a Sunday morning in the guesthouse garden I find myself in a reflective mood. I was out at 05:30 for seventy-five minutes of brisk walking: up to the reservoir, over the kloof, down to Gideon Scheepers’s memorial and back along the familiar road into sleeping Graaff-Reinet. With the prospect of only two full weeks in Eastern Cape clinics remaining, I’m thinking about some of the questions that blog readers have posed and that I’ve been rolling around whilst walking:
… your mention of Sundays being strange if you spend them alone reminds me of my time [working overseas]. It teaches you to enjoy your own company. I learnt the difference between being alone and being lonely.”
“I am wondering – are you enjoying it? Have you fallen in love with Africa?”
“… do you miss normality?”
“I suppose, as with all development jobs, it’s inevitable that when you leave you will feel both that you could have done more and also be pleased with many of the things that you achieved. I always feel re-entry is harder than the culture shock of going out. I hope you are thinking about ways to reduce reverse culture shock and if you begin to feel glum facing same old same old there is a very good returnees association that keeps things alive and kicking.”
Sources: you know who you are.
During our regular Skype conversations Angela and I have reflected that the prospect of my three-month assignment turned out to be more daunting than the reality that we’re experiencing. We’ve acknowledged that we’ve both developed self-sufficiency and have actually appreciated aspects of this strange independence that allows us to please ourselves. Equally our beds are sometimes too big… Contrasting ‘being alone’ and ‘loneliness’, I reckon I’ve walked the healthy side of the line. I’ve been lucky to live in Graaff-Reinet, a small town in which I walk everywhere, attend anything going and now recognise people wherever I go. Graaff-Reinet Midland Cricket Club has been great: firstly because the games eat up significant Saturday hours, secondly because the crowd is so friendly. However I have to report a nine-wicket defeat for G-RMCC second XI v Graaff-Reinet United second XI at the Fred Hufkie Oval in Kroonvale yesterday that tempted me to chant ‘Are you Australia in disguise?’ Much conversation here about an extraordinary first test whose most regrettable stat for me is that the Aussies ‘recovered’ from 21 for 9 to 47 all out in their second innings. Although South African victory was sweet I’d’ve loved 21 all out.
As for “enjoying it” and “falling in love with [South] Africa”… As you see I’ve found myself rooting for my ‘home nation’ when watching rugby or cricket. My strategy at the time that I received that email was simply to focus on the fact of this being a three-month assignment to which I was committed and to throw all of myself into it for the duration. Thinking it over, Steve Jobs summed matters up in terms that chime:
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.”
Connecting dots…’ blog
I love HIV nursing. And having this opportunity to do it in South Africa has been wonderful. It’s been a joy to see members of the team growing professionally, to meet people with HIV coming back into care thus cheating hospital beds and/or early graves. I do not exaggerate: their CD4 counts are almost universally below the threshold for antiretroviral therapy, many significantly so. The Foundation for Professional Development, reflecting (their) David Cameron’s satisfaction with what’s been achieved here, has requested a session for Gauteng mentors that they’ve entitled ‘Mentoring colleagues to achieve excellent results’. It’ll be in Pretoria on the day that I catch my flight to Heathrow, quite reasonably squeezing every drop of juice from my time here. I’ve asserted that I must have time to shower and change in advance of my taxi to Oliver Tambo Airport…
… and back to “normality”. Two reality checks have coincided: my line manager at Avenue House emailed to discuss my first week back at around the same time that I saw the blog comment about re-entry – forewarned and forearmed or at risk of self-fulfilling prophesy? I hadn’t thought about re-entry in these terms and am grateful to one of my career mentors whose experience means that I trust her to know. I’m reminded of Andrew Smith’s interesting book ‘Moondust, in search of the men who fell to earth’. He interviewed all the astronauts who walked on the moon, revealing the difficulties that they’d experienced back in the comparative mundanity of terrestrial normality. (Incidentally every man who walked on the moon was either an only or an oldest child – like me.)
Three weeks from waking beside Angela for the first time since 2nd September I’m alone but not lonely. I’m focussed on enjoying my present normality, which is NIM-ART mentoring in a South Africa that’s made me feel at home; I’m planning final reports, farewell braais and anticipating returning to what I love.
Fred Hufkie Oval and (by special request for Steve) more elephants at Addo
As you said to me six years ago: don’t waste a precious moment…
Brigid Jones text message on my departure to South Africa, returning paternal advice as she started at Birmingham University.
Well, besides work I’ve been to Graaff-Reinet film club’s screening of ‘Babette’s Feast’, a belly dancing evening with Maryna and her partner Jaco plus other friends and a night at aptly named Panorama – a former hotel perched above the town – where tourism students were being assessed for catering and hospitality skills whilst raising money for a cancer charity through R20 entry. However my focus is elsewhere, describing my weekend away.
I woke at 05:15 on Saturday morning for the three-hour drive to Port Elizabeth. Blog followers with long memories may remember that I arrived in Pretoria for briefing with Elizabeth Race, a Texan HIV / infectious diseases doctor, also volunteering with GMF/FPD. Last weekend she played host to me: it was time for that quintessential South African experience, the game park visit. As I sipped welcome filter coffee in Beachwalk B&B a khaki-clad ranger from the Schotia Private Game Reserve pulled up in his nearly full minibus expecting us to be ready for the next twelve hours… Hasty grabbing of binoculars, camera, sunscreen and anything else potentially necessary ensued. Without ado to Addo Elephant National Park which lived up to its billing. It was thrilling to see the massive grey tops of the world’s largest land mammals emerging through the bush, walking silently past our bumper and to the watering hole we were watching where they drank, bathed, socialised, did what elephants do… I could’ve watched all day. Our ranger estimated seventy-five elephants at Gwarrie Pan watering hole and two dozen at another.
Indeed Addo was the climax of my day although I enjoyed the birdlife and Schotia is home to an impressive roster of African game. As a national park, Addo conserves endemic species whereas Schotia matched Peter the ranger’s unintendedly ironic greeting, “welcome to Jurassic Park”. Remember the scene in which dinosaurs from multiple prehistoric eras are intermingled for the anticipated tourists? – That’s Schotia: everything from antelope to zebra, giraffe to gnu. We transferred to open Range Rovers, sitting atop. And it’s an experience to watch a pair of rhinoceros sharpen their horns on the bakkie’s bumper, to park beside sleeping lions… Once Peter had cottoned on to the fact that I knew my buzzards from my kites – driving the M40 gorges to Birmingham you recognise red kites by their forked tails – he pitched in with blacksmith plover (and four speckled eggs on the ground), bokmakierie, Egyptian goose, yellow billed kite, jackal buzzard, speckled mousebird, not to mention other birds reported in earlier blogs. Our package included regular drinks, lunch and dinner around a bonfire with a pay bar available where I asked a young man in a University of Birmingham hoodie if he knew former Vice President of the Guild of Students, Brigid Jones – and he did. As a finale we were taken back out on the bakkie for a night drive, Peter’s powerful torch illuminating lionesses setting off to kill under the southern cross.
Back in PE – aka ‘the Windy City’ / ‘the Friendly City’ / and like Eastbourne, ‘the Sunshine Coast’ – I woke a couple of hours before Sunday breakfast, so enjoyed a walk along the boardwalk as far as Kings Beach, amusingly damned in my Rough Guide as “somewhat marred by a jumble of coal heaps and oil tanks behind it”. True, the Humewood to Summerstrand section was more scenic – therapeutic for a man accustomed to daily cycling beside the English Channel to see blue sky and the white-topped ultramarine Indian Ocean whilst breathing coastal air. Elizabeth drove west to Sardinia Bay’s sensational white-sand dunes where we walked in virtual isolation on a dazzlingly beautiful beach before heading up-coast for lunch on the decking at Barnacles, a California-surf-styled shack perched above aptly named Seaview’s stunning rocky beach. I apologise for the superlative surfeit but feel sure that I do not exaggerate.
As I drove back to Graaff-Reinet I reflected that my next journey to PE will be on the last day of November to return the chevy to Avis before flying to Pretoria for my final two nights on this South African assignment…
Local nature continues to charm: outside: a giant kingfisher, two days running on Sunday River bridge as I walk out of town and in my room – all sing to the tune of Marvin Gaye’s ‘The World Is A Ghetto’ – don’t you kno-o-o-ow, the lizard is a gecko.
Watching bellydancing, entering Port Elizabeth, Addo elephants, Sardinia Bay