Archive for March 2014
Why not? If I hadn’t returned to the Valley of Desolation, location for my previous experience of NIMART mentoring, how would I have known that those nervous – some of them resistant – professional nurses were confidently managing hundreds of people living with HIV?
A great deal has changed in three years. I’ve compared it to seeing a friend’s children after a long interval: you notice and remark on how they’ve grown. So it’s been in Graaff-Reinet and the surrounding towns’ primary health clinics.
Nthabiseng and Marlene, colleagues then and now; the road to Steytlerville.
When I blogged in September 2011 I cited trombonist Jonas Gwangwa who said of South Africa:
When you plant a seed, it decays a little bit before it grows.  We achieved so much following the end of apartheid. Now we are going through some rot. It is this that bothers us: how long is it going to stay this way before we sprout?
Friday was South Africa’s Human Rights Day, a public holiday commemorating 1960’s Sharpeville Massacre, one of many rotten episodes in the apartheid era. On its first fifteen pages today’s Mail & Guardian documents today’s rot at the top. President Jacob Zuma’s licence to loot is exposed in the public protector’s report into massive inappropriate expenditure of public funds on his personal home. What must the struggle heroes be thinking? With a general election on 7th May, many South Africans crave an end to such rottenness. Even with its leader mired in controversy the ANC seems unassailable: how long many wonder before an end to post-1994 decay?
Returning to the Horseshoe, Kroonvale, Umasizakhe and other clinics where we planted seeds three years ago has been a delight. The tattiness of out of date posters on peeling paint has been replaced by light, bright modern-looking clinics that seem fit for purpose. I’ve been hugged and had my hand shaken by staff that I worked with before. And how some of those seeds have grown. As one nurse said in her interview, “once we were just issuing ART; now it’s comprehensive care”. Such is the progress they’ve closed Ithemba, the antiretroviral clinic at Midland Hospital, Graaff-Reinet. There’s more to do but seeds have sprouted.
Sister Bosch in Umasizakhe Clinic; Nthabi, Vicky, Martin, Dolly – Vicky & Dolly unable to find suitable employment after completing assistant social worker training; Umasizakhe Clinic 2011 & 2014.
If I’d never driven back over the impressive Ravelskloof into Camdeboo I’d never have known. I’ve loved the familiar semi-desert that reveals its springbok, kudu, ostrich in a way that denser bush up north does not. It’s been a week of reunions with guesthouse owners and staff, former colleagues, people – friends – I met along the way; so different from the lonelier weeks living out of a suitcase and speaking to nobody outside working hours. As my Aa’Qtansisi host Ria welcomed me last Sunday, “you’re back home Martin”. I’m so pleased to have had the opportunity to go back.
Back in the world
Back in the world
Back in the world
Back in the world
Crawlin’ through the trees
Stuck in mud up to the knees
There’s a Curtis Mayfield song, Back to the World (YouTube link below) a movingly soulful tale of a soldier’s troubles reconnecting with life back in the USA after serving in Vietnam. While a few weeks’ impersonal hotel living with weak internet signal cannot compare it’s the tune in my head now that I’m back at David & Sue’s in Pretoria. The further north I stayed, the weaker my internet connection and the greater my disconnection from you all. It’s a salutary reminder that some of the things that I take for granted at home are less widely available – or not available to all – in South Africa. This weekend’s M&G reports that in the provinces I’ve visited, the percentage of the population who have flush or chemical toilets or ventilated pit latrines is: Gauteng 88.9%, Mpumalnga 57.3% and Limpopo 37.9%. Be careful what you grumble about, blogger.
Bungeni Clinic cabin, delivering HIV care to 913 clients including 70 children; FPD bakkie with Donald Fraser Hospital roving team.
Many who know me will know that I dislike driving. Today I’ve driven 466km, the equivalent of motoring from Eastbourne to Folkestone, through the Chunnel and south beyond Paris. After five weeks and 2290 km I’ve returned the Figo to Avis. Ms TomTom twice Ms-directed me into on-coming traffic on a motorway slip road and ordered impossible right turns across solid barriers on dual carriageways but was an otherwise reliable companion. And some days the only person to speak to me.
Added to the Figo’s kilometrage, in the roving teams’ bakkies I’ve (pace Mr Superfly) been crawlin’ through the bush, stuck in mud up to the knees… as we daily traversed the lumpy, bumpy, at times close to impassable gravel roads to the backends of Nkangala, Capricorn and Vhembe. Here’s a suggestion for a simple infrastructure improvement from a mentor: the Government should build a tar road to every primary health clinic. FPD bakkies spend several hours a day crawling long distances in first & second gear; add in every delivery, laboratory courier – hours of staff time spent in vehicles – and it would pay for itself in no time. Out of an eight hour working day, four may be spent in transit. That’s sixteen hours a-day if you multiply for the doctor, nurse & health information system mentors and the data capturer.
The final interview at Tshiungani Clinic; Jones C & M Jones (Jones is a Zimbabwean waiter at Ambiance Restaurant, Polokwane, Martin is your blogger.
After one hundred and fourteen interviews in sixty-six primary health clinics I feel that this part of my research has reached saturation point. And I don’t just mean the torrential tropical downpours that can turn gravel roads to rivers in minutes; I’ve stopped hearing new things from NIMART nurses and their clinic managers. My next tasks are enriching the data by involving some of the more senior players and analysing it. I’ve a comparator week with a roving team from a different NGO in the Graaff-Reinet area: back in the world that I vacated in December 2011. It will be fascinating to see how those once familiar clinics have developed and delightful to hook up with Ria & her staff, MieMie, Rachel & Sylvia at Aa’Qtansisi Guesthouse; Maryna, Marlene, Nthabiseng & Vicky from the original mentoring team, the ‘Pioneers girls’ including Almarie & Rolien and hopefully others from the cast of three year old blogs.
Highlights of the far north? My final two days in the field with Sister K who changed a month of solitary dining, providing friendly company over fast food in Spur Steakhouse where Bafana Bafana 0 Brazil 5 was on the big screen and for a balmy evening on the lawns of an Italian restaurant where baboabs were dotted around a pool and fountains tinkled. In Vhembe’s furthest reaches and after hours driving past bush, we concluded our clinic visits close to The Big Tree, a 1500-3500 year-old baobab.
The Big Tree; Lord Greystoke; Guide and Sister K; baobab at The Guesthouse B&B, Musina.
The Big Tree guide took us slowly around its contorted trunk pointing out innumerable protrusions said – by him – to resemble a multitude of animals, not to mention – actually he couldn’t stop himself – genitals, breasts & buttocks a-plenty. His twenty minute tour included more sex talk than witnessed in six weeks in sixty-six primary health clinics delivering HIV care… I learned from a fellow B&B-er at Musina that as they age, male baobabs remain shapely and upstanding, while female trees droop, gnarl and the trunk expands – on International Women’s Day I have no more to blog on that subject.
The other thing I missed after Polokwane was exercise. I couldn’t work out if Thohoyandou and Musina felt entirely safe for walks and the ‘well-equipped gym’ in the former was inaccurately advertised. As Curtis reminds:
In these city streets everywhere
You gotta be careful where you move your feet…
I didn’t want to end up lamenting a leg stretch:
I been beaten up and robbed…
So it’s been work, telly and reading. Proteas v South Africa was a three-match test series that demanded five, two wonderfully compelling climaxes in the sporting world’s greatest format and a perfect hotel time filler. Then, just as I was beginning to believe that I might be becoming unhinged by Unchained Melody on a flautist’s compilation every breakfast time, I’ve returned from South Africa’s most northerly town, fast-forwarded through the Verwoerd Tunnels, up and down the spectacular passes of the Soutpansberg, dodged baboons on the motorway, re-crossed the Tropic of Capricorn, stopped for a reviving americano in familiar Polokwane before cautiously negotiating sluicing rain with extremely poor visibility in northern Gauteng. Now, after a pleasant evening’s brisk walking in Faerie Glen’s hilly streets I’m…
Back in the world
Back in the world
Back in the world
Back in the world…
Did you think your blogger was lost up the Limpopo seeking Mr Kurtz in Africa’s heart of darkness? Thankyou Marilyn for asking. Since the Big Game blog I have visited some remote corners, been one clinic from Botswana, gazed into Mozambique from Kruger National Park and next week will be close to the Zimbabwean border at Musina. Unlike Kurtz I left the ivory attached to its owners. More below.
In truth I have been somewhat lost. Outside FPD offices the wifi signal is feeble at best, struggling to support Hotmail – none for three days now – let alone Google or wordpress and Skype is out of the question. There have been occasions when I’ve been close to uttering Kurtz’s final words, “The horror! The horror!” The impersonal nature of hotel existing without the modern communications that I take for granted is salutary.
Thohoyandou’s roundabout welcomes you; Kruger elephant passes Ford Figo; Luvuvhu river looking west; Watering hole with zebra, impala
From Polokwane and Capricorn the Figo has taken me north to Thohoyandou, mouth-wateringly described in The Rough Guide to South Africa as “not a place you’ll want to spend time in. If you’re heading on to Kruger, you’ll be thankful that the road bypasses the centre of town.” Ah well, only ten nights in a town whose name means ‘head of the elephant’ and whose greatest charm is a roundabout (pic. above) on said bypass. Maybe a twinning opportunity for Slough? Non-UK readers, my wife Angela’s home town features prominently in a humorous guide to some of the UK’s less loved locations, Crap Towns: The 50 Worst Places To Live In The UK.
On Saturday I rose at 04:30 and headed to Kruger for dawn opening at Punda Maria Gate. Really I was happy that I’d been to Adoo National Park in 2011 but weekends need to be filled and the descendants of the little game that eluded Paul Kruger’s double barrels are on my doorstep. I can report dozens of delightful impala, zebra, giraffe and excitingly close up elephant sightings along with an array of beautiful birds, sadly unidentifiable without a Roberts Bird Guide of Southern Africa. My personal highlight was ten minutes watching through binoculars a woodland kingfisher dive repeatedly into the Luvuvhu river. Roberts is beautiful but costs more than entry to Kruger and is heavy.
I’ve been asked by David and by my son Chris how my work is going. Let’s put this into the context of this week’s Budget Speech. Handily the National Treasury inserted a People’s Guide to the 2014 budget in Friday’s Mail & Guardian. Within its big five headline statements for ‘improving the quality of primary health care’, number four spoke to me:
Over the next three years, government will allocate a further R1 billion for the HIV & AIDS conditional grant in 2016/17 to continue the rollout of antiretroviral treatment. A total of 2.5 million people are currently under treatment and 500,000 new patients are expected to join the programme each year.
Sounds good. However the same M&G ran an article, Health services too sick to mention based upon the ‘people’s alternative budget speech’. According to this it is only the success of ARV rollout that is improving overall life expectancy along with infant, child and maternal mortality rates. Critics of Finance Minister Pravin Gordhan paint a more depressing picture of South Africa’s health system citing mismanagement, rampant corruption and poor performance.
Earlier blogs preceded Gordhan in praising the progress in primary health clinics’ (PHCs) management of HIV since 2011. Perhaps progress in South Africa’s PHCs shares similarities with my drive through Kruger’s northernmost tip. I passed a lot of inert bush to reach of one of the big five. I wonder if much of the healthcare system is crawling through the bush in second gear even though progress in my ‘big one’ – HIV care – is as impressive as getting up close to Kruger’s elephants. I’ve visited more than fifty clinics already and I could tell Gordhan that there’s scope for improvement.
On a positive note, one reflection is of the impressive effort to ensure equal access to antiretroviral therapy for all who need it no matter how remote the village – and of the roving mentors’ efforts to supporting this. FPD bakkies have hopped the crags up gravel roads that wind in the shadow of the Soutpansberg mountains. If Thohoyandou town is unremarkable, the surrounding rural landscape is its counterpoint: lush, green with traditional Venda round houses dotting the hillsides, waterfalls tumbling over dramatic cliffs, tranquillity, beauty.
Donald Fraser Hospital, Vhufuli, Limpopo –‘I stand tall because I know my [HIV] status’; Makhaya Clinic entrance with health promotion notice about malaria; View from Lambani Clinic and on the road between Lambani & Thangawe Clinics
We visit clinics that are built to a modern template and older facilities, some barely fit for purpose. A regular media theme throughout my first six weeks here is of poor public service delivery with community protests and horror stories a-plenty, none sadder than the death of six year old Michael Komape who fell into his Limpopo school’s pit toilet and drowned. To accompany My Darling’s poor water supply (see Big wins), this week in Vhembe I’ve witnessed bare bottomed boys in school uniforms squatting to defecate in the field beyond their school, bare breasted women laundering in rivers and shortages a-plenty in clinics. To my considerable discomfort, I have entered a cramped, older building through a maternity room where two women nursed babies born the night before, a clerk sat working at his computer and privacy was non-existent; witnessed child health clinic taking place in another clinic’s corridor and more than once, two nurses conducting separate consultations with two patients in one room.
Have I answered David’s and Chris’s question? Briefly since this blog’s already nudging nine hundred words (each lovingly chosen for you, dear blog follower): my work’s generating loads of data indicating excellent working relationships between FPD and clinic staff, greater independent initiation and management of ART by nurses who describe NIMART as a vocation. However, to quote from a prevention mentor, “the [DoH] baby does not want to be prised off the [FPD] nipple”. There’s still a lot of metaphorical bush for those FPD bakkies to drive through. A map to the elephants may be emerging. And while there’s still darkness, there’s plenty in the HIV programme to warm the heart.