Lost in Limpopo
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.