Archive for April 2014
Linda Murray suggested writing down ‘what I expected to find’ during the flight to South Africa. Nearly twelve weeks later, reviewing page one of my Black n’ Red notebook… A few ticks and no, the newer protease inhibitors are not yet visible in primary health clinics. What I truly underestimated was the impact of Atroiza the fixed dose, triple combination antiretroviral pill that is equivalent to Atripla in the UK. There are public information advertisements about FDC as it is universally known, thousands are successfully taking it, and word of its availability has brought patients back into treatment.
What did I find out about myself? Toiling over my final report I couldn’t help remembering Meredith Belbin’s team roles exercise from a course in the eighties which identified completer finisher as one of my weaker suits.
Reflecting on my last twelve weeks working as a FPD evaluator: fascinating, fruitful, I’m amazed at what’s been achieved… but at heart, I’m a nurse. My highest highlights were in clinic rooms, sitting in during consultations, especially if there was a chance to chat with the patient.
Kruger Impala; with David and a glass of Windhoek, Sophiatown Bar
That should not be interpreted as churlish because it’s been another wonderful experience, immersed in South African primary health clinics and a fantastic chance to broaden my professional horizons. I’ve loved discussing HIV and mentoring with professional nurses, roving mentors and enjoyed travelling with such great teams, visiting so many clinics, interviewing so many people… The world’s largest HIV treatment programme has come on like an impala’s leaps and bounds.
David’s kindness, friendship and supervision have been superlative. He and Sue were so much more than an antidote to the loneliness of the long-distance evaluator. Reflecting on the differences with the 2011 experience: in Graaff-Reinet I had a small number of day-to-day contacts with people who became familiar – and some of them friends. During the last twelve weeks I had transient relationships with far more people. I might have struggled more without the anchor that David in particular, Sue and the FPD Evaluation Unit provided.
We rounded off my final weekend with a trip to a huge exhibition of mostly black and white photographs, The Rise and Fall of Apartheid at Museum Africa in Johannesburg. We’d seen it previewed in The Mail & Guardian and it didn’t disappoint: there were images of quotidian life under segregation; intolerance, violence, pain; the glamour of Drum magazine models, township singers and musicians… and for a UK visitor, Catherine Ross’s shameful shot of demonstrators against Margaret Thatcher’s 1991 visit to South Africa – she refused economic sanctions and viewed the ANC as a ‘typical terrorist organisation’.
The Rise and Fall of Apartheid exhibition; My Darling Clinic sign
On to the Workers Museum, housed in a way-below basic former hostel for municipal workers – Lewes Prison cells would be preferable – then Johannesburg Art Gallery, before edging through streets more congested than an early twentieth century municipal worker’s lungs for lunch in the Sophiatown Bar.
The assignment in numbers
1 white face in the 15,000 crowd: Polokwane City 1 v Orlando Pirates 0
2 PowerPoint presentations of my findings
3 run defeat in World T20: South Africa 196 (for 5) v England 193 (for 7)… or was it a victory..?
4 weeks in Limpopo
5 5:30 am: brisk walk with David every morning of 5 weeks in Pretoria
6 6:00 pm: check-in at Oliver Tambo Airport; 6:35 am: arrival Heathrow Airport
7 May: when Jacob Zuma will almost certainly win the general election despite wrongly spending R240,000,000 of public money on upgrading his home
8 blogs before this one
9 of us in FPD’s Evaluation Unit office: David, Promise, Shehla, Dawie, Alet, Renee, Nomsa, Frances and your blogger…
10 … if Fritz ever turns up
12 South African novels read
65 blog comments and lots more emails – thankyou all
94% of South African nurses feel more/much more positive about providing HIV care in primary care thanks to clinical mentoring
94% of South African nurses feel more/much more confident providing HIV care in primary care thanks to clinical mentoring
127 minutes: three focus groups
173 semi-structured interviews
526 km: Hyundia i20
2290 km: Ford Figo
8996 words in the final draft of my report, now with FPD managers
I leave behind the report, new and old friends, the Eastbourne Borough shirt on Chris’s back and their badge on the Evaluation Unit office teddy bear. And so much more. But my thoughts are turning to departure and return. Let’s hope that the dead hadeda ibis outside David’s drive is not an omen for tonight’s flight.
They say something about behind every great woman there’s a man trying his best. I’ve been here thanks to Angela’s support so I’ll leave you all with a song for Angela first heard on the shores of Nqweba Dam outside Graaff-Reinet in 2011. Its line, the loneliness was about to make me lose my mind resonated when I was ‘Lost in Limpopo’ (blog 03/03/14).
Chocolate is the answer who cares what the question is?
(Birthday card from Angela)
As Barry Jones has pointed out today I’m the same age as Colo, the oldest gorilla living in captivity. Erm, thanks Dad. It’s my first birthday not shared with a political hero, the late Tony Benn, the first British MP to table a motion concerning apartheid. Last night David and I celebrated early in a pizzeria with a couple of Windhoek beers on the side as he’s out this evening. At work I set a quiz inspired by a recently read novel, The Restless Supermarket‘s central character, a retired Johannesburg proofreader. There was a prize for the most accurate corrections of typos from my focus group transcripts and Jones-baked millionaire shortbread all round.
A thorn between Ria and Lisl: mother & daughter on their way to Graaff-Reinet’s first lesbian wedding; on the road in Capricorn
Even before that fun I confessed to FPD’s journal club, where today’s academic paper concerned HIV testing that I’ve been around long enough to have requested ‘HTLVIII’ when testing was first introduced. I’ve enjoyed my first South African birthday with two cards, numerous emails and Skype with Angela, Brigid, Steve & Chris. David wrapped some real coffee – hooray! The nut that holds together the cafetiere just went down the plug hole – boo!
Of late, report writing has occupied most waking hours. I’ve a vast data set and my 11th April flight north looms ever closer so it’s taken all my blogging and much of my emailing time. Apologies Will you settle for now for some pictures (paint a thousand words) and tables?
|Mentoring clinical mentors||Evaluating clinical mentorship|
|1 town and its environs||5 districts in 4 provinces|
|85 nights at Aa’Qtansisi Guesthouse, Graaff-Reinet||7 nights at Aa’Qtansisi Guesthouse, Graaff-Reinet|
|9 primary health clinics||78 PHC|
|4 pills-a-day first line antiretroviral therapy (TDF, 2x 3TC, EFV)||1 fixed dose combination pill: welcome Atroiza|
|£1 = R12||£1 = R18|
|“We cannot manage HIV in primary care” (Professional Nurses)||“I am empowered to handle patients with care and love” (PN)|