Sunday, April 29, 2007

Church for the Children

We had an especially tough church service today. It was centered around children, specifically children heading households. Rev. Spiwo made the link by reading John Ch. 21, Verses 15-19 in which Jesus tells Peter to "feed my lambs." Spiwo wanted to remind the congregation that there are many children in Guguletu and elsewhere that are on their own and need help. He had Noloyiso and her brother, Shepherd and Loyiso, and about 12 other orphaned children at the pulpit with him. They told their stories, as did another woman who had been caring for a large number of orphans. Many people were crying, including Spiwo. Based on the feedback from the congregation, I think they got the message. Now we'll have to see what actions happen.

After the service the girls' empowerment group made lunch for the orphans. We fed them hot dogs, sweet rolls and juice, plus a few sweets to take home. The food was purchased with money the girls made at yesterday's sale, plus some donations. I think the kids all got their fill - the orphans had full stomachs and the girls had full hearts. (A little cultural note: The girls volunteered to do the dishes afterwards, like it was expected. I have a hunch they all have this role at home where it truly is an expectation. Not quite the same as in the US, in my experience.)

Sisi Yvonne and I spent the afternoon driving to some homes with bread and warm clothes. It's been relatively cold here the past couple days, with highs only in the upper 50s. It's also rained everyday since Thursday. Some of the orphans had only lightweight clothes on in church, and a couple didn't even have long-sleeved shirts or proper shoes. Yvonne and I picked up some clothes with donations received at today's service and took them around to select houses. Driving through the shacks in the rain was more depressing than usual - leaky roofs, muddy floors, and smoke from paraffin heaters made borderline housing even worse. I also felt sorry for all of the township dogs, most of which don't have homes to go into. I saw a pile of 6 dogs and puppies, wet and shivering, doing their best to stay warm.

The Centre is closed tomorrow and Tuesday because of May 1st holiday (Workers' Day). So, after a half-day at the clinic tomorrow it's a day and a half of rest for me.

More to come.

Saturday, April 28, 2007

Funeral Day

Saturdays are traditionally when funerals are held in Guguletu. During the past couple years, because of the increased death rate, you'll also see funerals during weekdays, too, but the majority are still held on Saturday. It's a lengthy affair, but not all that much longer than American Christian funerals I've been to (if you add all of the time together).

One difference between American and Guguletu funerals is that multiple people are handled at one time. Today there were three people being celebrated. So, during the 90 minute service there were songs, eulogies for all three people, more songs (with lots of swaying), a sermon and final hymns. Rev. Spiwo gave today's sermon, based on verses from Revelations 21. The main thrust of his sermon was about looking to the future. He said that "people are a complex of memories of the past, realities of the present, and expectations of the future." He told of his own life and how he battled with his mother about going to graduate school in Scotland. She told him of the hardship it would be on the family and said that he should not go. He told her he needed to look beyond the here and now and live for what could be. He told the attendees that they all need to do the same, and help their children realize their dreams. There were many shouts of agreement, although I couldn't help but think about how truly difficult this would be for many of them.

After the service, Sisi Yvonne and I headed for the cemetary. (I still have to get pictures and will do that soon.) I now realize that when I attend things with Rev. Spiwo or Sisi Yvonne that I'm not just an observer, I'm a participant. I was placed with the clergy at the gravesite, got to throw dirt on the casket, and did my best to sing the songs (not knowing the words or the melody). Everything is completed while the mourners are there, including filling in the grave. Several men from the crowd pitched in and shoveled the sand. A simple wooden cross was the only marker. After everything broke up the clergy gathered as a group and asked me to pray for them. This was my scariest moment yet, leading a group prayer for people who did that for a living. They talked to me afterwards so it must have been okay.

After the burial, everyone goes for lunch at the home of the deceased person's family. It wasn't like sitting in a church basement - people sat outside under a tent or stood in the street. (You can easily tell when someone died if you see a tent/tarp attached to a house on Friday afternoon or Saturday morning.) I got to sit at the clergy table. No one from the family was circulating. They sat in a room away from the guests. They will mourn throughout this week and have a follow-up gathering next Saturday, at which point the funeral process is over.

All told, the process took about 3 1/2 hours. Again, not too dissimilar to other funerals I've been to.

Sadly and unexpectedly, the day also ended with a death. Zinzi, the 19-year-old woman who was helping with the girls' empowerment group, received a call that her 45-year-old mother had died this afternoon. She had been ill for some time and developed a chest infection with breathing trouble this morning. She was taken to hospital and died shortly after arriving. Zinzi was at JL Zwane with me and Sisi Yvonne selling items to raise money for a special breakfast tomorrow (more on that tomorrow). I was sitting in Rev. Spiwo's office when a call came in asking him to tell Zinzi about her mother, as the other family members nor the hospital staff wanted to do it. Before he could do anything about it she came into the office crying - she had gotten a call from her cousin with the news. It was a tense few minutes as she and Spiwo talked and Yvonne and I consoled her. Yvonne and I then drove her home. We sat with her family for about 15 minutes (actually, I sat with the family while Yvonne was in another room with some people. I sipped a glass of orange soda while the 5 women present talked around me until Yvonne came back) and then headed back to the centre.

I will probably have another funeral experience next weekend.

Friday, April 27, 2007

Freedom Day

Today (April 27) is Freedom Day, a national holiday that commemorates the first post-apartheid presidential election in 1994. I've seen pictures from that day showing lines of people over a mile long waiting to cast their vote. Ballots contained both the names and pictures of the candidates, since many of the Blacks were illiterate from being denied education by the White government. The hopes and dreams from those days are still very much here and people continue to work hard to acheive them.

The name Freedom Day is a bit misleading, though. People may be free to move around, discuss issues of the day, and gather in groups without fear of reprisal, but many people are not free to plan their futures because they can't see past today. Two cases in point:

Nomoyiso is a 16-year-old girl who lives in a two-room shack in Guguletu. Her mother died last year, leaving her to raise her 7-year-old brother by herself. Her father "doesn't see us," a euphimism for "he doesn't give a rat's ass about us." Nomoyiso has family, but they are in the Eastern Cape and they do not get together. They had tried to move her and her brother there, but the prospects for education bleak. (Her family also wanted to sell her shack to make some money, none of which would probably have gone to Nomoyiso.) She chose to stay in her shack and make the best life she can. To earn income, she and her brother go door-to-door and ask for laundry. She takes it to a shop to have cleaned, returning every Friday to get the clean clothes. She then takes the clean clothes back to their owners, hoping to collect a small sum for her troubles. She said that some people don't pay, or don't bother to collect their items for weeks or months, meaning that she has no income for that week. Then, she and her brother have to rely on the kindness of neighbors and strangers to survive.

Nomoyiso is 16 and a junior in high school. She is doing very well in school and has aspirations of going to University. However, she knows that money for college is not available. She is also worried about what will happen to her brother if she goes away to school, since she has no relatives nearby to care for him. She is committed to making sure that he has a future, even if it means putting hers on hold, possibly forever.

Nomoyiso is also very worried about where she lives. She says she does not feel safe there, as there are always drunk men around and people shoot off guns in the night. There are no locks on her doors, and it would be quite simple for someone to enter on a whim. As an attractive teenager, rape is a constant risk.

She misses her mother very much, as "she took care of us. I have no one to talk to about things."

Shepherd is 12. His parents died last year, leaving him and his 10-year-old brother Loyiso alone. Shepherd and Loyiso spend their nights in a one-room broken-down shack in Barcelona, a poor area of Guguletu. They have no electricity or heat in their shack, which means limited ability to cook, watch TV, or do their homework. They're fortunate in that their auntie lives behind them in her own shack and gives them some support. They also go to a cousin's house after school to play with other kids and get something to eat. (Thirteen people live in their cousin's house, a two-bedroom government-built house.) Their shack is a 15-minute walk from the house, and I cannot imagine what they think every day when they leave a brick house for a wooden shack that most people wouldn't put dogs in.

There's also some controversy about Shepherd's shack. Apparently his aunt has moved the boys into a different shack and her son is now living in Shepherd's place. I don't know if that's true or not, but if it is it's another example of how vulnerable children are exploited.

Because Shepherd and his brother do not have parents, they do not receive any financial support from the government (the same is true for Nomiyiso and her brother). The government pays about R190 ($27) per child, per month for children under 14. While not much, it helps to buy bread (a daily staple) and maybe some mealie meal or samp (mealie meal is like corn meal, while samp is like hominy). All of the kids who live on their own are forced to fend for themselves, in whatever way they can.

I have no idea what the future holds for Shepherd and Loyiso. The same goes for Nomoyiso and her brother. They'll be free, but unless something changes their futures will be meager existances of trying to find work; avoiding abuse, drugs and gangs; and surviving day-to-day. To me, it's hard to call that a freedom worth celebrating.

(In the picture, Shepherd is on the left and Loyiso on the right. They are standing in front of my car, the boot (trunk) of which is loaded with food parcels. The food was donated by Spar, a local grocery chain that provides about 50 parcels each month. People get mealie meal, rice, oil (extra-virgin olive oil, at that!), chicken, and several other items. Spar deserves to be commended for this contribution, and I hope other South African companies will follow suit someday.

By the way, I'm sure you'll appreciate that it took about two minutes of discussion to get the boys to stand together and actually touch. I guess brothers are the same everywhere.)

Tuesday, April 24, 2007

Tuesday: A Typical Day?

I had a busy day today, with what I hope will become a typical schedule:

1. Worked 4 hours at the clinic. It was a short day because of another appointment, but I worked hard enough for 6 hours. Tuesday is Blood Pressure Day, as is Thursday. We see lots of people for refills, plus a few acute conditions. More on this in a later posting.

2. I met with Mandla Majola at Treatment Action Campaign. TAC is an HIV/AIDS advocacy and activist group throughout South Africa, but very heavily active in Cape Town. They've been around since 1998, so they have experienced the rapid rise in HIV/AIDS first-hand. Mandla works at the office in Khayelitsha, a township of about 650,000 people (in an area about the size of Edina). Khayelitsha suffers from high unemployment, extreme poverty, and limited access to basic needs (water, sanitation). However, over 42,000 people come to Khayelitsha every year because it's better than where that are now. Many of these people come from the Eastern Cape, the province directly to the east of Cape Town's province (the Western Cape). Much of the EC is rural, with high unemployment (up to 80%), poor or no access to medical care, and even worse living conditions than the informal settlements (shacks).

TAC runs several programs, including condom distribution, door-to-door HIV/AIDS education, and public demonstrations against government HIV policy. They do all of this with only two full-time staff members and a league of volunteers. Mandla laid out some items where they need support, and one of them struck me. TAC wants to paint 4 murals throughout Khayelitsha portraying pictures with HIV/AIDS prevention messages. They will also include names and phone numbers for HIV support lines and medical clinics. The total cost for all 4 murals is R10,000 or about $1,400. I'd like to raise that money and get these murals done. If you'd like to help me make that happen, send me an e-mail and I'll tell you how.

I'll be spending more time with Mandla and his team and I'll tell you all about it right here. Stay tuned.

3. I spent an hour visiting shacks with Sisi Yvonne and Nomokwamse. Nomokwamse helps out at JL Zwane as an unpaid worker. She lives with her husband in a shack, I think in Nyanga, one of the older settlements around Cape Town (it was one of the first settlements set up in the 1950s to house Cape Town's Black labor). She has two kids, a girl aged 11 and a boy aged 7. Because of her financial situation, her children live with her sister in the Eastern Cape. She sees them 2-3 times a year, if she can afford transportation. Her daughter's birthday was today and they will most likely talk for a few minutes by cell phone. Interestingly, Nomokwanse considers herself very fortunate because she has a place to live, "my eyes, hands, and feet," and some income from her husband's temp job driving a truck for the sugar company. She has a strong faith and believes God will provide as he sees fit.

The shacks we visited were those of a 63-year-old man and a young woman with two little kids (2 years and 4 months). Both of these people allowed the Bethel students and me to visit them last week and see how they live. Yvonne and I gave them some clothes (pants and shorts for the man, baby jumpers for the young woman). They were very appreciative, thanking us many times over. (I asked Yvonne what mothers living in the shacks use for diapers, knowing how expensive they are. She said some use cloth, and some use just plastic shopping bags, like Cub's or Byerly's. Think about that the next time you're asked "paper or plastic.")

4. Yvonne and I met quickly with Nomasone about her new place. She found a new plot in Barcelona. No, not Spain, but a very poor informal settlement near Guguletu. One of JL Zwane's youth program leaders is lining up a truck and some labor to disassemble the used shack I mentioned previously and move it to the new site. Because of the long holiday weekend this week, everything will probably happen next week. More on this as it happens. One additional good thing, Nomasone joined the HIV/AIDS support group so she'll start to connect with others who have been in her situation.

5. I talked briefly to Sophe about Sam, the 5-year-old boy that was having problems with his HIV medications. The doctors have apparently found some spots on his lung, what sounds more like lumps than spots. He's going in for an operation in July. I'm trying to find out more about this and will let you know if I do.

6. Lastly, I seem to have been put in charge of an empowerment/skills building program for 8 girls. They're about 12 or 13 and are starting to think about what they want to do after high school. The group is a bit daunting, since I don't speak Xhosa (they speak English, but not 46-year-old American male English from the looks I get) and I wasn't a girl so I don't have their experiences to work from. Luckily, Yvonne is there and a new 19-year-old woman is joining the group (I've forgotten her name now). She was great, asking why girls chose the professions they did and what inspires them. She is doing advertising, so she has a good perspective on having a dream career and working for it. The group will be selling chips and drinks at a pageant on Saturday, and will be using the proceeds to serve breakfast to a group of kids on Sunday, these kids being heads of households (orphans who stayed in their homes and are raising siblings). It should be a very interesting experience, to say the least.

So, I'm tired and off to bed. More shack visits tomorrow, along with more Bethel student stuff before they leave on Friday. As always, comments are appreciated.

Totseins (goodbye) for now.

Sunday, April 22, 2007

Church, Change, and Clinic Changes

1. Church: I was introduced to the congregation today. Fortunately, I was sitting next to Sisi Yvonne and she told me what Rev. Spiwo was saying so it wasn't a total shock when he asked me to stand up. He explained to the group that I left my family back in America to work in Guguletu, both at the Centre and at Brown's Farm Clinic. I received a nice round of applause and a bunch of smiles.

When I thanked Rev. Spiwo after the service he said it was important to let people know that others are amongst them helping to make improvements. The only scary thing for me is that he told everyone that if they have HIV they should spend some time with me. I guess I'll be expected to actually know stuff, so it's time to really study hard!

For those of you who asked about how long services last, today's was about 2 hours and 10 minutes. That was with about 10 songs, the Gospel reading, sermon, 3 testimonies, and a listing of the upcoming funerals (probably a dozen or so). American preachers have nothing on JL Zwane testifiers - it was yelling and pulpit pounding just like you see in movies, except in Xhosa.

2. Change: I didn't notice it until today, but South Africa is doing away with their cents. Everything you buy from larger retailers is rounded to the nearest 5 cents, up or down. One cent is only worth about a tenth of a US penny, and you can't really buy anything for under R1, so it's really not worth using them. Time for the US to do the same thing?

3. Clinic changes: We had some exciting news this week. We'll be starting two new programs over the next couple months that will help the patients and the pharmacy. The first is a central-fill program for people whose conditions are stable and only come to the clinic for refills. We will send their prescription orders to a central pharmacy in Cape Town, who will fill them and deliver them to the clinic for dispensing to the patients. This will reduce the workload in the pharmacy by at least 100 prescriptions a day and should lower the waiting time for patients by at least 30-60 minutes. The Provicinal Health Department has done this at 29 other clinics, so it should go smoothly for us. We'll be rolling this out by the end of May and I'll let you know how it goes.

The other program is around HIV. Right now, people with HIV get referred to the Guguletu or Mitchell's Plain clinics for their care. Because both of these clinics are too busy, Brown's Farm will be initiating its own HIV clinic on July 1st. We'll be starting slowly, with 10 patients in the first month and going up from there. This means that we'll be stocking antiretrovirals and all of the other HIV-associated medications in the clinic. All staff will be trained on HIV and its treatment starting in May. I've offered to help with that and we'll see how the schedule works out. This will be a great service for the people living in Brown's Farm and I hope it works out well.

Related to the clinic: For those of you interested in medical care here, I'm going to write a longer note about how patients are treated in the next couple weeks. It's really different than in the US, but in some ways it's more efficient and probably just as good.

4. Just for fun: Biking is huge here in Cape Town. On the weekends you see many bike clubs making their way along the ocean up and down the Cape Peninsula. Well, I shouldn't have been surprised to see one based in Guguletu. These kids are part of one such club. They have about 30 members and I've seen them riding along the township roads after school. Clubs like these are being set up to keep kids busy and away from drugs and crime. I haven't figured out a way to connect with them yet but I'm thinking about it. If anyone has ideas send them to me.

More to come.

Saturday, April 21, 2007

House Hunting in Guguletu

In as process I can only compare to shopping for a garden shed, I went house hunting yesterday with Sister Yvonne and Nomasone. It's literally shopping - we drove down a seemingly main road in Guguletu, stopping at various points to wander through semi-completed shacks. They all use 2x2 lumber for the frame. Siding ranges from all-zinc ("zinc" meaning corrugated metal, like some Americans would use for patio roofs or barn walls), to flat metal that looked like tin or aluminum, to wood. They were all one-room, in sizes from 8'x8' to about 9'x12'. They all included a door and at least one window (I don't want to think about how hot a tin room with one window would be in the summer when it's 95 degrees and sunny). None of the "models" had roofs, but they would be complete when delivered.

Prices ranged from R2,000 to R4,000 ($285 to $570) depending on size and seller. You really had to shop around - one block could be 10-20% less than the previous one. Prices also included delivery and set-up, which would take about 3 hours.

We also looked at a used shack in Thambo Square, a settlement not far from JL Zwane. It's behind a woman's house and she is currently renting it out. The owner is opening a creche (nursery/daycare) and needs the space. It was big, about 12'x16' with an internal wall making for two rooms. The price was right, R2,000, but we would have to arrange delivery and set-up which could add R500-1000 rand. It also has asbestos in it, which I'm concerned about. We'll see what ultimately happens next week.

We also had a problem crop up with the plot where the shack is going. The woman who owns the plot also has a shabeen, an unlicensed bar. Given that Nomasone's daughter will be moving in, this is not a good scenario and, in Yvonne's words, it would irresponsible of us to put a shack there. So, Yvonne is on the hunt for a new plot. She thinks one of the HIV support group members has a spot and will speak with her next week. I'm still hopeful we can get everything done before next week's public holiday and long weekend.

More to come.

Thursday, April 19, 2007

The Price of a Dream

If I were to ask you how much you'd need to acheive your biggest wish, right now, what would it be? Ten grand? A million? How about 75 cups of coffee?

Nomasone is in her mid-30s. She's been HIV-positive for 6 years. She hasn't been able to work for quite some time due to weakness in her arms. Because of that, she's now homeless and without prospects. She's been sleeping in a church in Woodstock, a suburb of Cape Town. Because the church doesn't provide food, she is forced to scrounge for whatever she can. Most days she doesn't find anything and goes without, living on water and hope.

Nomasone has a 16-year-old daughter who she sees very rarely. She has never really lived with her daughter - due to her unemployment her daughter has stayed with her sister for most of her life. Her daughter goes to tertiary school (high school) in Simon's Town, a seaside village about 40km (26 miles) from Guguletu. She doesn't see her daughter very often because she has no money for cab or bus fare. Nomasone had another daughter who died from AIDS about 3 years ago at age 3.

Nomasone got hooked up with Sisi Yvonne at JL Zwane about a week ago. Originally, Nomasone was looking for help with her daughter's school fees. She owes the school about R5,000, and her daughter is at risk of being kicked out because of the debt. Yvonne will be calling the school to negotiate this down to a more reasonable number, maybe even to zero. However, once Yvonne found out the whole story, she knew that more had to be done. She arranged a meeting between the three of us to see what could happen.

When I met Nomasone she was very withdrawn. She wouldn't look at me or Yvonne. She wouldn't speak to me, saying she didn't know English well enough. It was like she wanted to run away but couldn't because she was desparate for help. She explained, through Yvonne, that all she wanted was to have a place where she and her daughter could stay together. She had found a plot of land in Guguletu's shack area but could not afford to build anything. She is very concerned for her daughter because of the high rate of violence against teenage and pre-teen girls.

A shack is literally four wood walls and a wood or tin roof. It will have a door, and maybe a window or two. They run about 10 feet by 10 feet in size, some larger, some smaller. A shack may house one person or a family of 6 or 8. A basic shack costs about R2,500 ($325) - R400 for each wall, maybe R140-280 for the rood. Usually a door can be scrounged up from older shacks. Furnishings can be built from scrap wood, bought used or obtained as hand-me-downs from people who were able to upgrade. All Nomasone wants is a basic shack with a primer stove (for cooking and heat) and a couple cupboards to store stuff away from the rats and insects.

Nomasone had already done the hard part: finding a plot in an already over-crowded area. In the "informal settlements" (the politically correct term for the shack slums) shacks are built on every possible piece of land, including drainage ditches and road easements. It was simple for me to offer to buy the shack for her. At that point, a flood of emotion let loose. Nomasone sobbed for about 2-3 minutes while Yvonne and I sat quietly. She looked at me for the first time, said thank you, and then we sat quietly for another short while. We then talked (her English was quite good) and I learned more about her and her life, stuff I wrote above. Because she hadn't eaten in over 36 hours, Yvonne arranged a plate of food and some items for her to take back to her sleeping place.

Friday we're all going to shop for walls and a roof. By next week Nomasone should be in her new home and she can make arrangements for her daughter to move in with her. Her daughter will then start school in Guguletu so mother and daughter don't have to be apart anymore.

So, I learned that sometimes dreams really can come true, and for a lot less than most people would think. Sometimes just 75 skinny lattes.

Tuesday, April 17, 2007

First Day at Clinic

I started at the Brown's Farm Clinic yesterday. Brown's Farm, also known as Phillipi, is a small settlement about 10 minutes drive south of JL Zwane. The clinic started out about 15 years ago as a project of Rev. Spiwo's. He obtained 12 shipping containers and bolted them together to make a waiting area, 2-3 small exam/treatment rooms, a small dispensary, a rudimentary lab, and one office for the manager. ("Shipping containers" are literally the large metal containers you see on freighters. Think semi trailers if you've never seen a loaded freighter.) He was then successful at getting the government to pick up funding for the clinic. Last year, the government built a proper building on the same site, with proper exam and treatment spaces, offices, a larger pharmacy, a tea room (break room), and a larger waiting area with real chairs (not little benches). The clinic sees an average of 200 patients a day, plus local emergencies.

The clinic is fortunate to have a full-time doctor and three nurse practitioners. There are two other nurses on staff, along with 2-3 administrative personnel. It seems to be a very efficient operation. All patients are seen by about 1:00 (clinic opens at 8:00) and the afternoon is kept for walk-ins and emergencies.

The pharmacy is staffed by Thomi, a pharmacist, and Ntombikayise, a technician. They fill about 200-300 prescriptions a day, with about a 50/50 mix of acute and chronic medications. Needless to say, it's a busy place. I'm going to be here Mon-Tues-Thurs, which are their busy days. I'll be at JL Zwane Wednesdays and Fridays, plus other sites in Cape Town where Open Arms sponsors programs.

Practicing pharmacy in this setting is unlike any other I've been in. Because it's a government facility, with limited inventory and deliveries, patients don't always get everything that's been prescribed. If the pharmacy's out of stock, then the patient has to come back or do without. Sometimes another medication can be substituted for what's missing, and Thomi has a lot of latitude to make changes. I will say that everything is clinically appropriate, that no patient gets treated badly because of the shortages.

My biggest problem was learning all the new drug names and the handwriting. The drugs use European names, which means about half of them have different brand names. Fortunately, the generic names are mostly the same and the ones that are different are pretty similar to the American names. I'll also have a real language problem with the patients, as most of them do not speak English.

Yesterday was asthma day, with just about every patient getting inhalers and theophylline. Just about every patient gets Panado (similar to Tylenol) and multivitamins. Today is rumoured to be high blood pressure day - I'm not sure if they're talking about the patients or the staff. I haven't seen any HIV patients yet, but I'm sure they'll be coming through.

I did go out last night and buy some pens and markers for the pharmacy. It's the first place I've worked where I had to hunt for a pen (usually drug companies leave a few hundred when they visit. I'm guessing no drug rep has been within 10 miles of this place).

I'll take some photos later this week and post them.

More to come.

Saturday, April 14, 2007

Zwane Photos

I've been working on my photos since my last posting. Here are some pictures of the Zwane Centre. The inside of the church was painted by two Germans in 2005 and is full of very nice art and hand-drawn quotes and scripture passages. I've included a couple of them, too.

Don't Count Your Wounds

I started at the JL Zwane centre this week. We're all still trying to figure out what I'll be doing, but things are starting to pick up.

The community centre is physically linked to the JL Zwane Presbyterian Church. The church has a registered membership of about 2000 families. It draws participants from a large area, including Guguletu, Nyanga, Langa, and Khayelitsha, four big Black settlements around Cape Town. The community centre serves even more people, as you do not need to be a member of the church to receive services (most are, though). JL Zwane has several meeting rooms, a computer lab, and very active kitchen. It runs an HIV/AIDS support group for about 100 members, an after-school tutoring program for kids having trouble in school, and an after-school program for pre-school kids. It also rents out its meeting rooms for community meetings, educational seminars, and many other things. It is a very busy place.

JL Zwane also provides daily meals to members of the HIV support group and the after-school program. For many of these people, it's the only meal they will get during the day. The meals are nutritious and hot, especially important as we're heading into winter and the rainy season. The meal programs are sponsored by Open Arms of Minnesota, a non-profit group in Minneapolis (of which I'm a board member). It's amazing how little it costs to feed people here - that doesn't mean there isn't a need for more. (Check out if you want to know more about Open Arms' programs and how to get involved. Or, drop me a line.)

The key people at JL Zwane are Rev. Dr. Spiwo Xapile, the pastor; Rev. Edwin Louw, Associate Pastor; and Yvonne Duki, Director of Ministries and Outreach. Rev. Spiwo has been at JL Zwane since 1989 and was instrumental in creating the centre and programs as they are today. Rev. Edwin has been there for about a year and is kept very busy with outside groups who want to use JL Zwane as a model for other faith communities to get involved in human development and HIV/AIDS education. Yvonne spends every day seeing people in their homes, assuming they have one, and helping them to keep hope in their lives.

Yvonne has telling me about her personal journey to JL Zwane. She used to be a senior person in the Methodist Church, almost becoming a minister a few years ago. However, she didn't feel a calling at that time and ended up very depressed and discouraged. She found JL Zwane about a year ago, and realized that it was where she was supposed to be. She has a very deep faith. She told me that people are not seeking her out when they need help, but are looking for a relationship with Christ and that she is only the conduit. I said she must get very tired being dealing with people all day, and sad with what's she's seen and heard. Without batting an eye she said "In a war, you don't stop to count your wounds. You just keep on fighting." That certainly shut me up for a few minutes.

Tomorrow, I'll be meeting 8 students from Bethel University who will be spending 2 weeks in Guguletu and at JL Zwane. (For those of you outside the Twin Cities, Bethel is located in a northern suburb of St. Paul, maybe a 25-minute drive from where I live. It's truly a small world). They will be living with families in the township and attending sessions at the Centre. They should get a very good experience, one that very few white South Africans have had. I'll write more about this later in the week.

Learning new words: I'm trying to learn some Xhosa while I'm here. The clicks are presenting a real challenge, as my tongue just doesn't want to participate in the lessons. I'll write more about this later. But, here are a few easy ones that you can use at home. They're pronounced pretty much as you think they are:
- Nkosi = thank you
- Nkosi kukule = thank you very much
- Molo = hello
- Uphile unjani = how are you
- Ndipelele = I'm fine

More to come.

Thursday, April 12, 2007

When Things Work...

One of the things you learn about living in South Africa is that nothing happens quickly, usually. Everything seems to take 2-3 times as long as it should (by American standards), and no one seems real eager to change it.

Case in point: my telephone. I went to Telkom on April 3rd to apply for an account and a number. I already have a phone and live line in my apartment. The clerk told me that the worker would be out on April 24th to connect the line. No excuses, just the normal 21-day wait. Given that the April 27-May 1 will be a long weekend, I'm expecting my line to be working sometime in early May. Our phone in Johannesburg took six weeks, so this really is normal.

Another thing happened to me just yesterday. I called Lexis-Nexis to order a pharmacy law book. The woman told me I could not just buy one with a credit card, that I had to open an account with them first. So, I completed their forms and faxed them in. Today she called and said my application had been denied because I am not a company. When I asked again about coming to their office and using a credit card, she said okay and would call me when the book arrives. All that work to end up back at the beginning.

An exception that proves the rule: my pharmacist license. I was licensed here from 1996-2001 when I managed a mail order pharmacy company in Pretoria. Yesterday, I called the Pharmacy Council, ZA's national pharmacy board, to ask about getting my license reinstated. I expected a long delay and to take the law test again (a 3-hour essay test. It was bone-chilling scary). The woman told me all I had to do was pay my back fees plus a reinstatement fee and I'd be good to go. It still seems a bit too easy and I'll feel better when I have my piece of paper. But, I have hope.

A couple other little things I've learned (again):
1. I have to spell my name differently. It's now Zed-A-double P-A. If I say it any other way it takes 3-4 tries.
2. Similar thing with numbers. Repeats are either double- or triple-. You would never say 5-5-5, just triple-5. I've had to hear numbers faster so I don't miss the combinations (phone numbers are especially bad. "Dial 082 triple 4 one double 5 seven" is not that easy. I'd rather say 4-4-4 15-57.
3. Everything is measured in metric quantities. Distance and speed limits are okay. Quantities are a bit trickier. Some are easy, like 30 ml to an ounce. Cooking is a bit of a challenge (how many cups in 800 ml?) and shopping can be a little confusing (300gm is how much of a pound?). The killer was at the gym - having to convert kilograms into pounds at 5:00 in the morning is not easy. And my waist is now 84, not 33 (centimeters, not inches). Yikes!

I started at my "job" this week. I also went to the clinic I'll be working at. I'll write more on those as I get going. I've also started on my pictures, and I hope to get some posted with the next few entries. Here's one to get started. This is the view outside my lounge (living room) window. That's the Atlantic Ocean. I get a nice partial sunset every evening.

More to come.

Tuesday, April 10, 2007

Easter Weekend

Easter weekend was 4 days long here. Good Friday is a huge holiday, even bigger than Christmas. People seem to connect with the message of resurrection and rebirth more than anything else, so they make Easter the major Christian holiday of the year. There are big church gatherings on Friday, Saturday night, and Sunday. The largest is north of Johannesburg where tens of thousands meet up to celebrate. The downside is that this is also the deadliest travel weekend of the year, with roughly 200 people or more dying in accidents.

We (the Minneapolis group and me) had an interesting Easter experience at the JL Zwane church. Zwane is a Presbyterian church with about 2000 members. We went only expecting to stay for about half the service, an hour or so tops. We were unexpectly asked to help administer Communion, which none of us were really prepared for. So, our rag-tag group that included two gay men, one atheist, one agnostic, one Jew, and two women helped the other dozen or so church leaders. I only got reprimanded once, for not going back for more when I ran out. At least I'll know what to do next time, assuming they'll ask me again.

Before Communion Kevin Winge pulled me aside to speak with a woman about her son. Sophie (I'm changing the names) has a 4-year-old son named Sam. Sam fell ill about 3 years ago and was found to be HIV positive. The nurse asked Sophie if she wanted to be tested, but as she said "if my son is HIV positive then I must be, too" so she didn't bother. Sam has been on antiretrovirals since being diagnosed (3TC/AZT/nevirapine). They've worked well until recently when his viral load, the amount of virus in his blood, went from 1,300 to 100,000. He started to have some liver damage and has developed seizures, which may or may not be related to the HIV or the medications. The doctor recently changed his medications (ddI/d4T/Kaletra) with the hope of bringing the viral load back down. Sophie takes Sam back to clinic tomorrow (Wednesday) to get tested to see if the new drugs are working.

Sophie is very worried about Sam. He is hardly talking and still has fits, even though he is getting anti-seizure medication (valproic acid). She has heard that Kaletra is a bad drug and is scared of it. I tried to explain that Kaletra is good for HIV and that she shouldn't be freightened. I will follow up with her later this week and see what the news is.

I'm starting to figure out why I'm here. If I can help people understand HIV better and learn to live with it, then I will have done something.

The Minneapolis group all flew back on Sunday night. They certainly made my first week an easy one. So, thanks to Kevin, Jane, Chris, Brad, Larry, Kelly, and Linda for letting me tag along on your trips.

More to come.

Saturday, April 07, 2007

Meeting Oumas, and a correction

"Ouma" or "Oma" is the Afrikaans word for grandma. On Thursday we spent time with about 25 of them, plus a few grandpas, at a senior center in Guguletu. This center, run by a truly amazing woman named Mary, is a day-care center of sorts for elderly folks. All of these people receive a monthly pension of about 850 Rand (R850), or about $115. From this they have to pay their rent (if they have any), buy food, pay for medicines, pay utilities, etc. As you can guess, it's not realistic. Mary provides them with a daily hot lunch, which is probably the only meal of the day for many of them, and all the love and support they could want. Mary is supported by a Catholic charity organization, but runs the center like it's all hers (and she started it, so it is hers).

We were all put to shame as the old folks danced and sang like they were 50 years younger. One man, probably 85 and definitely frail, stood up from his table, put down his cane, and proceeded to do a jig like there was no tomorrow. After we picked up our mouths everyone applauded and moved right with him.

One way Open Arms supports this group is to do mini food parcels twice a year, timed with the other larger ones. Each parcel will probably feed a person for 2-3 weeks easy, plus give them a couple "treats" that the probably don't see often. We hand them out in a Woolworth's shopping bag, which can be as highly prized as the food. People are bussed into the center, so getting the food home isn't a problem.

(A word about Woolworth's: It's not the 5-and-Dime you're thinking about. Indeed, Woolworth's is a department store on the order of Kohl's, with the addition of a food market like Dayton's used to have. It's THE place to go for specialty foods in a hurry, and the clothes and household items are good, too. I will be spending much money at Woolies.)

Yesterday was wine country day for the tourists, and I tagged along. We had a gorgeous day, sunny and relatively cool. I'll write more about this when I can post some pictures, because I can't possibly do it justice with just words. Before we went, though, we visited the home of our driver, Xolane (pronounced ko-lani, with a sideways click where the K is. More on clicks later). Xolane lives in Khayelitsha, about 25 minutes from Cape Town proper. He bought his four-room house in 1996 and has fixed it up nicely. He lives there with his wife and 3-year-old son, plus a cousin (many people live with extended familes here, for many reasons). The house has an outside toilet (an outhouse with a large bucket) and water faucet. He is on the waiting list for an RDP house, a government-built cinder-block house. He doesn't know when he will get one but he hopes it will be soon.

We also stopped by the local cemetery. I'll write more about this another day when I can post some pictures. Suffice to say you will not believe it.

One correction: When I last wrote, I said that Khayelitsha had only 500,000 residents. I've since heard that it has either 1.5 or 1.7 million. This is in an area about the size of Richfield, if that large (Richfield is a small suburb of Minneapolis, maybe 8-10 square miles). I don't think anyone really knows, because there's no census and people are pouring in from ZA's rural areas and countries to the north. I can tell you that the streets, such as they are, are packed to the gills with shacks and houses, and there are always dozens of people on the street. I'll be posting pictures once I have my permanent Internet connection done (hopefully Tuesday.)

(I'm also going to start referring to South Africa as ZA, its international abbreviation. It's a lot easier to type. Also, if anyone has questions about anything here, feel free to e-mail me and ask. If I don't know I'll find out and either post the Q &A or e-mail you back. Send it to

More to come.

Wednesday, April 04, 2007

Day Five

I've been in country five days now, and each has been a learning experience. Yesterday was "food parcel" day at the Zwane Centre. We made over 300 parcels, each with about 25 pounds of flour, sugar, melie meal (white corn meal), and rice, plus soup mix, seasonings, candy and a chicken (once frozen, it was well on its way to thawed by the time we gave them out). About 75 people picked up their parcels yesterday, with the rest being distributed throughout the rest of the week. One woman I talked with said this food would last her and her seven children about a full month when supplemented with vegetables and the occassional meat item. All that for about $40, all of it donated by friends of Open Arms of Minnesota.

(Let me know if you want to get invovled. There will be another parcel distribution on December 1st, World AIDS Day.)

It took over four hours to get the food from the market, something that should have taken an hour at most. There is a real different service expectation here. Things move slowly, and people just take it in stride. It'd be interesting to see how Nordstrom would do here. There were about 20 people working at the Centre, so once we got everything in place it moved pretty fast. When we were done the Zwane AIDS support group chorus sand and did a short play about living with HIV in South Africa. Even though it was in Xhosa it was very clear that people with HIV still carry a major stigma, and that more people need to accept and support them.

We closed out the day at a braai (barbecue) restaurant in Guguletu. Boerwors (sausages) and lamb, with spicy baked beans and salad. I really felt South African as I waddled out of the place.

Today, we spent the full day in Khayelitsha, the largest township in the Western Cape province. Khayelitsha has about 500,000 people, 70,000 of whom have HIV/AIDS. We first went to the local office of Monkeybiz, the employment and empowerment project for women in township women. These women make beaded dolls and other items, some of museum quality and all cute and colorful. Some of you may have seen their work in my office or attended the big sale in December. We went to the homes of four beaders and we were able to see first-hand what Monkeybiz has meant as far as improving the lives and conditions of the women and their families. It is truly remarkable what this organization has done to take people out shacks and into brick homes.

This afternoon we spent at the Treatment Action Campaign. This group is a major force in HIV awareness and education, not just here but internationally as well. They are also educating people on tuberculosis, since about half of all HIV-infected people also have TB and multi-drug resistant strains are on the rise here. They go door-to-door in the townships teaching people about HIV and safe sex. They hand out condoms at taverns and shabeens (unlicensed taverns), and make sure people are aware of what violence against girls and women is doing to the townships. It's all a matter of control - when most men are unemployed, and questioning what they can add to society, they try to seize control wherever they can. I'm hoping to work with this group along the way.

More to come.

Sunday, April 01, 2007

Arrival! And, seeing tomorrow.

After a long trip, 25 hours total, I arrived in Cape Town. I can't fully explain the range of emotions I was feeling: Excitement at the opportunity, apprehension about starting something so different, sadness at leaving the people (and animals) I love. I've never regretted my decision, but I've awoken the past three mornings with a nervousness I haven't felt in quite a while.

I moved into my flat today. I have a great view of the Atlantic Ocean, with beautiful sunsets. That will be a nice way to end the days. Getting set up was a bit of a chore - it's a bit like moving out of your parents' house for the first time. You have absolutely nothing to your name except clothes and hand-me-down furniture. I wandered through the grocery store throwing stuff into my cart seemingly at random: Paper towels, soap, sponges, tea, Coke, napkins, etc. etc. I haven't even thought about food yet, since that will be even harder (do I really need 10 pounds of sugar? a quart of oil?) I'll probably shop everyday for a while.

I'm starting to take pictures, and I'll post a couple once I have a permanent Internet connection. It's tougher to do that at an Internet cafe.

I've been meeting up with a group of people from Minneapolis everyday. They're from Open Arms, the non-profit group that I'm on the board of. They're here to see the townships and distribute food parcels on Tuesday (300 pails of staples, including flour, sugar, corn meal, beans, and oats). They're here until next weekend, so I'll be hanging with them meeting people and figuring out what I should be starting to work on. I've heard that I'll be starting at the clinic on the 10th. That will be different, to say the least.

Saturday we spent a couple hours with Rev. Spiwo Xipile, the pastor of the JL Zwane church and leader of the community center where I'll be based. He told some very powerful stories. The messages from one of them is really sticking with me. The first was about a young man who did not have the education to get into college, and did not have any job prospects. When Spiwo was counseling him to have hope and work for tomorrow, the man said "You can not ask me what I will even be doing on Friday. Do not even ask me about tomorrow. I only know what I will be doing today. I cannot see tomorrow. " Spiwo said he had never considered what it means to lose all hope, or how to help people who are in that position. For a man as powerful and experienced as him it was quite an admission. For me, it's something to consider as I try to find my way around his people and look for ways to help see new tomorrows.

More to come. Totseins vir nou.