The Halfway Point

It's been six months since I arrived in South Africa. The time has both flown by and crept at a snail's pace, depending on which aspect you're looking from. I think, therefore (I am?), it's time for some introspection.

A lot of people I meet here, basically everyone who's not a black South African, ask me why I came to Cape Town. Most people assume I'm here on a religious mission of some sort, or through some international non-profit group. When I tell them I came on my own for a year, that I was tired of the corporate rat race so I quit my job, left my family and came just to do something meaningful for other people, I usually get about a second of stunned silence. Then I get the standard comments like “That's so great” or “Wow, good for you.” And then they're on to something else, like they quite can't understand me.

(I also remember being asked by someone at home if I was that dedicated to “the cause,” meaning HIV/AIDS, or if it was something else. I hadn't considered helping people with HIV/AIDS as a cause, just the right thing to do. I still think that way.)

So, why did I come? Well, the initial idea came from Open Arms of Minnesota's desire to have a local representative in Cape Town, someone who could bring some organizational oversight to their programs in Gugulethu and look for other areas where we could help. I sit on the Board of OAM and on their South Africa program committee and was at the meeting where this was first discussed. Originally, the idea was to find a person just out of college who wanted some international program development experience. When the idea was raised, though, I thought it was a unique chance to come back to a country I liked and do something really different.

But that's only half the story. I was going through a rough time at my job and the future didn't look so bright. I needed to find something else but had no clue what that might be. South Africa was a chance to run away for a while, to escape the shackles of real life and find out what I really wanted to do with my life. It was also a good time from the family perspective – Cindy and I were in a really good place, our parents were healthy, and we were set up well financially. (To her credit, Cindy never said no, never raised any huge concerns about my being gone for so long. I think she knows me better than I know myself most of the time, and she knew that I needed to “find myself” again.)

Now, there were a lot of people who thought I was crazy for even thinking about going. Many people, including my parents and my in-laws, couldn't understand giving up a well-paying job and relatively easy life to live by myself in a far-away place for a year. I think they thought I had really lost it. I had a hard time explaining what I'd be doing; in fact, I had no clue as to what I'd be doing once I got here. I knew Spiwo was looking forward to help with his programs and that Zethu wanted a pharamcist at the clinic. That was it. But, I had two advantages:

1. I knew Spiwo, at least a little bit, and trusted he would work with me to make it a good experience

2. If things didn't work out, I'd simply pack up and come home, get a pharmacist posting somewhere, and get back into my old routine

My worst case scenario was actually pretty good. I'd spend some time in a lovely city, get some nice photos, and have some sort of experience I could tell people about. To me, there was very little downside to the move and the upside was unlimited.

So, did I have any doubts? Well, there was one night I still remember. It was a Thursday night. I had been in South Africa for a week and my apartment for three days. I was living behind a double-locked door and a security gate. The only possessions I had fit into two large suitcases. Kevin Winge and some people from and associated with Open Arms were here and they were leaving three nights later. I hadn't really started with JL Zwane or at the clinic yet, since it was Easter week and Spiwo and Zethu were away. I laid in bed for much of that night asking myself what the Hell I was doing. If I hadn't signed a lease on the apartment, I may well have gone home.

But that night turned into Friday, and then the weekend came and went, and I started my jobs. I began running every morning, and my days slipped into a certain routine. Pretty soon it was the next weekend, and then the next, and April slowly turned into May. By that time I had seen and met children living on their own and talked with adults struggling to survive with HIV and TB. I had learned the process at the clinic and actually talked with some of the patients. Both the staff at JL Zwane and the clinic figured out I wasn't leaving anytime soon and became friendlier. And, as you may have read, I've been busy with many projects since then and have made this my home away from home.

Have I met my goals? Really, the only goals I had in coming here were:

1. Help people

2. Learn about life in the townships and help people back home understand it

3. See if I could scale back my life and live simply again

I think I've met all of these goals with flying colors. Well, maybe except for number 3. I have scaled back a bit, but I haven't exactly given up my comfortable life. I have a nice apartment with satellite TV and a decent Internet connection. I live two blocks from the ocean and can walk along the promenade for miles. I live above a shopping mall so I never have to walk more than 100 yards to buy groceries, a newspaper, or a cup of tea. I have hot water and an indoor toilet, and a bed with sheets and pillows. The only simplicity I've really had to contend with is doing my own ironing. And that's only because I've been too cheap to hire a domestic servant or use the laundry service downstairs in the mall.

And what have I learned? One thing: I really like being a pharmacist. I haven't actually practiced in about 15 years, and working at the clinic has reaffirmed my satisfaction with it. I have a lot of relearning and updating to do, but I could see myself working in a pharmacy again when I come home. Of course, getting the right kind of office job wouldn't be bad either, as long as it has some kind of meaning behind it.

The second thing, which is the whole thing, is that the vast majority of people are decent and hard-working with a desire to improve their situation. I've met many people here who have every right to be bitter and disillusioned, to complain and protest or just give up. However, every one of them continues to scrape and struggle and fight to move ahead. They look for work when prospects are few, they scrounge for things to improve their homes, and they ask for help to make sure their families are taken care of. Many are also helping others in whatever way they can, including visiting people in hospital or helping sick folks with housework. The spirit of ubuntu (what it means to be human, or becoming a person through other people) is not just a concept here, it is a reality. I didn't have a word for it before I came here, but I was raised around that concept and have tried to practice it throughout my life. It's one thing I hope to bring home and spread around.

Do I have any regrets? At this point, no. I have wondered what it would have been like to live in Gugulethu, but I don't think the experience would have overcome the security risk. I've also wanted to get closer to some of the people at the Centre, but I'm a little too old to be part of the In Crowd (only Spiwo is older than me, and only by two years). But, those are really minor points. I've had fantastic opportunities and I've taken advantage of each one as they've come. I know there will be more coming, like going with Spiwo to the Eastern Cape in two weeks, coaching baseball and working on a U.S. tour for Siyaya.

So, it's six months down and five to go. I have set my return date for March 4^th and already bought my ticket. But I'm in no hurry to leave and am looking forward to what comes next.

More to come.

Living in Survival Mode

As you may have read previously, I've been helping a man named Mogise and his family with food and other necessities. It started small, a few groceries here, some paraffin there. Every week, though, it's been escalating to a point where I was spending close to R500 a week on various things. It also grew into an entitlement program of sorts - the past two Sundays he just showed up after church expecting to go to the store and then get a ride home. He shows up at the Centre in the afternoons expecting to get food to take home, and a free ride in my car. The most difficult thing for me is that what he gets is never enough. If I spend R400 for groceries, then he needs R100 for electricity. If it's money for electricity, then he needs transport money. Last week it was money for a haircut (actually, he wanted a clippers), to which I said no.

And the groceries he got were over the top. Because the first couple times I let him pick the items, that became the routine. It ended up being sausages and lamb chops, sweets and custard, peanut butter and jam. Everyone else who gets food aid gets staples: samp, mealie meal, rice, flour, sugar, tea, soup mix, things like that. I felt uncomfortable calling him out in the middle of the store, so I let it go. Big mistake on my part.

Things hit a high (or low) point this past Tuesday. I was working at the clinic and he called me on my cell phone at about 10:30. "I'm at the robots [stop lights, about a half-mile from his house]. You have to come and get me." It wasn't a request, it was a demand. I told him I was at the clinic and couldn't leave. He hung up on me, and I went back to work. About 20 minutes later I got another call. "I'm outside the [Centre] gate, come out and get me." Again, I told him I couldn't leave. "Plus," I said, "I won't be at the Centre until later this afternoon. Why did you come this morning?" He said something I couldn't understand. I told him I would stop by his house later in the day. "Then you can bring me my plate [of food]," he said. I said no, I wouldn't be at the Centre. Again, he hung up.

Well, it was a slow day at the clinic and I got out earlier than expected. I did go to the Centre first and sure enough, he was there to get his food. I sat down with him and explained that what he did that morning was not appropriate. I told him I was not a personal taxi service, and if he needed a ride to get his food he needed to arrange his own taxi or other transport. I also told him that he should be eating his daily meal at the Centre, since the rules were that no food leave the premises. He nodded that he understood (he speaks English pretty well, so I'm sure he did) and we left it at that.

Then, I told him that I was worried about how dependent he was on me for food, since I wouldn't be around forever and he needed a broader support network. I also said the amount I was spending was getting high, especially because I was supporting several other people. I told him that he has to take some responsibility for finding other support, including a government grant. (If his CD4 count is below 200, he may qualify for a disability grant. He hadn't been tested to see what his count was, even though he promised to do that before.) Again, he nodded that he understood and he left.

I decided I needed help. Mogise has told me before that he'd been visited by one of the Stellenbosch University social work students who come to Centre for practical experience. I spoke with the woman who works with these students (Johanna) and arranged a meeting for last Friday. I also told Mogise to come. I met with the student (Josias) and Mogise for a few minutes, reiterating what I had told Mogise on Tuesday. Then Josias sent Mogise away and we chatted for a few minutes. Josias said he was fully supportive of my position, that Mogise should be living in survival mode right now and trying to maximize whatever he gets. He told me a little more about the family's history, which helped explain some of the problem. Apparently, Mogise's family had been fairly well off when his parents were alive. Since both of them died, the family has fallen on hard times. His sister lost her job, which took away their only full-time paycheck. His brother only works three days a week and doesn't earn much. A cousin who lives with them used to work at McDonalds but his contract expired and he was let go. So, they went quickly from a life of relative luxury to one of poverty. They are just now learning what it means to live from hand to mouth, and that's why Mogise is struggling.

After we met, Josias, Mogise and Johanna sat down to develop a plan. I had told Josias that I could sustain R200 a week for Mogise, so they created a food plan inside that amount. It has all of the protein and carbs they'll need, and it will be supplemented with free vegetables from a local church. Then, to cement the plan and make sure R200 was sufficient, Johanna, Mogise and I went to the store.

As we walked the aisles, Mogise was clearly unhappy. We picked only those items on our list, plus a couple small add-ons. Mogise asked about a cake once, and anchovie paste another time, but I held firm to the plan. Johanna had to set him right a couple times - I know just enough Xhosa to know she wasn't happy and told him how things were to be going forward. The bill came to R189, so I know we can make it work for the long term.

When we got home, Johanna had a long talk with Mogise's sister. She explained what we bought and why, and how there was going to be a limit on what they would get in the future. The sister didn't seem to have any problem with it and understood why things had to change. We also ran into Mogise's brother as we were leaving, and he was very appreciative, as well. We made an extra run to top up the electricity account, and then Johanna and I left. Well, not before Mogise asked for more money to come to church on Sunday. I told him no, that he should arrange his own transport, and so did Johanna.

We both felt good about what happened. I can now help two people for what I was spending on just him, and Johanna knows that he will get some sustained assistance. Johanna said that she thinks Mogise was trying to hold the seat of power in the house by bringing in money and food. Part of the reason he's upset, she said, is that he may lose some standing with his siblings. I can't help that, and his better standing won't help them survive any better in any case.

We'll see what happens this week when he and I are alone again. And, he didn't come to church today.

More to come.

A Story in Contrasts

I just left the funeral of the oldest elder in the JL Zwane church. Tembile Silimela was 88 years old, a remarkable age for a community where the average life expectancy is 54. His funeral was an amazing contrast to that of Nokuzola (Rosey) Kokoana, age 34, which was held yesterday. (Rosey is the woman who I've been writing about for the past few weeks.)

Rosey's funeral was held at her house, as the family didn't think many people would attend. They were right. Only about 40 people came to the funeral, and most were family members. It was a very modest affair - it had all the pomp and circumstance of a regular funeral, but less of the pathos that I've seen before. It became apparent why, when the neighbourhood leader spoke. He explained that Rosey had shut out many members of her family, telling them not to come to her house when she was sick. This is why most of her family were never around during the time I've known her. The neighbour also told of a time when Rosey had moved back to the Eastern Cape and let others stay in her house. These people apparently created all kinds of trouble for the neighbourhood, making noise and getting up to bad mischief. The neighbour called Rosey and told her to come home to take care of the problem, and she refused, telling him to mind his own business. This created much ill will in the neighbourhood, and the bad feelings still exist today.

This is a very different story than what I had heard before. I'm sorry for passing judgment on the family before I knew the facts - they were not as uncaring as it seemed, just estranged because of what Rosey did. This estrangement is also the reason why most of the family did not want a big funeral (in fact, some didn't want anything) and why it was a very modest affair. It turned out to be a nice celebration, and I think everyone was pleased when it was over and done.

(I don't know what interaction I will have with Amanda and Bonga now that this chapter is closed. They have new family members to depend on, and I don't think I'll be needed any longer. I'm sad about that, but I'm glad they can have a more stable family situation now that the bad feelings are evaporating. Amanda may still be looked after by Yvonne's disciple team, so we'll see what happens in the future.

(Also, it's customary to have a picture of the deceased at the funeral and on the programme the family has printed for the service. I was very surprised to see what Rosey looked like before I knew her. I knew she was tall, close to six feet. I didn't know she was a big woman, probably more than 200 pounds in the picture. When I first met her she couldn't have weighed more than 130 or 140, and at the end she had to be under 100. It was a rapid and dramatic change and it set her up for a bad outcome.

(Another somewhat bizarre thing happened as we were leaving the luncheon. Someone from the family, or maybe a friend of Rosey's mother, came up to the car and said Rosey's mother wanted to see to get the cause of death. I was a little stunned, and before I could say anything the women in the car told her that it was confidential and that they should go to the hospital and ask for the death certificate. I think she was trying to find out if Rosey was HIV-positive, which I only know because Rosey told me. I have never heard the official cause of death, so I couldn't have answered her anyway. It could have been from the TB, or it could have been a stroke, or it could have been a brain infection, or any number of other things. I hope she is able to get her answer.)

Mr. Silimela's funeral, on the other hand, was the largest and most celebratory I've seen to date. He was loved and revered by his family, friends and the congregation as a whole. The service was filled with song and testimony, with over 400 people taking part. Because it pulled in people from across the community it was also filled with colour, as well. Members of may different ladies' auxiliaries were present. There were white hats and black berets, leopard-skin pill-box hats and multi-coloured scarves. White coats, red sweaters, green-grey plaid wraps and traditional African dresses were scattered around the hall. There was even an honour guard in their red sashes that spoke on his behalf.

One of the touching moments was when his white jacket from the men's auxiliary was passed to the family. First, the men paraded the jacket around the hall accompanied by a very spirited hymn. Then, a long speech given and the jacket was handed down to a member of the family. It was like they were retiring his number after a long and storied career.

I first met Mr. Silimela in 2003 on my first visit to JL Zwane. He always had a smile on his face and kind and welcoming words for strangers. When I came back in 2006 he remembered our first meeting even if I didn't and had the same smile for everyone in our group. He was a great steward for JL Zwane and he will be greatly missed.

In celebration of his life, the church is serving a lunch today. It should be a big affair, with a few hundred people possible. As one person put it, it will be just a little chaotic today. An understatement if I ever heard one.

More to come.

My $1000 Lesson in Humanity

It's a foggy night in Cape Town. Spring is here, with Summer soon to come. The days are warmer but the nights are still cool, so the mist settles in soon after the sun goes down. It looks pretty, and I don't have to worry about frost on my windshield in the morning.

Not to stretch a pun, but some of the fog is lifting on how things work in the township. My lessons come courtesy of Rosie's family. Now, I knew most of what I was getting into as it happened, but I'm still surprised at how people can take advantage of sincere gestures and quickly ruin a relationship.

I did take Amanda and Bonga shopping on Saturday. They each got a new skirt, shirt and casual blazer for the funeral, plus new shoes. They initially asked for my help with picking colors, until they discovered that pharmacy school didn't prepare me for that. So, I stood around waiting, just like when I accompany my wife. Except I was about 20 years older than anyone else in the store and, you know, a different color. We picked up some KFC for lunch and headed home.

When we arrived, it became very clear that the balance of power in the house had shifted to Rosie's sisters, especially the one from Kraaifontein (the one I picked up a few weeks back). Amanda and Bonga were visibly anxious around them, and I decided to leave so as to avoid any problems. Bonga sent me a SMS (a sort of e-mail that comes on my cell phone) later apologizing for what happened. She also said that someone told her she shouldn't contact me anymore. I wrote back and said everything was fine.

On Monday, I had a conversation with Nomokwezi and some of the women from the JL Zwane HIV support group. Kwezi is now working at a church in Nyanga, trying to start a community centre there based on JL Zwane for the people in the immediate area. She has a team of people from the support group who visit people affected by HIV, and Rosie was one of them. So, they know the family and the dynamics of the house. Kwezi told me in no uncertain terms that I should not go to the house alone anymore. Apparently the neighbors were talking about how I was going there, and she was concerned that one of these times I was going to be robbed. She was also concerned about some of the stories she was hearing from the support group women, that they felt my "sweet nature" was being taken advantage of. The women told me that the family only wanted to get Rosie buried and didn't have any interest in doing it right or with respect. They also felt that any contributions I made would be partially diverted to buy other things (like liquor). So, I promised them that the next time I was asked to come to Rosie's house, I would take one of them with me.

Now, I knew some of that they had told me already, and I went ahead with my donation to the funeral anyway. I knew that about R1000 of the R5400 quote from the undertaker would likely end up in the family's hands. But, I paid it because the family has very little and if even half of the "excess" went towards food it would be a good thing. I didn't like the fact that they weren't planning a lunch after the service, but I couldn't make them do it. I still felt good about the shopping trip for Amanda and Bonga, because I saw first-hand what they went through to care for Rosie and thought they needed to feel happy for at least a little while.

Today is when I got my eyes opened. I got a call about 1:00 from Bonga's phone asking me to come by. The voice was new - the woman spoke English well (Bonga doesn't) and it had a different pitch and timbre than I'd heard before. I should have asked who it was but I didn't. Anyway, because I promised, I called Kwezi and asked if she would go with me. So, at 3:00 I picked up Kwezi (and two other women, because they wanted to come) and we went to the house. When we walked in Amanda and Bonga's faces were a mix of disappointment and anger. When I said someone called me to come, no one knew who it was. Kwezi talked to them in Xhosa and still no one admitted to calling me and why I would have been called. After a few minutes we left shaking our heads.

Rosie's mother was at the house, which surprised me because I was told she wasn't coming to the funeral. She didn't say a word to me (which is rude in Xhosa culture, to at least not get an introduction), and in retrospect it could have been her who called. Kwezi told me she speaks English (how she knows that is beyond me), and she was the only person there whose voice I hadn't heard before.

Driving back from the house, Kwezi and the women explained that things were happening just as they expected. They said that I had become the patsy, someone that the family knew had money and wouldn't ask too many questions. The family expected me to show up alone, and they would have asked me to cover more of the "expenses" (which the women said would have included hair styling) or purchase more groceries. The women are upset enough that they are only going to attend the funeral and leave, and stop any more help for the family. (They had been planning to provide a small funeral lunch out of respect for Rosie. No longer.) They also told me that I shouldn't answer any more calls from Bonga, which I had already decided not to do.

As you can imagine, this whole saga didn't end as I expected. I'm disappointed, more that any respect for Rosie is being lost to family squabbles and greed than that I overpaid for something. I now have greater concerns for what will happen to Amanda and her siblings, especially after the funeral when the family starts to fight over who gets what. The sisters are allegedly talking about kicking Bonga out of the house, which will leave Amanda with people she doesn't really know.

Amanda will probably still be on the list for support through the HIV orphan program, so hopefully Yvonne can make positive things happen. She's finishing her junior year in high school (at age 16 - she is a full year ahead of her age) and she has hopes of studying to be journalist. It would be a real shame if her dream was abandoned because of her living situation.

More to come.

Potpourri for 10, Alex

(This was, or is, always my favourite Jeopardy category. I remember as a kid calling it pot-porie. What I did I know about French?)

I have several random anecdotes and comments today. First, though, a Rosie update. She will be buried next week. The funeral will be at a different church, my first not at JL Zwane (except for the two home-based services I attended). I don't know any arrangements yet, although I expect to find out soon as I'm helping to pay for it.

Unfortunately, as is often the case here, trouble is brewing. I've been talking with three women from the HIV support group who are helping Amanda (Rosie's daughter) and Nokubonga (Rosie's half-sister and roommate) with things. Because Rosie had a house, it means that there is a precious asset in play. Apparently, two sisters have come out of the woodwork and are invading (my word) the family. They were nowhere to be found when Rosie was sick, but now they are large and in charge. There is talk about kicking Nokubonga out of the house, even though she was the one who cared for Rosie 24/7. That would leave Amanda with people she doesn't really know and who may not have her best interests at heart. The support group women are also concerned because one of the two sisters drinks and smokes, which often leads to other larger problems in the townships (use your imagination). Right now, I have to stand back and wait to see what happens. I do have a little sway, though, because of my financial position with the funeral, my history with the family and position with the church (the outside family thought I was a priest until last week). As always, I'll keep everyone informed as things happen.

I've also expanded my relationship with Bonga and Amanda a little. I've bought them groceries for the past couple weeks, and tomorrow we're going dress shopping. No, not for me. They want nice dresses for the funeral and have nothing to get them with. So, I'll be spending Saturday morning in women's departments with two young women. I hope the stores have comfortable chairs to wait in.

Now onto random events of the week:

1. I saw this on the back window of a police car today: Patrol/Explosive Dog. Is it a bomb-sniffing dog? Does it run really fast? Maybe it has a bomb vest? Or, did it eat bad food? We'll never know.

2. They play baseball in South Africa! Well, at least in some of the schools. There are teams at some of the high schools in Cape Town, and a couple squads have been started in the townships to keep kids busy. I'm going to try and help out, since I have some experience and they are looking for coaches. I think I can still catch and throw. I never could bat well, but I know the mechanics, at least. Now, if I can just find a glove...

3. I was the pharmacist-in-charge at the clinic this week. Ok, so I was the only pharmacist at the clinic this week. Kayise and I actually had a good week together. I was a little worried because we'd never spent more than a day without Tami before. She actually improved as the week went on. I'd like to think it was because I actually have her feedback and compliments, which I've never seen Tami do. She "yelled" at me a couple times because I never took a break, but I explained that I'd feel guilty about leaving for an hour only to make patients wait for me. I'd rather get done early and leave and have the patients happy, too. I did have one lady compliment me on my isiXhosa today, when I correctly replied back to her greeting. That was nice.

4. Speaking about yelling, I did get cussed out by a patient this week. I had no idea what she said, but I knew it wasn't good (Kayise called her rude so I know it was bad). It stemmed from my mixing up the customer queue. At our clinic, most everything happens first come, first served. At the pharmacy, that means we fill the orders and dispense the meds in the order they come in. Well, Kayise was filling and I was checking and dispensing. She'd fill three or four, and I'd pick them up and hand them out. I didn't pay attention to which of the three I did first. This woman apparently was keeping track, and when I called the person after her in the queue first, she blew up. She sat in her chair in the lobby and spouted off a few lines. I heard her say her name, so I waved her up to the window to show her she was next. She wouldn't come. When the patient I was helping left, I called her name and she came. She continued to rant at me in Xhosa. I gave her her meds and she went and sat back down. For about 10 minutes. Kayise said "If she was in such a hurry why is she just sitting there?" We had a little laugh and carried on. Life is too short to worry about that. Everyone else was very nice and most everyone says "Thank you, doctor." (Zethu told me once that every white face in a township clinic is a "doctor." I haven't told anyone that I actually have a doctoral degree.)

5. I had a good chuckle with a couple names this week. I think I've mentioned that people are very creative when naming children here. Many times the parents wait a few days before naming their kids, and most names mean something. You see a lot of variations on Themba ("hope"), Thando ("love"), Sipho ("gift"), and others like that. Ntombikayise's name means "daddy's girl" (ntombi=girl, kayise=her father). She named her son Zanele ("enough"). The one I laughed today was Noholiday. That's not exactly isiXhosa and I can only imagine what the mother was thinking. I also know a couple people named Nceba, which means messy. Just think of the fun we could have if our names portrayed our personalities. I'm sure I would have been Moody.

6. We've had mice in the pharmacy for the past couple months. They came in when was cold and rainy and it was impossible to get rid of them. Well, I've caught three in the last two weeks and they got increasingly larger, so I think I finally got the mother today. I couldn't understand why they were so docile when I found them. The last two literally just stood there and let me pick them up with absolutely no fight whatsoever. (The second one was actually comical. It had its back to me and was licking its paws. I just put a little box over it, scooped it up and took it outside. It never even tried to get out.) Today I figured out why. They had made their nest on a bottom shelf where we store our excess inventory. It happened to be near the end of the alphabet by the vitamins (they were fit little mice). It was also by the valproic acid. That's a drug used for epilepsy, and sometimes for certain mental health conditions. I found a pack with teeth marks and two missing pills. These mice were very calm and relaxed, with not a care in the world. So, I'm going to write to the D-Con people and ask them to try this in their next product. You may have mice, but they'll be so nice you may not mind having them.

7. Imagine you're driving to work at 8:00 am on 494 between Highway 100 and 35W (for those of you not in the Twin Cities, pick the busiest stretch of your favourite Interstate Highway at rush hour). Now imagine if the people living in Richfield decided they didn't like their living conditions and stormed the freeway. That's what happened on Tuesday this week. The N2 is one of two major highways leading in and out of Cape Town (the other is the N1). The N2 travels south and east along the coast from Cape Town to Durban, and the cuts west to Johannesburg. About 8 miles outside of Cape Town along the N2 is an area called Langa. This was the first township constructed in Cape Town in the 1930s. There's a section called Joe Slovo that sits almost immediately adjacent to the road. The government is attempting to build new homes in this area. However, in order to do that they have to move almost everyone out. The plan is to move them to Delft, a settlement about 10 miles further away from town. This is going to greatly disrupt people's lives, especially travel to and from work (and increase their costs, since taxi rates are based on distance). Tuesday morning, the residents of Joe Slovo showed how upset they were. They invaded the freeway, throwing burning tires and stoning police cars. They started at about 4:00 am and were still going at 8:00. The police had to shut down the freeway, which created all kinds of chaos on the other routes and caused tens of thousands to be late to work (including me). It's been fine the rest of the week, although the mayor posted police and security guards along the route all week. More protests are rumoured, so it could be a fun couple weeks coming up.

8. I'm now considering setting up my own savings and loan at JL Zwane. Maybe just the loan part, anyway. This week I had five people ask me for small "loans." These are amounts ranging from R50 to R200 ($7 to $30). Usually it's for food or clothing, sometimes for transportation. One of them will probably also pay for some alcohol, but I can't prove that. It's approaching a point where I'll have to talk to a couple repeaters and give them a final no. Everyone always has a good story, though, and it's tough to not give in. Everyone promises to pay me back, but so far no one has save one guy from last month. Maybe if I start charging interest...

That's enough for today. More to come.

Bad News Comes in Threes, Even Here

It's been a tough couple days, full of the typical ups and downs of township life. Let me start with a couple small positive things:

On Friday I got to help a girl see better. One of the women in the HIV support group is caring for her 15 year-old niece and 10 year-old nephew. Their mother died of HIV last year, so she took them into her small shack in Tambo Square (a little village on the other side of the railroad tracks from Gugulethu). Her niece lost her left eye when she was very young. Apparently, she got something in it and no one knew. She rubbed it so much that the item scratched her eyeball beyond repair and the doctors had to remove it. Because of that, her right eye has been working overtime and is now very tired. Her teachers have written home saying she needed glasses but the aunt couldn't afford them. So, she asked me to help and I couldn't say no.

We went to the local optometrist on Friday. The girl got her exam and picked out a nice set of frames. She'll have her glasses next Wednesday and will have a better outlook, in more ways than one.

Also on Friday, the Centre sent six women off to America. They'll be there for 17 days between churches in Dallas, Pensacola and Philadelphia. Three of them had never been to the US before (or anywhere else out of South Africa) so they were pretty nervous. I tried to convince them that Americans are nice people, but I'm not sure they were buying it. Hopefully they weren't basing their opinions just on me!

The tougher things started Thursday and grew to a head today.

First, Rosie. She died yesterday afternoon. She continued to deteriorate throughout the week, becoming almost comatose on Friday. She was very thin and weak at the end, just skin and bones lying the bed. It's hard to believe that just a week ago she was up walking and looking forward to being home soon. I saw her every day, and went with her family yesterday. We left at about 4:00, and by 4:15 she had passed on. It's like she was waiting for everyone to come before she let go.

One nice thing we experienced was when one of the nurses got everyone together and explained what was happening. That was the first time I'd seen any compassion or sympathy in the nursing staff at Jooste. I'm not saying they don't care, because I'm sure they do. It's just that they are so overwhelmed with the patient load that they don't have a lot of time to spare on dealing with family issues. She stayed in the Casualty unit, what we'd call the ER, the whole time she was there because there was no room in the ward. While this upset me at first, it worked out to be a good thing because she had a corner to herself and it was relatively quiet. (Because this is where the doctors hang out, the men guarding the door assumed I was one of them and so I got to walk around and take in the family without any hassles. Being white still has its privileges sometimes.)

The bad thing about her passing was that no one called the family to tell them. They didn't find out until today when some of them went to say prayers over her. When they got there, she wasn't in Casualty. She also wasn't in the ward. After a little while they discovered she had died. That's the third time I've heard of that, where the hospital didn't contact anyone to tell them. I'm sure that doesn't happen in the private hospitals.

The second thing that happened today was a call from Lydia. You may remember her as the mother of Niwo, the boy who is supposed to be having a lung operation related to his HIV infection. Lydia, besides having HIV and the problems that come along with it, also has severe esophagitis, or erosion of her esophagus. She's been in and out of hospital for that over the past couple months and is awaiting an operation to repair it. Today, she called just to say she was in a lot of pain and hasn't eaten for two days. I went to see her, and it turns out she has another problem now. She has some throat infection that the doctor isn't sure of. He gave her some medication but it's not helping. She said she'd go to the day hospital later tonight if it's not better. Since it was dark already and I needed to leave Gugulethu, I left her with her sister. I felt horrible but I didn't have any option to stay with her. She said she'd call me tomorrow and let me know what happened.

The third thing was earlier today when Mogise caught me at church. He's the 28 year-old unemployed man who looks after his household of five. He hasn't eaten for a couple days, again, and needed some food. He was supposed to be getting support from another church nearer to his house, but apparently that hasn't happened yet. He's also supposed to be enrolled in the hospice program, but that's not going either. Or, it could be that he's being helped and not telling me. In any case, we went shopping and got him stocked up on groceries. I'll check on the other support this week and try to get him a long-term plan to support himself.

Mogise is a challenge because he's the first person I've come across who feels like he's entitled to whatever he asks for. He doesn't like it when I say no, or when I tell him I don't have cash for electricity or paraffin. I get the sense he's working the system and getting support without disclosing it, or not following up on his commitments with people to get support. I explained to him today that I cannot support him too the level I am for much longer, but I don't know if he was listening. We'll see how this plays out over the next couple weeks.

This coming week, Tami is off at the clinic so I'm the pharmacist in charge all week. This will be a good test for my job qualifications when I get home. Of course, I'm really only in charge of locking the door when we close because Ntombikayise (the assistant) tells me what to do while we're working!

More to come.

Alone Again

Cindy went home last night, so I'm back to bachelor life. We had a great second week (plus a couple days). My cousin John and his wife Renae happened to be vacationing in Cape Town last week, so we spent Monday together. It was fun playing tour guide, seeing some places I hadn't bothered to see yet. We also had fun watching Renae "negotiate" with the market vendors. She walked away with a couple huge bargains, including a pair of masks for 25% of the asking price. "It's all about the thrill of the hunt," she said, and it was clearly true.

On Tuesday it was back to work. Cindy came to the clinic with me to see what it was all about. Tami happened to be sick that day, so I had to be the pharmacist and Cindy got to play technician. It only took her about 30 minutes to get the hang of things, with Ntombikayise holding her hand a bit. She agreed that it doesn't feel as busy as it is, since there are no computers or telephones or insurance claims. But it gave her a good feel for life in a township clinic.

Wednesday and Friday were spent at the Centre. We went with Yvonne to a couple homes, including Nancy's home for disabled children and Priscilla's foster care home. It was an eye opener, especially at Nancy's. Like before, there were about eight kids in the small room, some on the floor and others in cribs. None of them talk, except for the occasional babble. We spent about 20 minutes there, just holding hands and tossing a big rubber ball around. I think the two helpers felt good to have a break - I'm not sure I could be in that environment for hours at a time under constant pressure to make sure no one hurts themselves. At Priscilla's, most of the kids were in school so it was pretty quiet. We chatted with her for a few minutes and then went on our way.

On the way back to the Centre Yvonne told us about a student at a local primary school that she heard about. This girl, 13 years old, was discovered to be pregnant just recently. The father? Her own dad. Her mother passed away and her father is still at home, so the school principal is trying to get her placed into foster care so that she can have some chance at a "normal" life. The baby will probably be placed for adoption, but that isn't definite.

We stopped at the school to speak with the principal about the girl. During the conversation the principal told us about another young student at the school who was nearly raped recently by a neighbor. The man was going to pay her R150 ($22) to have sex with him. The girl managed to get away before anything happened. She told her teacher, who informed the principal. The principal called the parents, who said the neighbor apologized and they accepted, and now the whole thing is forgotten. The principal is convinced the neighbor gave the R150 to the parents as hush money. She is not going to let it drop, though, and is getting the police to open a case. We'll see how that ends up.

(Zethu told me just today of another 13 year-old girl at a different school who is pregnant by her father. Her mother also passed away and her dad has now disappeared. I asked Zethu if this is a common occurrence. She said it's not common, but no one knows how many times it happens and goes unreported. It seems to me that 2 stories in 1 week indicates a big problem, in any case.)

On Friday we spent some time with Mandla Majola at Treatment Action Campaign. We happened to arrive during one of their leaders' meetings, so we were invited in to listen. We were introduced as the mural sponsors and received a nice round of applause. Zackie Achmet, the founder of TAC was there, so I finally got a chance to meet him. He doesn't seem like a powerful activist (he's about my size with a pleasant demeanor and nice smile), but looks can be deceiving. When Zackie talks, the country and its politicians listen. I showed Cindy the two completed murals as we drove through the shacks of Khaylitsha and she agreed they were well done and informative.

Saturday was spent at Kirstenbosch Gardens, a very large nature reserve right in the heart of Cape Town. It was a perfect day, with lots of sun and a nice breeze. The Gardens contain just about every plant you can find in South Africa and every one is marked with a name and other interesting facts.

Sunday and Monday were rest days for Cindy. I spent Sunday afternoon visiting Rosie with her family, and Monday was spent at the clinic. We spent Tuesday doing last minutes tourist stops, including the District Six museum, the Castle of Good Hope and Rhodes Memorial. I'll write about them another time.

As far as Rosie is concerned, things took a dramatic turn today, and not in a good way. I saw her last Thursday, and she was the most lucid, talkative and happy I'd ever seen her. She was walking the halls, albeit with a walker, and most of her pain was gone. She was looking forward to going home soon, although it would be at least a week or more before that happened. On Sunday, when I was there with Amanda and Nokubonga (who I discovered is her half-sister, not just her roommate), she had just woken up from a nap so she was a little groggy. But, she was still talkative and responsive and we spent a good hour together.

This morning, I got a call from her nurse. (I gave Rosie my number when she was first admitted, and it was the only one the nurses had for family contacts.) Sister Namona said that Rosie had deteriorated since yesterday, refusing to eat or to do her physical therapy. She asked me to have the family come for a visit to see if that would improve her condition. So, I had Zethu call Nokubonga (only because her English is not so good and we've had misunderstandings before) and arrange for her to be ready for me to pick her up. Zethu also told her to see if Amanda could get out of school and come along. Zethu also offered to come, which I gladly accepted.

When we got to the house, Nokubonga was ready and Amanda was home from school. We all piled in the car and drove to the hospital. No one said much of anything; we were all expecting something bad. And, that's what we got. Rosie was in a private room now, and she had a look that I haven't see since I worked on the Mounds Park Hospital psychiatric ward. She was staring into space, occasionally focusing on something on the wall or on the ceiling. She was cold and clammy and her arms were constant twitching. If you called her, she would look at you, but she either wouldn't respond or would say something totally unintelligible. The nurse said that she was actually improving from earlier in the morning, but that would have meant she was catatonic at one point.

The doctor had made arrangements to transfer her back to GF Jooste so that she could be evaluated. I don't understand that, since it seems like a big step backwards (Jooste is a little hospital with big wards and few services, while Tygerburg is a huge place with small rooms and "real" hospital departments). My cynical nature says they're sending her there just to fade away. I plan to see her tomorrow afternoon and will pray for the best. I hope it's not a stroke (she's been laying in a bed for the better part of four months) or a brain infection (meningitis or worse), since the long-term outlook for those here is very poor.

Two other things which bring home the impact this is having on the family:
1. When I brought Amanda and Nokubonga home, Amanda asked for R5 to buy some bread. I could tell it was hard for her to ask, but I heard her tell Nokubonga she was very hungry and I'm sure she hadn't eaten in at least a day. I took Nokubonga to the grocery store instead and got them stocked up for a few days.

2. Amanda's neighbor called me this evening and said they received a letter about needing to pick up their child support check by the 5th or it would be lost (this is apparently money from the childrens' father, not the government grant). I asked when the letter came, because today was the 5th. She said it came last week but Amanda was scared to open it. Now, she and Amanda will have to go to the Social Services office and fight to get the child support payment that is due them. I can only hope the office takes into consideration Rosie's health and does the right thing.

More to come.

It's been a while since my last entry, mostly because I've been away playing tourist this week. My wife, Cindy, arrived last week and we've been driving around the countryside to places we never went when we lived in Johannesburg. So far, we've:
- been to the penguin colony in Simon's Town
- gone on a 2-day "safari" at a private game reserve in Albertinia, a 4-hour drive from Cape Town
- driven through the West Coast National Park, a huge wildlife and wildflower area on the Atlantic ocean about an hour's drive from here
- hiked through Kirstenbosch Gardens, a 575-hectare (1450-acre) protected park on the east side of Table Mountain that's full of flora (and some fauna) from southern Africa, including many endangered plant species
- walked through the local craft market (twice) doing our best to support the local economy

We've also been out to eat 6 nights in a row, something really unusual for me. It's been fun though, as some places just aren't fun if you're alone. It's meant a little extra work at the gym, however.

This coming week, I'm going to taking Cindy to work with me. We'll spend at least Tuesday at the clinic (maybe Thursday, too) and Wednesday and Friday at the Centre. She should have a better sense of the challenges in the townships and what people are doing to overcome them.

Before I picked Cindy up from the airport last week, I had another interesting experience. I went to see Rosie at Tygerberg Hospital. She was transferred about 10 days ago because GF Jooste needed her bed for more acute cases (it's unusual for people to be admitted there for more than a few days, and Rosie had been there for three weeks). She's in a rehab unit where they are trying to restart her TB medications. They had to be stopped for a short time because she developed drug-induced hepatitis, a form of liver damage brought on by medications. I'll stop and see her this week, and I really hope she's doing better so she can get back home soon. (No one ever thought she'd be in the hospital for one week, let alone five).

When I was getting home from the visit, I got a call from a friend of Rosie's. Somehow I had promised to drive Rosie's daughter Amanda to Kraaifontein to pick up her aunt, who was going to stay with her for a few days and help with the kids. There was a little confusion about this trip, as I never talked to her about it. But, they had made up their minds and we were going. So, I picked up Amanda and her friend's daughter, Precious, and off we went.

First stop: Phillipi to get the aunt's address. Well, no one seemed to have it, so I was "given" a navigator who knew the way. Now, Kraaifontein is about 30 minutes from Guguletu, if you have good directions. Unfortunately, my navigator had been drinking all afternoon and didn't exactly have a keen sense of direction. We took a lot of shortcuts, so many that it took over an hour to finally find the shack. It was now dusk, and I was only a little worried about being in an unfamiliar place and finding my way back. I needn't have worried: Everyone I met was very friendly and happy to see a white man helping someone in need. One person told me I was the first white man they had ever seen in their neighborhood, which I don't doubt (it's a bit rural, and there's nothing there except homes and shacks).

While we were waiting for Amanda to collect her aunt, I had a nice chat with Precious. (I'm not using her real name, for reasons that will become obvious.)

- She gave me some background on Amanda and Rosie and why their situation is so precarious. Apparently, Rosie inherited her house from her father. As I understand it, government houses can be passed down only one generation. However, if Rosie were to die, the house would be reclaimed by the municipality and Amanda and her two siblings would be on the street. Needless to say, everyone in the neighborhood are concerned about what's going to happen if Rosie doesn't come home.

- Some people are looking at Rosie as an example of how tenuous life with TB and HIV can be. Rosie had been a very strong woman with a good job before she became sick from her TB. Others around the neighborhood watched her go downhill quickly, and people started examining their own lives. I hadn't thought about this until last week, when I thought about Rosie and Tozama, the woman who recently passed away (more on her a little later). It must be very difficult for members of the HIV support group, or just people living with HIV in general, to go to funerals and memorial services. They have to confront their own possible futures with every death, and those of their families, just like Scrooge had to do with the Ghost of Christmas Yet to Come. They have to see the impact it has on their families and loved ones, emotionally and economically. Yet they still come to pay tribute and thank God that they are still living.

- Precious then shared with me that she's HIV positive. She found out earlier this year when she was pregnant. She was treated with medications during her pregnancy, so her baby was born without HIV (although he still has to be tested for a few more months to be sure). Precious has not told her mother, though. She is very afraid her mother will be disappointed in her, as she was when Precious fell pregnant. She said she thinks her mother knows, though, because her mother saw Precious taking her medication one day and said it looked like what people take for HIV. Precious told her they were just vitamins for the baby and her mother didn't push it. While I understand the hesitancy to disclose her status, I still don't understand why Precious felt comfortable telling me, someone she had just met a couple hours earlier, and not the woman who loves her more than anyone on Earth. I hope she can find the courage to tell her mother when the time is right.

After about 30 minutes of waiting, we got everyone back in the car and headed back to Guguletu. Amanda and her aunt talked the whole way back – well, the aunt talked and Amanda sobbed. Amanda's had it very tough over the past few months, caring for her mother, brother and sister, keeping up the house and cooking, while still going to school and trying to be a teenage girl. I don't think she's had anyone to confide in and talk to for weeks and had a lot of emotion to get out. It will be good for her to have someone in the house for a while.

On Sunday, while Cindy slept in, I attended Tozama's funeral. It was on Sunday to avoid a conflict with a nearby funeral that was held Saturday. It was a very nice service, all held at the house. We started at about 8:00 with a small prayer service. The casket was in the small bedroom, with about 10 family members crowded in the room as well. About 10 of us sat in the lounge and listened to the prayers being said. At about 9:00, the casket was moved outside to the front yard and the funeral began. I was asked to help carry the casket, which seemed to weigh almost nothing. Of course, Tozama only weighed about 60 pounds, and the casket was wood and simple adornments. Very different than other pallbearer experiences I've had, where six guys struggled to carry the casket. This one could have been easily carried by two men.

Tozama's mother, Thomi, asked me to say a few words during the ceremony. I made some observations about Tozama, that she was a strong woman who wanted to live for her family, but for whom God had a different plan. I also offered a short prayer for the family. I'm getting much more comfortable with these, even though I hope I don't have to do too many more.

After a short burial service at the cemetery, we were served a nice lunch at the house. I was the only man at the “umfundisi table,” completely the opposite of other funeral lunches where there might be one woman at a table full of men. Then it was home to start my vacation.

One last thing: This week I heard a great quote from Herman Melville: "Of all the preposterous assumptions of humanity over humanity, nothing exceeds most of the criticisms made on the habits of the poor by the well-housed, well-warmed, and well-fed." I know this has applied to me in the past. I won't comment on anyone else, except to say that everyone here seems to have an opinion on what the problems are. Now, if someone would just ask the people living with the problems...

More to come.

An Expensive Day

I've now been here long enough that people looking for help (money) are coming to see me at the Centre. Here are three examples, all of which happened Tuesday/Wednesday this week:

1. Ntozama's mother
Ntozama is the proper name of the woman who passed away this past weekend (the one I took to the day hospital about 10 days ago). I knew she came from a very poor family, but didn't realize how poor until her mother called to ask for a meeting with me. I met with her after I finished at the clinic. She said she was struggling to pay for the funeral, to be held on Sunday. (She picked Sunday to avoid "competing" with another funeral down the street that's being held Saturday.) The undertaker is willing to do the whole job for R4500. Unfortunately, the mother only has R1000. Her ex-husband (Ntozama'a father) has nothing. Ntozama's husband was supposed to come to help but didn't show up. So, the mother was very worried about how to bury her daughter with dignity.

A look around the house confirmed the state of affairs. Ntozama slept in a room with a mattress on the floor. That's it. The lounge (living room) had maybe two chairs and a TV. All of the walls were bare and the rugs threadbare, where there were rugs. They had one paraffin (kerosene) stove for heat and cooking.

After checking my finances, I offered to contribute R5000 to the cause. The look of joy I received in return was enough payment for it. The mother can now have a proper service and lunch, just like she wanted. Everything will done at the house to keep expenses down - she has a very small house, so I'm not sure what kind of crowd there will be. Members of the HIV support group will be there, so it should be a good turnout. The mother received a pail of paint from a neighbor, so she had a couple men busy painting the lounge and front of the house to make it look clean.

2. A woman traveller
A woman Yvonne knows came to the Centre yesterday morning to see me. We went to see her late in the afternoon. She is very poor, living in a shack behind a house just a few blocks from the Centre. She buried her brother-in-law three months ago and spent quite a sum to help the family. Then, last month her brother died from HIV-related disease in the Eastern Cape. She very much wanted to go to the funeral but could not afford transportation. A round-trip bus ticket would cost R600, and she would need some extra money for incidentals and clothes.

I offered to loan her R1000 so she could attend the funeral. She insisted it is a loan and that she will pay me back in time. I gave her the money today, and she is excited to be able to go.

(I've given several "loans" since I've been here. I have yet to be paid back for any of them. I gave myself a rule very early on in my stay: Never give anyone anything you can't afford to lose. So far it's been a good rule to follow.)

3. Mogise
Mogise, who calls himself Gladstone, is a 28 year-old man living in Crossroads. He became HIV-positive in 2001. He is the oldest in his family; both parents have passed away. He lives with 5 other family members, one of whom has a baby. No one is working, except for a rare day job as a labourer. As the oldest, everyone looks up to Mogise for food, heat, and other necessities of daily living.

I met Mogise in church about 3 weeks ago. He was brought there by a couple members of the support group. Initially, I was only asked to provide transportation to the support group meetings (he cannot afford the R8 needed for a cockroach taxi). After we talked a couple times, he got brave and asked me to help buy some electricity. Then it was some money for paraffin. Yesterday, he bit big and asked for some groceries to cover the 4 days until his sister gets the child-care grant for the baby (R200). So, Tuesday we went to the grocery store and I bought R265 worth of assorted groceries. I also gave him R100 for more electricity and transport.

To try and find some long-term help for him, I set up a meeting with our social worker for today. After she and he got their plans sorted out, Mogise asked if I could take him to buy a blanket. So, back to the store we went. After that, and buying some vegetables from a stand outside the store, I took Mogise back home. He invited me inside to show how dire his situation is. He normally sleeps in a shack outside the house, but roof was lost in the last windstorm. Now he's sleeping in a room in the back of the house, one that leaks wind and rain. He had one blanket on his bed, no sheets or pillows. His house was also very bare and quiet, considering the number of people who live there.

(I had another interesting experience at the market. First, you need to understand where we were. Nyanga Junction is a shopping area above a busy train station, the main station for rides into Cape Town. It's a quasi-strip mall with a number of small, independent shops with a couple chain stores mixed in. It's a very busy place, right in the heart of Guguletu and near to Nyanga. It's very unusual to see a white person there - I could have been the first one there this month. Anyway, as I was standing at the vegetable stand waiting for Mogise, one of the youth leaders from JL Zwane came up to me and asked me what I was doing there and if I was alone. The look on her face showed she was very concerned, bordering on fear. I pointed to Mogise, and she relaxed. I appreciated her concern and attention and will thank her on Sunday. It also told me that I need to be very careful if I ever go back there.)

The long and short of these examples is that there are lots of ways to help people, but also lots of ways to get pulled deep into difficult situations. As long as I follow my own rules I will be okay.

Two other things:
1. Rosie update: Rosie is looking much better. She's alert and smiling, even more than this past weekend. She can now sit up and is trying to use her crutches. Unfortunately, she's had a setback with her TB medications. She had an episode of drug-induced hepatitis, so all of her medications had to be stopped. The doctors are going to transfer to a rehab unit in a different hospital so that they can slowly restart the medications and get her stabilized again. I'd hate for her to go backwards and be so ill again - I don't think she'd survive it.

I'm really hoping she can be home within the next couple weeks. She misses her family a lot, and she's lost a lot of weight because she won't eat the hospital food. I'll bet she's down at least 20 pounds from when she was admitted 3 weeks ago. At home she can get good, basic food and quickly regain some weight.

2. My "wish I had a camera" moment this week happened on Tuesday morning. I happened to be driving by the commuter railroad tracks at the right time and saw a fully loaded train go by. And I mean fully loaded. There were guys hanging out of the doorways, standing between cars, and even riding on the roof. It reminded me of pictures of India's trains. I know that train surfing (literally standing up on top of the cars, dodging obstacles) is big in Soweto, but I didn't expect to see it here.

More to come.

Wild Thing Has Nothing On Gugulethu

Wild Thing is the name of the biggest roller coaster at Valleyfair, the big amusement park near the Twin Cities. It has a great (size and fun) drop-off at the first hill. You go up and up and up, and then all of a sudden you're free falling. Or at least it feels that way. That's how my afternoon was today. And here I thought I'd have nothing to write about this week...

I saw Rosie twice this weekend. She's doing much better. She's not confused anymore, she can sit up now, and she's starting to walk with crutches. She also seems happier, even though she absolutely hates being the hospital. Of course, there are stories for both days:

Yesterday, I took her housemate Eric (I think he's the partner of Nokubonga, the other woman in the house) to visit. When we got to GF Jooste, they swore she wasn't there, but was still at Groote Schuur. Groote Schuur (pronounced Groot-es-kewer, with the G sounding like you have a phlegmy throat) is the major public-sector teaching hospital in Cape Town. It'd be like the pre-Fairview University of Minnesota hospital, where GF Jooste would be like Hennepin County Medical Center (but worse). Rosie went to GS to have a neurology consultation about her feet and legs. It wasn't clear when she went if she'd stay there or come back to Jooste. Well, it appeared like she went there and stayed. So, Eric and I drove to GS. After wandering the hallways for 30 minutes and asking for help about 6 times, the nurses swore she was back at Jooste. So, we went back to Jooste. Sure enough, she was there all along, one aisle over from where she was last week. We visited for about 30 minutes (now past visiting hours, but I didn't care) and then left. I promised to come back today with her kids.

As promised, I picked up Amanda and her baby sister, plus Nokubonga and her daughter, and we all headed for Jooste. When we were walking in, a woman I kind of recognized pulled me aside and told me that Nokuzola had just died. At least, that's what I thought she said. Nokuzola is Rosie's real name. I stood there dumbfounded. I said I had just talked to her yesterday and she seemed fine. After pausing for a few seconds, I continued to walk into the ward with Amanda and Nokubonga. I stopped us at the nurses desk and discreetly asked if it was true that Rosie had passed away. The nurse looked at me a little funny and said No, she's just sleeping. When we walked to the bed, she woke up.

It took me a few seconds to realize that the woman in the hallway was the sister of the woman I had taken to the Gugulethu day hospital last week. It was she who had passed away. I went over the bed, which was surrounded by the typical hospital-issue ugly beige curtain. Her mother was just coming out. I gave her a hug and she sobbed a couple times, then straightened up and walked out with the other family members. I will stop and see how they are doing tomorrow. (The mother also had a cast on her left arm, which is new since last week. I'll have to get the story on that another day.) I feel bad about the fact she was in hospital and I didn't know, especially because she was literally in the bed next to Rosie last week and I didn't even notice. I also never checked up on her after the day hospital trip, which I'm embarrassed about.

We had a good visit with Rosie, though. she got to hold and play with her baby (now 16 months old) and talk with Amanda and Nokubonga. Nokubonga also trimmed her fingernails and rubbed some cream on her feet. After about a half-hour we left and I took everyone back home.

Up, up, up with Rosie; crash-dive with the other woman; up, up, up again with Rosie. I think I prefer Wild Thing - at least you know it ends.

Personal Space: A Privilege

I am not an overly warm and cuddly guy. One of the things I treasure is a sense of personal space. The unwritten rule in Minnesota (at least with everyone I know) is that everyone has a 3-foot buffer around their body at all times. You have to be invited into that space, and to breach it uninvited is just wrong. I clearly believe in that rule and follow it as often as I can. Clearly, though, people in the townships have never heard of that rule and I've had to adjust.

I'm not sure if it's cultural or a result of the living conditions; probably both. But, it's the norm to pack many people, without complaint, into what we would consider small spaces. Seven in a car, two on a chair, four around a desk, it's all an everyday event.

Privacy is also very different. Most township residents do not expect the level of privacy we're accustomed to in the U.S. I've mentioned before that people living in shacks and hostels do their bathing and dressing (and other things) within plain sight of other family members. At the clinic, people crowd around as they get their prescriptions, and everyone can see and hear what the other person's getting. I've even had women come into the men's room at the Centre when their stalls are full. They come in fast, so as not to embarrass anyone (them or me), but they come just the same. They'll even go into the stall in pairs. (I know women visit restrooms in groups, but that seems a little much to me.) It's just not a problem.

I had an experience in the extremes of personal space and privacy when I went to visit Rosie in the hospital this weekend. (By the way, I found out her real first name is Nokuzola. She is Sotho, from somewhere in the Free State.) She is in GF Jooste, the main hospital for Guguletu and all the surrounding areas. Jooste has four wards, each holding about 50-60 people. Two are for men and two for women, one each for surgical cases and one for medical cases. The wards are big rooms with partitions that divide them into 6- or 8-bed cubicles. The beds in the cubicles are about 3-4 feet apart, with only a curtain to separate them. The curtains are kept open so the nurses and aides can get a sense of what's happening.

As you can imagine, there is little to no privacy in Jooste. Even when there is an "emergency" going on, most everyone knows what's happening. It's worse during visiting hours - there must have been 20 visitors in Rosie's cubicle today, all standing around beds trying to have conversations. A group was holding a prayer service for a patient one cubicle over, but it may have been next door. It's hard not to see what's happening, from the woman eating ice cream to the one with the backless gown sitting without a cover on. Or the woman who just got sick all over her bed.

I also had another "white person privilege" experience. When I went to see Rosie yesterday it was because her daughter called me to come. Apparently Rosie had had enough and wanted to go home. She was also under the assumption that she needed to have an operation, because her doctor had told her she needed to go to Groote Schuur Hospital, the teaching hospital in Cape Town, for a consultation. I said my hellos to her family and spent a little time talking with her. I noticed her chart sitting on the bedside table, so I started to read it to see what was happening. I didn't get very far before the nursing sister told me that I wasn't allowed to do that, that only a doctor or nurse (her) could read the chart. I told her that I was a pharmacist at Brown's Farm Clinic and was trying to help Rosie understand what was happening. She said she or the doctor would come back and help me. And she said it 2-3 more times over the next 20 minutes.

Now, doctors don't round at Jooste on weekends. The only doctors in the hospital are interns who cover emergencies and new admissions. The intern on duty happened to be at the next bed helping a woman who was having an asthma attack. After he got that resolved, he did take some time to speak with me and we got everything sorted out (more on that in a minute). You had to be there, but I'm convinced if I wasn't a white guy, and probably a white American, that I wouldn't have seen anybody yesterday. I would have been brushed aside and had to have waited until Monday. I say that because no one had talked to Rosie's family at all, even though they had raised the same concerns. That's just wrong.

After a barrage of tests, it appears Rosie has tuberculosis (TB) and a bad pneumonia (PCP). She started on TB drugs last week and will be on them for at least 6 months. She also has TB in her abdomen (which is fairly common) and this has been the cause of her stomach problems. In addition, she has bad peripheral neuropathy, which is where the nerves in the feet (and sometimes the hands) get damaged resulting in numbness and pain. The TB drugs can cause the neuropathy, but she's had it for several weeks. So, that's why she's going to Groote Schuur, to go to the neurology clinic. She doesn't need an operation, and should be going home fairly soon. That's good, because she's not sleeping or eating well in the hospital.

In closing, let me also say I had one of my most difficult days on Thursday after I heard about the bridge collapse. It took me a little while to realize it, but I felt like I did on 9/11. I didn't directly know anyone affected by the disaster, but I knew that I wanted to be there to support those who were affected. It was especially hard because people here either didn't know about it or didn't make any connection between Minneapolis and me. I didn't have anyone to talk about it with, especially in the morning when I read Cindy's e-mail about it (because of the time difference). I now have a better sense of what real isolation means, even though I'm closely surrounded. My thoughts are with everyone there.

More to come.

Week in Review

(No fancy title for this posting, mostly because I'm not feeling too creative today.)

It's been another good week. Or, to put in Minnesota terms, it was interesting.

Last Saturday I attended part of a youth camp for kids living in Guguletu. It was put on by the Multi-Talent Group, a non-profit started by two men, Nceba and Zolile, in Guguletu. They started their organization to give kids something to do besides walk the streets and get into trouble. Every Friday afternoon they have a open stage at the Sports Complex, so kids can come and dance, rap, do poetry, or whatever they want to perform. Their "shows" last 5 or 6 hours and attract a few hundred kids every week.

The camp was held at a Rotary campground about 20 minutes away. The 65 kids stayed for 2 days and 2 nights, living 4 to a room in small dorms. The agenda was a mix of lectures and play. Nceba and Zolile lined up speakers on drugs, crime, and self-improvement who did a great job engaging the kids in discussion. The play time was divided into outdoor activities and dance classes (Zolile is a DJ, and he has many friends who are semi-pro dancers). By all accounts it was a very successful event and all of the kids enjoyed themselves.

I got to attend because I paid for their food. It seemed like a small thing to do to give these kids a diversion from normal township life. During lunch I had a really stimulating talk with 3 of the adults about tribalism in South Africa and how it's still interfering with unity amongst the Blacks. Most people probably think that South Africa's problems are primarily a Black and White problem. After listening to these men, it sounds like it's also a Black and Black problem. It seems that every week I hear of a new cog that needs alignment in order to move the big machine forward. That's why it will be at least 2 generations before this country really starts humming.

Two other cogs are accountability and social responsibility. I read an article in the newspaper yesterday that the garbage in portions of Phillipi (where my clinic is) has not been picked up for 6 months. It seems that the government forgot to award the tender and no one bothered to get the job done. They have moved on it recently, and now there's a fight amongst 3 vendors about who has the best community connections. People living in the township have thrown rocks at some workers of certain companies because they don't like the company (not politically connected or not Black-owned). The mayor is threatening to bring in Army personnel to protect the workers from the citizenry. I've seen the trash, and I cannot believe how people can prevent its collection. It's a real health hazard, especially with the recent rainfalls, but some people don't seem to care or understand.

Wednesday evening I spent 5 hours in the KTC Day Hospital, an urgent care of sorts in Guguletu. It was one of the most disgusting places I've been to. The process started when I walked into the Centre at 4:15 after painting with my GLA students. Two women from the HIV support group were waiting there for Zach to help them take another support group member to the clinic. They asked if I had time to take them, and I said sure, thinking it was a quick trip. The woman, Notozama, had been sick for many days and was feeling very weak. She got infected with HIV in late 2006. According to her mother, up to then she was a very beautiful, dynamic woman with a good job. After she got infected her boyfriend "disappeared" and she started to wither away. She stopped eating and just slept all day. When I saw her, she looked to be about 90 pounds, if that. She could barely walk to the car, and every step came with a grunt of pain. We got to the day hospital at about 4:45. They didn't think it would take very long, and there was some hope she'd be admitted to hospital, so I hung around to give them a ride back home or to the hospital.

She was finally taken to a room at about 6:00. Half an hour later, she was taken for a chest x-ray. (As soon as I saw that I thought of TB. About half of all HIV-positive people here also have TB, and it can cause wasting similar to HIV.) Her mother came from work about this time and went back to sit with her. Then, about 7:30, her mother said the doctor was going to give her a drip (an IV), but only a pint so it wouldn't take very long. So, more waiting.

During this time I saw people of all ages come in for treatment. There was the man with the bloody leg (either a fracture or a knife wound), the woman with a head wound (she either fell or got something thrown at her), the man with the stab wound in his back (who proceeded to bleed all over one of the benches), and two kids with head wounds from falling down. There was also a woman with a cold, a woman having bad abdominal pains, and other run-of-the-mill urgent care stuff. The odd thing was that everyone was talking to everyone else, almost like they knew each other. I don't recall seeing that in any other ER I've been to. People generally keep to themselves and don't share their life stories. Not here.

At one point Notozama's mother asked me to sit with her, because she was saying she wanted to leave. I went back and spent a little time, convincing her that she needed the drip and that it would be over soon. As she dozed in and out I had the chance to look around. What a contrast to Brown's Farm Clinic. Our clinic is nearly brand new and very well maintained. The day hospital had seen better days. The gurney Notozama was laying on had dried blood in the grooves between its parts. There were blood drops in the walls, alongside the dirt and mud stains (I imagine someone had kicked mud off their shoes at one point and it never got cleaned up). The storage lockers for the IVs and supplies were a mess. There is little privacy, with 3 beds to a room and no curtains between them. I guess it's better than nothing, though, which is what much of rural South Africa has.

We finally left the clinic at about 10:30. Notozama was scheduled to go to the TB clinic the following morning to get started on TB medications. Once that's stabilized, which will take 2-3 months, then she'll start on HIV medications. Hopefully, these will allow her to get her appetite and energy back so she can start living again.

Yesterday was the last day for the GLA program. We got a lot of painting done, more than I expected. We finished about 90% of the outside and all of the inside, save two small offices. They had a fair amount of time to interact with the local kids, playing games and just giving hugs. They also spent two afternoons this week with the after-school program, helping kids read and do homework. It was a really great experience for me, to see some of our future leaders in action. One other nice thing: During their class presentation about their experiences they voted me one of the top 100 people in the world. That made me feel good. I'm attending their closing dinner tonight, which should be fun.

Off to work now. More to come.

My Jinxed Friday

As I was eating breakfast this morning (Captain Crunch! thanks to a care package from my nephews), I was thinking about how uneventful the week was. I should have known that was a great way to make today full of adventures.

It started innocently enough. I got to the office at 8:30, the usual opening time for the Centre. I had a cup of tea and caught up on overnight e-mails. Wednesday was the monthly food parcel day, and we had a few extra bags, so I decided to take one over to Rosie and her family. Rosie is the woman who had no bed that I wrote about a few weeks ago. She and her three kids stay with her sister and her family in New Crossroads, about a 5-minute drive from the Centre.

Rosie has HIV, diagnosed when her last child was born a couple years ago. Her CD4 counts are high, so she should be in good shape. However, she's been struggling with a GI bug for the past month and has had really bad problem the past couple weeks. I had taken her to clinic on the 16th when she was very weak and unable to eat. The nurse gave her an IV with some multivitamins, and the doctor order some medications and special food (porridge and milk powder) to help renourish her. I thought that would take care of the problem.

When I stopped today, I didn't get but one foot in her room before she started crying and asked to be taken to hospital. Not only has her diarrhea not gotten better, now she was unable to control her other functions. She hadn't eaten in over 5 days and looked very emaciated. She's also very concerned about how much of a burden she is to her sister and her family. I told her sister that I would check on what had to be done in order to get her in the hospital. So, I drove to the clinic and spoke with one of the nurses about what to do. In order to be admitted to hospital, people must be referred from their primary care clinic (like Brown's Farm). So, back to Rosie's house to bundle her up and bring her in.

Her sister got her ready to go, not an easy process when you're so weak you can hardly sit up. She also couldn't walk today, a combination of the weakness and some nerve problems in her feet. Fortunately, her sister's partner was at home so he helped me carry-walk her to the car. Of course, just as we got to the door it started to rain. I gave Rosie to her sister and went out to move the car closer. We eventually got her into the back seat and away we went.

I waited while the doctor saw her, just in case she was not going to hospital and had to be taken home. The doctor agreed to send her, so they called for an ambulance (not that it was an emergency, it's just how they do the transport). I gave her my cell number and R20 (no such thing as a free call in hospitals here) in case she needed anything and I left. I stopped at her house on my way back to the Centre to tell everyone what was happening and leave my cell number. So far, no calls, but I don't expect the weekend to pass without some word on what's happening. My guess at this point is that she has hepatitis, which is surprisingly uncommon here. We'll see what develops.

One 5-minute job that only took 2 hours. Not the first time that's happened and probably not the last, either.

I got back to the Centre in time to catch the tail end of a planning session with Edwin and Yvonne about blankets. Yesterday, I learned that politicians CAN be trusted. When the Deputy President was at JL Zwane in May, she said she was working on a blanket collection program with some women golf pros in September. But, she said, she knew that they would be needed in July and August, so she was going to try and get them to us earlier than originally planned. I'll be darned if 37 assorted blankets didn't arrive yesterday afternoon, delivered by 4 of her staffers. She also sent over 3 boxes of bath towels (about 36 in all) and a dozen warm-up suits for kids. They couldn't have come at a better time - the prediction for the weekend is for an emerging cold front with highs only around 55 F. It's also been very, very windy and rainy for the past 2 days and that's supposed to continue through tomorrow. So, I told Edwin yesterday that we had to get these blankets out today, and that's what he and Yvonne were discussing.

Yvonne made a list of about 12 kids who needed blankets and we arrange to start delivering them after lunch. Before that happened, I had a women come to see me who I had not met before. She said she need some money for food, that she and her children had nothing and were really struggling. I gave her some money and she went away happy. (My name is getting out there as someone who can help people, and I'll occasionally get a visitor who needs a "loan." I've bought shoes for someone, paid for a bus ticket to job training, and paid for another ticket for someone to see family in the Eastern Cape. I figure if they had enough courage to approach me, then I should have the grace to help. I don't expect to get these monies back, but someone wants to repay me I'll gladly accept it.)

Now that we ate, Yvonne and I were on our way. I had thought that these deliveries would take a hour or so. Silly me. I should know by now that working with Yvonne has it's own timetable and it takes as long as it takes (not that that's bad, you just have to be flexible). The upside is I got to see some new places and a whole lot more of Guguletu.

We picked up Nomokwezi, a woman who works in Nyanga and helps Yvonne with the child-headed household program. We went to the regulars, like Noloyiso and Shepherd, to drop blankets and a couple food parcels. It's always good to see these kids, and I see them regularly enough that they will talk to me. Noloyiso's house was broken into a couple weeks ago and she lost her electric kettle, iron, and a sandwich maker. I need to see if I can help replace them.

We went to a house where a woman started a center for mentally disabled kids. She had one of her own and couldn't find anyone to take care of her, so she quit her job and started taking in other similar kids. She now has 14 in her house and gets no government assistance, relaying on the kindness of strangers and the few parents who still look in on their kids. She had 7 cribs in a space the size of my living room at home, and I could only guess where the other kids slept. Some kids had blankets and bedding, some didn't. The food and blankets we brought will be very appreciated.

Just down the street, we stopped at a foster care home with 7 children to drop some blankets and towels. There was a (God-awful) aroma of tripe boiling on the stove, and it took me a minute to realize that it wasn't a dead mouse or something. The kids in this house are well cared for and seem very happy, which is not always the case with foster care here. Some people do it just for the support checks and the kids are not looked after.

We stopped at the home of our head custodian, Noboniso, to drop a prescription from the clinic. She lives in New Crossroads, in a shack behind a house. Normally this would be okay, except that her plot is at a low point and she had about 8 inches of water in her "front yard" (the driveway). I asked if she had water in the house and she said yes, and that it would take about 2 days to dry out. Sadly, those 2 days won't start until Monday, and the problem will be a whole lot worse by then. There were two guys bailing water from the yard and pouring it down a storm sewer. I think if you look up futility in the dictionary, a picture of them will be next to the definition.

We dropped some blankets and warm-up suits at a hostel called WJM (not the station from Mary Tyler Moore's show). The hostels are not for backpackers, they are where families were originally moved to when resettlements took place under apartheid. The hostel unit contains a shared common room (usually used as an eating area) and 4-6 "apartments" where people live and sleep. Families used to share rooms in the old days, but now one family has a room to themselves. Of course, this doesn't normally mean 2-3 people, it means more like 6-12. The family we saw today had 11 in their room - a grandmother, her daughter, her daughter's children, and a couple cousins who lost their parents from HIV within the past 2 years. This is not unusual, although this is one of the largest families I've seen in one room. Because there's usually only one bed, people end up sleeping on floors and any furniture that might be around. Again, blankets will definitely help keep the chill away.

I got back to the Centre about 4:15, after dropping Yvonne and Nomokwezi at the corner to catch a taxi. I spent a few minutes with Edwin about some staff problems, and then went home. None of my task list items got done today, except the one that says "help someone today." Gold star for that one.

Off the topic a bit, here are some things from this week that I won't forget anytime soon:
1. Watching 5 cows, yes real cows, walk side-by-side down a road in the middle of Phillipi, the township where I work. Their front-right hooves were tied to their necks so they couldn't run away. Like they wanted to. The ambled along not caring about the taxis honking or cars trying to pass. They (and the goats that you see even more often) are owned by locals, and no one ever tries to mess with the animals. They are usually allowed to roam free, although they spend most of their time in fields. Seeing them in the shack areas is unusual and it made a good visual.
2. Driving to clinic on Wednesday and seeing a baby funeral happening in someone's front yard. Wednesday was the only sunny day this week, and it was probably warmer outside than inside. There were about 6 men in suits on one side of the small yard, a little pink casket on a bench in the middle, and 8 women sitting on the other side. Someone was preaching as I drove by, and I can probably guess at what he was saying.
3. Fulfilling a promise to a boy at Stormont Madebela school to buy him a new pair of shoes and seeing his face when he got them. This boy had shoes with no soles on them. He needed to wear shoes to school so he had no choice but to wear them. At least the new ones will keep his feet dry. Unfortunately, now that he has the shoes he's hitting me up for a sweater, slacks, and shirt too. And, don't forget socks.
4. Driving to the school for more painting and getting nice waves and thumbs-up signs. I was worried after the water debacle of last week that I wouldn't be welcomed back. But, everything seems to be forgotten now. The kids were back to play just like before. If I could just get them to understand not to touch the wet paint, life would be perfect.

More to come.

Funny, But Sad Story

I got this story via e-mail from someone at the Centre. I'm glad there are pictures to support it.

ISANDO/KEMPTON PARK - R25 & M39 (Tembisa Interchange) on 21 July 2007 at 10h00

Photos: ER24, Werner Vermaak

It was a free for all when a fuel tanker overturned in the R25 Interchange near Tembisa this morning. [Tembisa is outside of Johannesburg in Gauteng Province]

At approximately 10h00, emergency services received an emergency call for a fuel tanker that overturned and is leaking fuel. Paramedics that arrived on the scene found an extremely hazardous situation.

A fuel tanker, believed to carry almost 38 000 litres of fuel overturned on the on-ramp of the R25 towards Tembisa. The driver of the tanker was the only person that was injured and there were no other vehicles involved. He was transported to the Aarwyp Hospital by the Ekurhuleni Emergency Services.

A different site quickly developed on this highly explosive and flammable scene. Pedestrians and commuters from everywhere ran towards the overturned tanker to get their share of the "free" fuel. Literally hundreds of people stopped alongside the highway and on top of the bridge to collect fuel. Some of them used anything from a can, beer bottle, buckets and water bottles to collect fuel.

Some of the fuel collectors were so arrogant on scene that they demanded a share in the fuel and started fighting amongst each other. It is amazing to see how quickly people can get buckets and other fluid holding devices on scene. Some children were running down the on-ramp to get fuel.

The situation got worse when the "fuel collectors" started having a casual chat on the scene and lighting cigarettes. The commuters and pedestrians quickly outnumbered emergency services. The police was called in and arrived quickly on the scene.

Fire Fighters had no choice, but to use extreme action to disperse the crowd in order to continue with cleaning up operations and prevent more fuel escaping into storm-water drains. A fire hose was directed at the "fuel collectors" and opened with full force.

People were running and screaming in all directions, up the embankment and up the on-ramp. The crowd got angry that they were not allowed to collect the "free" fuel and started throwing rocks at the fire services. A quick turn of the fire hose at the rock throwers were no match, as the fire department quickly scored in their favour. The powerful water stream swept them off their feet straight into the arms of the police. The police managed to cordoned off the area, it is not certain if anyone was arrested on the scene.

Fire fighters used all means possible to contain the spillage and closed off the complete intersection as it holds a high safety risk.

Every now and again when a passerby tried to gain access to a leaking manhole on the truck, his urge for free fuel was quickly washed away with a fire hose.

Werner Vermaak
Public Information / Scene Safety Officer
ER24 EMS