Thursday, January 8, 2009

South Africa: Update on Escapades

In Robin's own words . . .

So, yesterday was quite exciting. Mo and I woke early in the morning to fetch the train. We have a 40 min walk to the train station from her house. There are rules to getting on the train - always ride first class, get on a carriage with other people (never get on alone), keep your eyes open in the train station and you will be safe. We arrived in Cape Town 1.5 hrs later. We had a minute to sit and drink a cup of coffee/water before we went to interview the director of health. He was a very generous man and had two nurses who work with mentoring in the city sit with us in the conversation. This made for a good contact for Mo for the future and they were very interested in my study. From there we went to see the cape region. It is beautiful - a working harbor. We ate a sandwich and then headed to the Nelson Mandela museum - if you have time you can ride a ferry to Robben Island where he was imprisoned. We had to leave to fetch the train home. After we arrived home, I interviewed a physician in the country who has worked in quality assurance for HIV/STD program in the northern part of the country. She was very nice. I am finding a pattern to my interviews as I speak with individuals from different agencies.

Today, I was to take the train to Cape Town and then to Masi clinic in Fish Hoek on my own - a long ride alone. I felt ok about doing it. I knew the rules. That is when the rules all changed. I only saw one other man taking first class. I got on the same carriage as him but then he changed. I did not know what to do. I stepped out to tell the guard outside of the train and that quick the doors closed and the train took off. She kept scolding me, "Why did you get off the train". Somehow the train managed to stop, the guard quickly opened the door, and there I was thrown into third class - you see there is no second class. All eyes were on me. I apologized to all of the eyes for holding up the train and found a seat beside of a woman. It was a long ride to Cape Town, but I managed fine. It is interesting. In second class, between stops a beggar will get on the train - an individual who is physically disabled and walk the car looking for coins - as I placed a coin in the can of the first man, the man across from me looked at me disapprovingly. No beggars come to first class and yet these are the individuals with more resources (lower middle class). There are no padded seats in third class only hard metal benches that line each side of the carriage. I was the only white person in the whole carriage. Only lower middle class and poor take the train to Cape Town. To Fish Hoek, young adults and teens who were well dressed boarded the train as we got closer to the beach, some of them with surf boards. Also, a guard accompanied us part of the way. I was sitting first class on this trip. The whole ordeal took me 4 hrs just to get to the clinic.

The clinic lies in a semi-formal settlement. There are a few cement structures placed by the government and tin and stick structures are built around these. There is running water and some kind of sewage system. Thousands of people live in a very small area. It is hard to imagine. The patients were very gracious. I was sad to hear that the NP that I was working with will be leaving the clinic at the end of the month. She is very good but over worked and worn out. The individuals on ARV treatment are doing very well. The children and adults all look healthy. The side of effects of the treatment are evident in those who have been on treatment for some time. The treatments used are ones that work effectively but have greater side effects than the ones we now use in the US.

I had a ride home from a travel company "The Backpackers" - It took 45 mins! However the trip on the train was 15 Rand and the trip home was 300 Rand (one rand is approximately 10 cents in US money, so $1.50 as opposed to $30)! I took Mo out to dinner as today is her birthday. We had a feast and a lovely walk to the town and back. I have walked more miles since I arrived here than I did in all of 2008! My stamina is increasing - however, my feet have blisters from a poor choice of shoes one day.

Will be heading to the northern cape on Sunday and more interveiws with nurses and public health workers. Then back to Cape Town for a final interview and then home to the US. Woohoo! Love to all of you. Keep up the prayers. God is truly with me. Sleeping is getting better.

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