Hambani kahle (Go Well)

August 25th. It's a time for farewells and the start of new travels.

It's a beautiful morning in Durban as we pack up our possessions and all of our new purchases and head out on new adventures. Inge and Meredith are headed off to the Durban airport, where they will have a short flight to Joberg then the 17.5 hour flight back to DC. One more short flight will find them safely back in Boston where they can settle in and re acclimate to life in the USA.

Candice and myself are off for another fun week of sightseeing. We will be picked up by bus and taken to Underburg at the foot of the Drakensburg Moutains. We will spend some days there hiking in the mountains and taking in the beauty of this area. We will take a day trip to the Sani Pass, which will take us into the landlocked country of Lesoto. After our time here we are heading to Victoria Falls (via Joberg) for a few more days. After this, I will be heading state-side and Candice will meet up with her boyfriend, Thomas, and continue the adventure for a few more weeks.

Last night the four of us girls were able to sit down together, enjoy a meal and reflect on our experiences here in South Africa. We were all moved by the graciousness of the people we met, we were educated by the various organizations we worked with and we were amazed at the community focused approach by South Africans to help the vulnerable members of their society. We will take away from this experience all the of the friendships made and memories shared. We hope you enjoyed following us on this journey as much as we enjoyed experiencing it.

Visits to NGO's ( non-governmental organizations)

Monday, August 23rd was a treat in that we were picked up at 11:00 AM. After a run of early morning departures, this later morning pick-up allowed us to get on with some other activities including banking. Joslyn Walker, Communications Manager of NOAH (Nurturing Orphans of AIDS for Humanity) kindly picked us up to take us to their facility near Phoenix (a sub-division on the outskirts of Durban). There we met various colleagues who were looking after children of various ages. Their population of children has grown during the day with the teachers' strike and no school. The little ones with whom we interacted were three to five or six years old. As it happened, we ended up giving the children attention through play and then helping with the noon lunch. I think we were of help in giving the children some attention and providing help to the staff. The mission of NOAH is " Empowering communitites to care for their vulnerable children". Although they are currently providing food and care, they are rethinking their approach of providing direct care to one of facilitating such care. There are a number of such centers and the central staff work to making the centers independent of NOAH so that NOAH can help establish groups in other communities with vulvnerable children. The visit to Noah was made possible by Karen Krakowitzer,the CEO of NOAH, whom I met at the International AIDS Conference in Vienna

Tuesday, August 24th began with a pick-up by Zodwa Sithole, the Advocacy Manager of the Hospice Palliative Care Association of South Africa who took us to Highway Hopsice. It was good to see Zodwa again. When we arrived at Highway Hospice, we were greeted by Karen Hinton, a nurse and an old friend from prior visits to Highway Hospice. I never cease to be amazed at how forward thinking the group at Highway Hospice is. We have so much to learn from them. Therafter Moosa, a nurse with Highway Hospice, took us to two facilities with whom Highway Hospice collaborates to various degrees. The first clinic was at a space at which Highway Hospice may establish a satellite clinic. At the second facility, we saw care being provided for orphans, and seriously ill people without caregivers. Both of the latter two facilities were in financially empoverished areas.

A lot of the discussion on both days was on the impact of the teachers and nurses' strike on those who are ill and needing care as well as on the school children. The effect on patients has been a dire impact in some cases. We heard of incubators being smashed after the babies had been transferred to other hospitals. We have not witnessed such events but in private converstaions, newspapers, and TV, the big news is the strike. It's a far cry from the national jubilation that was described for the time of the World Cup.
Hopefully, all will be resolved soon so that nurses have an appropriate salary and patients receive their care.

Inge

Safari Day 2

We were up again at 5:30 the next morning. After a quick coffee we climbed back into the van to head to Hluhluwea Game Reserve. Upon entering the park we immediately saw giraffe, rhino, zebra and more impala. We spent the morning driving slowly around the park in search of the big 5 (rhino, leopard, lion, elephant and water buffalo), with breaks for breakfast in the bush and coffee at Hilltop Cafe. On top of plenty more zebra sightings, we also spotted water buffalo and a fresh kill (less than 24 hours old). Adrian explained that it must have been a lion's kill to take down such a large animal (it was a water buffalo).

After another light lunch from the kitchen on wheels we headed out of the park, still excited from our multiple wildlife sightings. On the way home we stopped at Ilala Weavers, where we enjoyed browsing the textiles and crafts made by the locals.

When we arrived back in Durban, tired from our excursion, we were spoiled yet again. Jenny and Costa invited us up for some soup and sandwiches. It was the perfect post safari meal and end to another incredible weekend.

Safari Day 1

Woke up at 5:30 for a 6:45 pick up to start our safari! We were met by Adrian and Mark of Mygration Safari and headed out on a three and a half hour drive to our first destination, St. Lucia. Were were so delighted to discover that we were the only group scheduled for this Safari, which meant we got the entire 10 passenger luxury vehicle to ourselves! We each were able to enjoy the South African country side through the giant picture windows that lined the bus. Adrian was our tour guide, and the owner of the company, and supplied us with fun facts about all the places we encountered as we headed out on the drive to St. Lucia and then onto Bonamanzi.

We made a stop in St. Lucia so that we could have the chance to see some lazy hippos before continuing onto our camp site. We arrived at Bonamanzi and had some great photo ops with the crocodiles, who were awaiting their lunch. It was amazing to see the crocodiles up close. Afterwards we continued down the road to our camp site for a quick lunch prepared by, Mark, Adrian's brother. We were amazed by the trailer hitch which was essentially a kitchen on wheels, equipped with an oven, freezer, dishware and refrigerator. We were very spoiled and enjoyed a great lunch before going to a Zulu village to learn more about their culture. The Bonamanzi park is unique in that it has no predators in it, enabling the animals living inside to flourish. We saw many impala, nyala and red daikars.

Afterwards we headed back to the campsite where Mark was cooking a leg of lamb on an open fire. We helped set up our tents and sat around the campfire enjoying conversation with our safari tour guides. When it was time to head to bed, we each had our own unique tent. The 'cot tents' as they are called are two person tents that are raised about a foot and a half off the ground. They unfold quite easily (we think, they were set up for us :) ) and being set off the ground made for a comfortable nights sleep.

St. Apollinaris Clinic Day

Friday morning! Last day at St. Apolinaris hospital. We got to the hospital around 8am. Inge went to meet Dr. Bhengu who ran the ARV clinic on site, Candice and Meredith went back to pediatrics and Jill went back to high care.

Candice and Meredith were excited to return to the children they had grown so fond of. They were able to give baths and play with the children. With more time this morning they were also able to focus more on the children they knew were orphans or had no visitors.

Jill spent another busy day in high care. A newly diagnosed HIV/TB patient was being transferred into the unit. She had developed Steven Johnson syndrome, an adverse side effect to one of the medications she was taking. This syndrome causes the skin to slough off, an excruciatingly painful side effect. This girl was only 15 and was very I'll. It was interesting to see the admission process and how a new and critical patient was handled.

We were able to be on the floors until about noon, then we had to meet to head back down to Durban (all were a bit sad to leave the B&B and Bruce). We had only been away for 2.5 days but if felt like much longer. We stopped on our way home for a pit stop at Mugg and Beans, a local restaurant that is famous for their large muffins and bottomless cups of coffee (all of you Americans who have traveled internationally and had to pay for refills will appreciate this!).

We arrived back in Durban and got ourselves ready for our big weekend... A real African Safari!!

Outreach Clinic at Donnybrook

Today was a great day. We started back at the hospital where Meredith and Candice spent some time observing in the Pediatric ward and Jill spent some time in the High Care ward, which is similar to an ICU in the States. The pediatric unit was crowded with sick children and some parents there as well. They have a burn unit where four children were. Three of the four children were awaiting transfer to Edendale Hospital for skin grafts, however, due to the impact of the strike at Edendale and surrounding areas, they have been unable to transfer the children and were not sure when they would be able to. They played with the children who could and just provided some human touch to others who were orphaned. They were both moved by the time they spent with the children.

Jill was on a High Care ward that had the sickest patients in the hospital. It was interesting to compare this ward to a high care ward at home, seeing that this ward had no telemetry monitoring system, didn't have oxygen set up at every bedside and didn't even have IV pumps. What they did have was a dedicated staff that worked hard to care for their patients.

After spending time here, we took off with our new friends, Mr. Zuma and Cresentia and set out for a different outreach clinic, this one a little closer at Donnybrook. Today was cold and rainy and the clinic site was in an old building on the grounds of a Catholic monastery. This clinic was less established than the previous one, and we were collected vital signs and weights for over 53 clients. We started to pick up some Zulu (nearly every patient is only Zulu speaking) and had fun trying to speak with the clients. We were again amazed with the relationships Mr. Zuma had made with these clients and watched as he brought a quiet room to life with his charismatic personality. After a long day seeing patients and distributing medication we headed back to the B&B.

After a cold and rainy day we were elated to see a fire burning strong. We changed into warmer clothes, made some tea and settled by the fire to discuss the day. Then we were treated to another amazing dinner, put on by the B&B staff. We went to sleep excited for our final day in Creighton.

Jill

Starting Our Mountain Adventure

We woke up at 4:30 am on Wednesday for an early drive to Edendale Hospital, where we would be meeting with Joy and taking off to Creighton, a rural area in the mountains. As we arrived at the hospital, we realized that the government strike, which includes nurses, had finally reached the gates of Edendale. The access road we use to drive up to the hospital had two burning tires on it. We waited until the flames went down before driving up to the gates and gaining access to the grounds. By the time we met up with Joy and the iTeache team, there was a small group of peaceful protestors outside the hospital grounds. We made it out of the grounds without incident and started our two hour trek up to Creighton. "The girls" slept for most of the trip but Inge informed us it was a beautiful drive; switchbacking up the mountains, overlooking tiny housing settlements and the wide variety of livestock that lined the roads. We stayed at a small, yet peaceful bed and breakfast that suited us all nicely. We all felt right at home in the cozy cottage complete with a large dining room table, a warm fireplace and our very own (and very large) mascot Fabio. Fabio was a large mastiff that we instantly nicknamed Bruce. He followed us around and slobbered all over us, but never took to his new name.

After settling in we headed about a half hour through the mountains to St. Apollinaris Hospital. We got a tour of the various wards (male, female and peds) and stopped to talk with one of the medical doctors, who was impressed with our desire to learn from this hospital, but encouraged us not only to take something away, but to leave some knowledge behind.
Joy then brought us to meet Mr. Zuma and Cresentia, the two team members we would be traveling with to our first ARV outreach clinic. Mr. Zuma is a professional nurse, and we have learned that the treatment of HIV in Africa is becoming more nurse driven because there is such a shortage of doctors. Mr. Zuma was the perfect example of how this approach can work.
The people in this area live across great distances. It is difficult for them to travel the many miles to the hospital to get the ARV and TB treatment they need, so Mr. Zuma and Cresentia take the clinic to them. They are very efficient, bringing all the files and drugs packaged together in alphabetical order. We saw about 50 clients that day. Each one was weighed and had their vital signs taken and their pills counted (to ensure adherence) then came in to meet with Zuma. He was so wonderful with his clients. He was kind and warm, yet full of life and energy. The clients responded so well to him. We learned that he has been doing this for two years and has built great relationships with all of his clients. Mr. Zuma then interviewed them to make sure they were healthy and were not experiencing any side effects of the medications. He would take blood if it was needed (every six months), give them their medications and send them on their way. We all really enjoyed today, meeting this wonderful man and seeing how he works so hard to bring HIV treatment to the people of this rural area.

After we finished and packed up the clinic we headed back to the bed and breakfast, where a lovely meal awaited us. We realized we were not the only guests staying there and enjoyed a delicious dinner with our new friends.

The Girls

Edendale

On Monday we arrived in Edendale early and were greeted by Joy Van der Plank who works with a program called iTeach. iTeach is a nonprofit organization that trains nonmedical personnel to screen potential TB and HIV+ patients on the wards. If a patient tests positve the iTeach "warriors," as they are called, guide the patients through their clinical workup. In the morning we attended the iTeach weekly morning meeting, where each warrior shared statistics of the previous week's patients. After that we had a tour of two medical units that treat TB patients, including the isolation rooms. On these wards the sickest patients were closest to the nurses station. We had the opportunity to meet with nurse managers and discuss various medical topics from HIV to diabetes to TB. We compared and contrasted practices in South Africa and the United States.

After the morning, we headed back to the iTeach office where Joy invited nurses from around the hospital, including student nurses to attend an hour long diabetes lecture given by our own Jillian Baker. It was interesting to hear about the obstacles diabetic patients face in managing their disease. Many are unable to do daily finger sticks because the equipment is too expensive. We tried to share practical tips for managing diabetes in such situations. We ended the day by attending a session on the updated South African guidelines for ARV treatment at the TB clinic. The most significant aspect was that D4T will no longer be used as a primary ARV medication, unless the patient was previously taking it without complication. We then boarded back into our van for the hour long trip back to Durban, making sure to take in the beautiful countryside.

Tuesday we traveled back to Edendale to visit the Edendale College of Nursing. We were warmly welcomed by the principal of the college, Clementine, as well as the faculty. After meeting the faculty and learning about their respective curriculum, we headed over to the auditorium packed with faculty and students to engage in a panel discussion about nursing training programs in South Africa and the US. We were taken aback by the greeting they provided us with. About 20 first year students stood up on stage and sang a traditional Zulu gospel song. It was incredibly beautiful. We have attached it so that hopefully you can enjoy it as much as we did, but no video could do their performance justice. The president of their student organization prepared a detailed description of the nursing program from a student perspective for us. Afterwards Jill, Meredith and Candice described our curriculum at the MGH IHP and talked a little about nursing programs in general in the US. We also fielded any questions they had. It provided for a very interesting discussion regarding the difficulties nursing students in South Africa face. Examples include, the patient load they take on because of short staffing, lack of equipment and resources and the acuity of patients they see as novice nursing students. We ended the day with a tour of the campus. The campus is beautiful and we left feeling fortunate for how much access to technology and resources we have in the US.

Sunday Tour with Costa and family

Sunday we spent the day touring Durban with our host family. Costa took us to see some original art deco architecture around town followed by a trip to the Durban Botanical Gardens. At the gardens we caught site of some young monkeys running around the trees and some interesting plant life including a Canonball tree. Afterwards we headed outside of Durban to see the Albert Luthuli Homestead. Albert Luthuli was an African leader against the apartheid and the first African to win the Nobel Peace Prize. We also learned that while he was under house arrest, he was forbidden to leave the grounds. When Robert F. Kennedy was visiting South Africa, he requested a meeting with Albert Luthuli and was declined due to the provisions of his house arrest. RFK therefore took a small helicopter and landed at the Luthuli homestead on a small patch of land to obtain his meeting after all.

After leaving the Luthuli homestead we headed over to Gateway Mall, which resembles a Mall of America in that there is a water park and other activities to be had other than shopping. Later in the afternoon some of us went to the UShaka Marine World on the waterfront. There we saw sharks, stingrays, and a dangerous reptile exhibit. We headed home for an early night to get some rest before starting our busy week in Edendale.

Meredith

Exploring Durban in the Weekend

Finally got a chance to sleep in even though it was only until 8am. Inge took us to the Flea Market, where we were able to browse through local arts and crafts. After a couple purchases were made we headed to the Durban waterfront, where we got to see the soccer stadium used during the 2010 FIFA World Cup and more purchases were made. We took the Sky Carrt to the top of the stadium where we were able to get a 360 degree view of downtown Durban and the Indian ocean. After that we attempted to walk the 9K beach front, but ran out of time. We opted for a quick swim in the Indian ocean. After our swim we headed back to Musgrave and made a delicious Mexican dinner and called it a night.

The girls

Friday Night Fun in Durban!

Friday night we met up with our new friend, Emily, who we met when we toured McCord Hospital earlier in the week. We discussed nursing school with Emily over a glass of wine, as she is interested in the MGH IHP. She and her boyfriend, Simon, took us to the waterfront where we got drinks at Moyo, which is a bar built on one of the piers along the beach. Hundreds of fishermen lined the beach sporting head lamps and fishing in the Indian ocean. It provided the perfect backdrop of Durban lit up at night. Afterwards we ventured over to Florida Street, which is lined with several restaurants and trees that remain colorfully decorated from the World Cup. We ate at an Indian restaurant and tried the local Indian staple, Bunny Chow. The history of Bunny Chow dates back to the apartheid, when Indian workers needed a way of transporting their lunches as they went to work each day. A loaf of bread was hollowed out and filled with curry seasoned meat or vegetables and then topped off with the remanents of the bread. After dinner we headed back to our apartment near Musgrave.

August13, 2010- Mission Accomplished

I know you have been waiting with baited breath to learn whether we were able to secure the 100 participants for the research that was our goal. Wait no longer-we did! I think we all found it an interesting experience and not that different from our work at the Boston Living Center, Lynda, other than patients saw us prior to and after seeing their health care providers. We have again taken pictures of signs and people (with their permission) that we thought you might find of interest. Even the Zulu speakers among the research participants knew a little English, so that once the study has been explained to them in Zulu, and informed consent obtained, we were able to be of help. Failing that, Innocent and Busi were avaiable in the two data collection sites. Fortunately these sites were in the same hospital so we were able to scurry back and forth when additional resources of any sort were needed.
After thanking the managers for allowing us to collect data, we took one last picture of the S.A. research team ( at least most of us) then Busi drove back so that we could see some of the informal housing settlements. There are far fewer of these than I've seem on previous visits. The government's efforts to replace these tin roofed dwellings with something a bit more substantial is evident in the more secure houses.
Thereafter, the week-end was spent getting to know the Durban environment a bit better- sometimes the 4 of us and someimes just the girls. Arrangements continue to be adjusted and I needed to work on a two hour lecture which I will be delivering this next week, as well as some one hour lectures. "The girls" will each be giving a lecture as well. It should be interesting. More about the weekend shortly. Lastly, we so appreciate your comments and good cheer. Thank you to all and especially, President Bellack, Provost Johnson, and Prof. Lynda. Inge

another exciting day

This morning we returned to St. Mary's to continue the peripheral neuropathy research. The goal for the week is to complete 100 surveys. After only completing 13 surveys yesterday, we were nervous we would not find enough participants to finish. But this morning was a different story. After a busy morning, we managed to bring our total up to 61 surveys completed. We are very excited at the prospect of completing the 100 surveys tomorrow.

Tonight we had two visitors from hospice organizations here in South Africa. We prepared an elaborate meal complete with appetizers and dessert and it was well worth it. Zodwa Sithole from the Hospice Palliative Care Association of South Africa and Sue Boucher from the International Children's Palliative Care Network were nice enough to spend a few hours with us sharing their experiences and giving us insight into palliative care both in South Africa and internationally. Their passion for the work they do was inspiring. And they prepared us for another great opportunity here in South Africa. Zodwa not only offered to organize a trip for us to accompany nurses on home-care visits, she insisted on it. As it looks we will be visiting Highway Hospice on the last day of our trip. The people here have been so gracious. I think they really want us to see as much as possible and have a good understanding of health care in South Africa.

I have included pictures of St. Mary's, of us preparing for dinner and of Innocent. Innocent has been so helpful and kind. He has an amazing way of connecting with patients and putting them at ease that has been wonderful to watch. Learning experiences are coming in all forms for us here!!!

Candice

Research

Today marked our third day in Durban and the official beginning to the work we had set out to accomplish As part of our trip to Durban, we had promised two of our professors at the IHP that we would help distribute surveys regarding peripheral neuropathy to clients in South Africa living with HIV/AIDS. We were picked up at our apartment by Busi Ncama, who is a colleague, a professor of nursing at KZN and a co-investigator in the research project. We have talked so much of our friends Busi Bhengu and Busi Ncama. We have attached a picture of Busi Ncama next to her car (complete with vanity plates!) She drove us to St. Mary's Hospital where we took a short tour before beginning our work. This hospital housed a variety of health clinics such as a TB clinic, an HIV clinic and a hospice clinic. We settled in with the help of Busi and one Zulu interpreter, Innocent who helped us communicate with the patients and obtain the data necessary. While assisting with data collection, Inge saw an interesting sign and wanted to share it with you.

After completing some surveys, we headed over to McCord Hospital for a tour of the facility and to speak with Tamryan, a researcher working on prevention of mother-child transmission. She was a lovely person and a wealth of knowledge regarding the history of HIV in South Africa, problems with treatment and medication shortages and the other quality of life issues that people living with HIV/AIDS deal with. After a wonderful and informative chat, we toured the hospital. This setting was quite different from yesterdays visit to Albert Luthuli Central Hospital. McCord was smaller and not as technologically advanced. We toured five wards, the female medical unity, the male medical unit, labor and delivery/nursery, surgical/ortho, and the emergency department. The wards were large rooms with 6 beds each, separated by curtains. There was an isolation room with two beds set up for patients with TB. Although McCord Hospital wasn't as large and glamorous as Luthuli, the quality of care was exceptional and the patients were well cared for. McCord Hospital has a special tie to this group, as Inge had spent a great deal of time there while conducting research a few years ago. We were able to meet with some of her old friends on our tour, including a nursing administrator and an MD.

We walked back to our apartment and stopped at Woolworth in the mall to get supplies for dinner. I have vague memories of being a kid and having a Woolworths in the center of my city, but I though they had all gone out of business. Well believe me, Woolworth's is thriving in South Africa!

That's it for tonight! Tomorrow we have another informative day ahead of us. Its back to St. Marys for more data collection then we are having a special guest back at our apartment for dinner. Tune in tomorrow to hear all about it!

Jill