The Drive Back to Pretoria

I made it back to Pretoria. I woke up early enough to make it back in one day. It was a nice 15 hours to jam to home-made cds and sit in my own thoughts (Highly recommended by the way).

One thing I kept thinking about was how familiar this place was. For the first half of the drive I kept thinking that I had been here before and completely chalked it up to the fact that I had made a very similar drive, slightly different route, but very similar when Will and I drove down almost two weeks ago. But about half-way through the drive I started thinking my familiarity with this country was a lot deeper than one drive two weeks ago.

The grand conclusion for the drive was that this place is America all over again. Sounds crazy but that is what I have decided. Cape Town is like San Francisco, Johannesburg is Detroit. The people are obsessed with sports, almost as obsessed with sports as they are with TV. We call ourselves the melting pot bu there they have 11 national languages. They all speak English but make fun of eachother for their different accents. They have a government run by a black majority, which all the white people think is corrupt, like Memphis. Fruit grows down around the coast (California), and for hundreds of miles in the middle of the country all you see is cows and corn (Nebraska).

The only differences I could think of are that they all sing a lot better than any of us, they say howzit instead of whatzup (both equally indifferent to the response), and they drive on the left side of the road...which was contantly on my mind Thursday. That's about it.

Maybe we aren't so special over in America after all. But you still gotta love the good old Red White and Blue. There is no place like it (I recognize the contradiction). I'm coming home tomorrow. Flight leaves at 8:20 pm South African time, 1:20 pm Memphis time. I'm really ready. It has been a great experince, and Will and I learned a ton, but I'm ready to be home. Love to talk about the trip with you so just ask, or call, or make a lunch appointment.

This won't be the last post. I plan on reading back through my journal and trying to summarize some stuff, so stay tuned for a long one.

Paarl

Look it up on the globe, Paarl is this little town about 45 minutes from Cape Town. It is really beautiful (this area is probably the most scenic place I have ever been), and it is where I have been for the last 3 days, there and Stellenbosch. There is a group out here that has a bunch of clinics in this rural part of South Africa, so I have been in and out of some clinics out here and helping with different projects with these folks.

Dr. Nelis Grobbelaar runs and organizes a lot of the clinics out here and I have been in his back pocket for three days. He has been wonderful to me: incredibly welcoming, genuinely encouraging, and just nice to be around. He has been picking my American brain for the last couple of day trying to understand us, learn from us. He is 45 years old, he doesn't know me, why in the world would he give a rip aobut my opinion or perspective? But he did. Like he wanted to know what the American dream was, and what my American dream. He wanted to know about generation differences and the effects of internet and connectivity and social networking on our society. These were fascinating conversations to be having with a South African Dr. It was wonderful, made me feel great, and I think I learned as much from how he treated me as I did from how he treated patients or clinics or HIV.

On the other hand, he does have a lot of neat ideas about HIV treatment. He is on the forefront of moving clinics to nurse-initiated treatment, electronic medical records, and general HIV treatment. Because of the huge numbers of the epedemic, they are putting in place new ways to distribute drugs, keep track of patients, and break down some of the things that hinder treatment. He sees so much more to the problems than the physiology difficulties of the disease which in my experience is incredibly rare for a doctor.

There has been much more to this last chapter of the HIV tour (like Shoots and ladders baord game with an HIV twist, flipping through charts to collect clinical data, and chatting with the technology assistant guy who manages the electronic medical records system), but that is enough for tonight. Internet in Paarl is expensive.

Tomorrow I am back on the road headed toward Pretoria. Stopping tomorrow night in Kimberly... I think. It is just a long uneventful day of driving through the Karroo. Should be back in Pretoria Friday night and flying out of this deal on Sunday night. It is wrapping up in a hurry.

Entropy

Physical law of nature--in a given system, molecules tend to decrease in the degree of "order" or entropy in the system. It takes a net input of energy into the system to maintain or increase the order of the system.

For example, if you put a carving (highly ordered object) in a sealed jar, give it enough time and that jar will just have dirt (much less ordering of molecules) in it.

On Saturday I hiked up Lion's Head, a small hill/mountain in Cape Town. It was a gorgeous hike, beautiful weather, great day. On the hike however, you can't help but notice all the boulders and rocks that have rolled off the top of the mountain and lie at the base and all along the way to the top. The other thing I noticed is that the trail is really well built, and someone has hauled these wire baskets or cages filled with rocks (their are kinda like portable brick walls) up the trail and placed them in different places on the trail to prevent erosion. They support and hold the dirt and other rocks on the mountain. If they weren't there the trail would have washed out long ago.

It is the law of entropy in action. The mountain tends toward disorder. It's tendency is to end up as a little pile of sand blown around by the wind as those huge boulders crumble and get smaller and smaller. Here is the deal though. Someone has put in energy into this system. Someone carried those rock baskets all the way up the mountain. You can't drive up there. There is no lift or anything. Someone carried them up or built them on the trial. Someone put a heck of a lot of energy into that system. I could hardly carry myself up there, much less a couple hundred pounds of rocks. And the whole deal, energy input deal, is simply to keep the mountain like it is, to prevent it from eroding, not even to make it bigger or better or something.

There is another place I have seen the idea of entropy at work, AIDS. The whole deal with HIV/AIDS is just a way that society demonstrates it's tendency toward disorder. You leave society alone and don't put any energy into keeping it going and it breaks down. If you don't treat and educate and work and think and love and care and pour into a community it will become increasingly disordered. It is costing 48 billion dollars and thousands of working hours on the part of tons of people just to keep the HIV prevalence at 12%. Take away all that "energy" and it is going to 50%.

Application: let's step it up and put in energy into the system, not suck the system dry to make our lives fluffier. There is only so long a system, a society, can handle its inhabitants living like parasites, using people and situations, and resources for whatever they can get out of them. We can live in a way that gives people confidence and value and courage and knowledge instead of mining people for those things and keeping it to ourselves. We can increase the order in people and in the system instead of destroying the order.

Sorry for rambling. Just some recent thoughts. More to come.

Little Moments in the Hostel

So I am living in a youth hostel called Cape Town Backpackers. Tonight is my last night here.

Ok I need to tell this story to give a little glimpse of life around the hostel. Living in a hostel is kinda like living in a college dorm room with a bunch more people in closer quarters, and then add a full bar on the hall. It is truly a combustable setting.

Last night (Friday night) I got back from Khayelitsha, got dinner, journaled and read for a while, and went to bed around 11. Between 10:30 pm and 2:30 pm is the quietest time of the night around here as everyone is finished with their drinking in the hostel and are out on the town, so at 11 pm there last night there was no one in the room and I fell asleep really quickly.

The tough part of the night was when the crew stumbled back in. My 5 roomates didn't make it back until around 4:30 am. I was more than a little frustrated at them for rousting me, but I rolled back over and tried to get back to sleep. Just as I was dozing back off I heard a huge crash and the sound of bare skin slapping the polished brick floor. I looked down to see one of the two Argentinans rolling around on the floor having fallen out of his top bunk bed. He hit really hard.

Call me a bad guy but I deeply enjoyed laughing at this guy for a couple of minutes as he rolled around on the floor in pain. The Argentinans have kinda been on my bad side because since they first got here they periodically douse the entire room with AXE spray deoderant (aweful), and after all, he did wake me up from a great sleep. I did eventually check to make sure he was ok. He didn't really acknowledge me but seemed to shake off the tumble, and after lying on the floor for a good little while, he managed to summon the courage to attempt the climb back up to his top bunk, more succesfully on the second try.

It is those little moments that stick with you ya know.

Training of Coaches Wrap Up

Today was the last day of coaches training at the Football for Hope Center in Khayelitsha. It really turned out to be a great experience as we were confronted with so many tough issues surrounding HIV and attempting to prevent it in a place like this. I have so many thoughts from the week.

The thought or summation or idea that keeps coming back to me this week is the way in which AIDS feeds off so many inequalities and injustices. Gender inequality is the most apparent. That is the incredible degree to which girls are less educated, 100% financially dependent, completely socially subservient, and devoid of voice presents quite a difficult challenge to prevention.

Poverty presents a unique challenge. You see HIV/AIDS is not urgent. It takes years to really set in, even without treatment. Hunger is urgent. Shelter is now. Safety is now. For a woman, having a man to provide for her 7 children in paramount. AIDS is the last thing on so many of these people's minds. If people don't have anything to live for why would they care about HIV?

Racial inequality destroys prevention efforts. It does so by destroying leadership. South Africa existed for such an incredibly long time under Apartheid, recial inequality that makes segregation seem lame. African people down here grew up with no vote, no voice, no social mobility. No one understands that they can make a difference. The African community is devoid of initiative, motivation, hope, dreams, confidence, etc. There is no leadership, not in townships like Khayelitsha. So when an organization like GRS goes to get people from the community to train them and pay them to implement and cook-book, ready-made AIDS prevention curriculum, they can't find anyone, not many. The last two days the trainees have been doing "teach-backs" where they basically practice presenting a lesson to their peers for evaluation and training purposes. Quite honestly these two days have been pretty discouraging because although it seems they have received excellent training, very few (maybe 5 out of 20) seem to have been able to succesfully present the curriculum. I am not talking about being great, dynamic teachers, I am merely talking about tying together ideas in a coherent way to deliver a basic message about HIV/AIDS. These trainees are awesome. They are great people. Truly. They just have incredibly low confidence, self-esteem, and they one by one got up to practice talking in front of a group struggled. It was tough to watch.

I don't want to sound too tough on these guys. I think they will get there and GRS continues to work with them and develop them. They will go with experienced coaches for a while to sort of learn the methods in more of an apprenticeship fashion. But the repercussions of inequality and repression are so apparent.

While all that inequality is depressing in a lot of ways, and the challenges facing AIDS continue to seem overbearing and impossible. However, I really noticed something today that was exciting. Although this AIDS prevention stuff my have no hope whatsoever, it may decades before the epedemic is in any way manageable, the problem is a wonderful excuse to deal with some of these deeper issues. Like GRS may not succeed in making this group into effective implementors of their prevention curriculum, but every day this week those people heard over and over again that they were valuable, that they matter, that they can change people's behavior, that they can influence a child's life. They were told and shown that what women say has equal weight to what men say. They were given a cause to increasingly be knowledgable about and have tools to contribute to the battle. They were given 2 meals and 10-20 Rand a day (about $1.50). Way more than the roughly 80% unemployed in Khayelitsha. And next week they will be placed in schools and communities where they will have the ability to present that same sort of justice to 40-80 kids a day. Pretty cool. So what if we can't beat AIDS. Maybe AIDS is exactly what Khayelitsha needs (obviously there would be a lot of people who disagree with that last statement). It is worth thinking about.

Culture...What is the answer???

3rd day in Khayelitsha sitting in on the training of coaches to do AIDS prevention education.

It was a really tough day in a lot of ways, but it was also an incredible day in terms of what we experienced first hand. Today we were apart of a couple of group discussions (the group of "coaches" consists of 20 young adults from poor, urban backgrounds). In these discussions the topic of sexual practices and condom use were discussed with incredible frankness and honesty. It was certainly the most realistic and open look at the culture in South Africa and the cultural difficulties that underly the AIDS epedemic here. We weren't reading about this stuff from a book or hearing some white, American academic talk about. We were seeing it in real life. We were watching people talk about this stuff and revealing their own personal history and experience. In many ways it was really exciting to be there for these conversations. However the truth that these discussion revealed was deeply disheartening.

The honesty about the prevalence of people having multiple sexual partners was unbelievable. These people mostly come from the Xhsoa ("click"osa) culture which for centuries has practiced polygamy. The president of the country before the current president had multiple wives. Under that culture it is completely common for a man to have multiple (as many as possible) sexual partners, whether married to them or not. That is how men think and that is what even the women expect.

We had a conversation with the head instructors during one of the break and they said that the idea that kids will abstain from sex and wait for a mutually faithful partner/marriage is an absolute "pipe-dream" and isn't a legitimate education stance for an prevention organization that wants to actually make an impact in South Africa. Wow!

On top of that, there was incredible honesty about the infrequency of the use of protection. In the heat of the moment, these people admitted to rarely using protection. For an hour the group went back and forth about why and gave many different reasons. They were telling personal stories and admitting to the frequency of unprottected intercours. Another Wow!

So how do you do prevention?? The two halmarks of prevention (abstainance and protection) seem to be absolutely useless here, if not useless they face a long, uphill road until they actally have an impact on AIDS prevalence and incidence.
We have our own thougths but very few answers.

AIDS is a beast. It is incredible how it strikes at the heart and thrives on these deeply entrenched cultural values. We have mentioned it before but it is so much more than a medical disease. It is a social disease, it is a cultural disease. How do we defeat that?

The typical Amerian solution, that is for the most part true about how our nation is handling this problem in South Africa, is to sit from a distance and throw our money this way and hope for the best and pat ourselves on the back for our noble "altruism," but, as was said today by one of the South Africans, the people of the world who are trying to help need to come and actually see what is happening in South Africa and understand all sides to the HIV/AIDS epidemic problem. More is needed than just a supply of ARV's. These people need role models, and cultural alternatives. How do you change a social norm by throwing money at a culture? It won't happen. There is something deeper at work here than a simple medical disease? We are at a loss for how the epidemic can be stopped with the existing social norms. Something has to change in the minds and culture of this people. How to bring this change about seems beyond anyone at this point in time, but there are multitudes of people here who care and are trying.

Despite all this negativity, we had a great day and learned a ton. We really felt included by the group and we participated in all the activities of the day, and the group listened to our input on the different discussion that took place. We also go to just sit and listen to some really powerful, open discussions that really brought the roots of this HIV epidemic to light.

Update and Thoughts

Last weekend was tourist weekend: Table Mountain, Cape Point and the Cape of Good Hope on Sunday. Neat stuff.

This week we are back at GrassRoots Soccer in Khayelitsha. They are training a group of about 20 young adults to present/teach/use their curriculum for HIV/AIDS education and prevention. Interesting in a lot of ways. They do an incredible job of modeling in the training sessions how they want their trainees to teach the kids. Without even knowing almost, the trainees are being taught with the same methods that that are going to use to teach the high school kids (not sure if that makes sense). But you can see how effective a method that is at training these people who have never been teachers to teach in a week. The training works not by telling these guys how they are supposed to teach but by showing them. After they get through this week of training they will have spent 9-5 in the kind of classroom environment that they are supposed to create when they go to schools and communities. Interesting to see in action.

One thing that is discouraging to me however is that the only tool AIDS prevention seems to have is condoms. That is all the education curriculum is based on getting awareness out there about what HIV/AIDS is and how it is spread and then getting people to use condoms. Some of these classes are taught to 12 year olds and they are going to hear the message: "you are probably going to have multiple partners so make sure you always use condoms." It is like culture is too tough of a beast to tame so all we can do is tell them to use condoms. What about someone saying you can sacrifice your little petty desires short term and wait until you find someone you are willing to serve unselfishly for your entire life. And when you do that it is awesome and difficult yes, but so worth it and emotionally fulfilling etc. etc oh and by the way you won't get AIDS either. But culture is too tough of a beast so we give up, give up on 12-year-olds. Seems sad to me. I think they can be different. Maybe I'm naive.

Sorry if that was a little more than you bargained for.

Off to more prevention education sessions and making posters and flip charts. We are getting really artsy.

The Top of the Bottom of the World

Saturday we hiked Table Mountain. Awesome. We aren't hikers and don't have much to compare it to, but it was a decently tough hike. It wasn't that long (2hours) but it was very steep. They had a really well built trail so it was safe but steep.

The coolest thing about it is this mountain is right in the middle of the city. You get to the top and have just and amazing of erverything around you. It was pretty neat.

That night we went to the waterfront and ate dinner and watched the local professional rugby match in this huge outdoor amphitheatre. There were probably 300 South Africans there too, and they were really into the game because it was like the semi finals or something. Neat cultural experience. They take that stuff seriously, and it was fun to be there. It was a really fun game to watch as well.

Kayelitsha...the slum

Today we went to the Township of Kayelitsha. It was probably the toughest slum we have been in. In Cape Town it was a beautiful, clear, blue-sky day, but on the drive in, there was this aweful fog that seemed to hover over the slum and nowhere else. Kayelitsha is in the lowlands, the Cape Flats, surrounding the gorgeous costal Cape Town and the juxtaposition of these two extremes of wealth and poverty, beauty and darkness is truly incredible. If you think the wall between Chickasaw Gardnes and Binghampton is significant, this place makes Memphis look egalitarian. We were with an organization called Grass Roots Soccer, which is using Soccer to do HIV/AIDS prevention in many communities throughout Africa. They are really gearing up for a lot of programs as the World Cup approaches. We sat in on the beginning of a "coaches" training sesssion in which GRS broght in members of the communities, primarly Kayelitsha and began to train them in their AIDS prevention curriculum and program. There is a lot more to it, but I won't get into the specifics of the GRS program and curriculum.

What was most apparent was the way AIDS affects communities more than idividuals and even nations. You could see in this training session the value of community. The "coaches in training" were just every-day people from the community who were essentially unemployed (the unemployment rate here is unbelievable and these people were very smart and motivated, many had a college degree or some education after high school). What was neat about the group is that you could tell AIDS had impacted almost all of them in a very significant way. They came together because they all hated this evil of AIDS and wanted to stop it. They wanted to prevent it spreading and destroying more lives, homes, families, and communities. It was a really neat experience. Most of the training was in Xhosa, pronounced (click) O sah, so it was difficult to follow, but you could just see and feel the group comming together in order to beat this disease that is so destructive.

One of the most clear things we have learned down here is that AIDS is a social disease as much or more than it is a medical disease. It is hard to wrap our heads around when we come from a world of Western "medical miracles" where science and medicine can figure it all out and conquer everything. However, it seems so clear that AIDS will not be defeated until the people, the communities, decide they have had enough. I am not sure there is a miracle cure. The cure seems to be resolve and determination. Until people decide to change the culture and the norms and the perspective on AIDS it will continue to spread and nothing scientists or doctors can do to stop it.

You might be in Africa if....

7) The government makes a point to put up signs telling you not to feed the baboons.

8) You eat dinner and get offered the filet of Ostrich special.

9) You can see the Indian Ocean and the Atlantic Ocea at the same time. (We drove down to the southern most tip of Africa on our way to Cape Town (Cape Agulhas). This is where these two oceans meet...Awesome. We'll show you pictures when we get back, just ask.

10) You are at an internet cafe and you set both of your backpacks down at your feet and one of them grows legs and walks away without a sound. (Yea we are down a backpack. It had some really valuable stuff in there. Oh well, just stuff. It also had our camera cord, so no more blog pictures, we're sorry!)

The Indian Ocean

We went swimming in this thing this morning. Kinda cold but really awesome. Huge waves and most of ya'll know how much we love the waves! They dominated us. Makes you feel small. It makes you feel pretty silly and powerless, yet we put ourselves on the same level as the Guy who made all of this and rolls those waves in one after another, all day and all night. Just a thought.

It was certainly an experience.

We are off to Cape Town now.

Lodging Night 2

Roadtrip Day 2 continued...

Roadtrip day 2

Sunset...

Night 1 Lodging

Roadtrip day 1

The Last 5 Days

It has been a while since we updated the blog so I am going to take a minute to give a quick run-down of the last few days.

First, Friday night was an amazing night. After some hard days in the clinics where things seemed pretty dismal, we went to a Concert outside of Johannesburg where the Soweto Gospel Choir performed. These guys have won two Grammy's and they are incredible. We were on the third row and it was truly amazing. It was a small crowd in a church and everyone got so into the music. Very much a community feel of joy and hope and excitement. The most unbelievable contrast ever to the hopeless, sad clinics of the previous two days, and the difference was the Gospel. Truly the joy these people had in singing about Jesus in 5 different languages was unbelievable and incredibly unifying. It was something you could feel in the room as people increasingly stood up, moved to the sides and started dancing to the music. Really neat experience.

Saturday was a pretty uneventful day. Kinda like a Saturday in America. We did spend a lot of time learning to drive a manual transmission truck which was fun and certainly worthwhile.

Sunday we went to Goenkloof (sp?) nature reserve. It is in Pretoria and it has Jeep trails and all kinds of African animals: giraffe, impala, water buffalo, ostrich, zebra. It was neat. That was pretty much Sunday.

Monday we officially decided that we were headed to Cape Town for our next PEPFAR work so we spent the day preparing for the trip. Mall, maps, looking up lodging, and other stuff like that. Our hosts helped us out greatly with that process.

And Tuesday morning we were off on the road to Cape Town (the left side of the road). It is a long trek down there, 14oo km (you can look up how many miles that is but this trip has convinced us of the value of the metric system). On Tuesday we went as far as Colesberg where we stayed at a really neat Dutch-style Bed and Breakfast called Kuilfontein. It was really neat except for the driveway where we got a flat tire when we hit a rock on the mile-long dirt road into the B&B. Bummer, but we got it changed and got a new tire in Coles=berg this morning and it didn't set us back.

Today was a great day on the road. We went from Colesberg to Graaf-Reinet, a small French/Dutch town that was beautiful. Then we moved on to Port Elizabeth on the East Coast. From there we drove around the coast to Wilderness which is a small tourist destination between the towns of Knysna and George. It was an unbelievable drive. Beautiful landscape and scenery. We passed the highest bungy jumping platform in the world and although it was tempting we decided not to try it. Although we did have to pause on the bridge the bunjy jumping was staged from over a beautiful river gorge that emptied into the Indian Ocean. Really amazing. We took pictures throughout the drive, but they really don't do the scenery justice.

Tomorrow we are finishing the drive to Cape Town where we will be for the next week and hoping to get back involved with some more PEPFAR work.

Stay tuned for more pictures.....

Hope is not lost!

It is very true that there is a lot of hopelessness that surrounds AIDS prevention in South Africa. The numbers are astounding, and at times it seems like it is an unconquerable task. If the only goal in all our efforts to beat this epidemic are in curing the country of HIV/AIDS then there really seems to be no hope. There is no way to rid this world of evils, people will always be sick, and for the forseeable future HIV will always exist in South Africa to some degree. But there is hope in what we can accomplish. The ARV drugs that have been provided through the ART program really do amazing things. There have been patients who have had to be carried into the clinic with such severe HIV that they are on the verge of death, and after a mere 5 days on ARVs they are walking around in decent health and able to live a pretty normal lifestyle. There is potential to really helpe a whole lot of people with these drugs and a potential to give very sick patients a normal life. Since the beginning of the ART program that started about 5 years ago huge numbers of patients have been treated. Right now almost a million people are on the ART program. A million people! Yes a lot of these patients do not adhere to their prescribed ARV regimen and don't see the desired results, but think of the number of lives that have been changed. It is true that many the public health workers have lost passion and hope in fighting HIV, but there are so many people excited about helping and people who are really passionate about their work fighting HIV. There will always be room for improvement and ways to improve the system, but the hope has to come from the perspective that so much has been accomplished. If you think of all that hasn't been accomplished or think about all the flaws in the system it's true that there really seems to be no hope. Hopefully support for this cause will continue because there really is potential to make huge strides against this epidemic that is tearing apart an entire country. People cannot and must not lose hope!

Where is the hope?

Yesterday, we experienced arguably the worst symptom of AIDS--hopelessness. You could see it in the patients' faces. Even scarier you could see it in the health care providers' faces. It has got to be one of the cruelest diseases there is, not because of what it does to your body, but because of what it does to your soul. It never goes away, and always spreads. Yes there are amazing drugs that treat HIV/AIDS but nothing cures it. Nothing gets rid of it. Most of these patients have been coming to this clinic, waiting in the overcrowded double-wide trailer for hours, and getting grilled by healthcare professionals on taking their medicine, improving their lifestyle habits, and coming back here next time, every two months since the clinic opened roughly in 2005, and they know they must keep doing that until they die. There is no end. There is no victory. There is no hope. AIDS attacks the most intimate of relationships as well. The HIV positive husband explaining himself to his HIV negative wife. The HIV positive mother explaining herself to her HIV positive son who wants to know why they have to see the doctor and take these pills all the time.

And the health care professionals can't win either. They first start working, excited to take on one of the most difficult epedemics in the history of modern medicine, and by now they have nothing left. They have seen no progress, there is more AIDS than can be treated, and they see newly infected patients every day. Best estimates are that 1 out of 10 people in South Africa are infected with HIV. But there are population groups, like Letlhabile, where closer to 1 out of 2 people have AIDS, 50%. Unbelievable! Where is the hope in that? So the doctors and clinic managers just show up, punch the time clock, and get through the day, trying to emotionally engage with the circumstances as little as possible so they can have some sort of normal life when they get back home. For these people it is just a job, and they don't care if things aren't run smoothly, or if patient files are incomprehensible, or if there are 50 people sittimg in the grass outside the clinic for 3 hours before they are seen. They don't care because at this point they can't care.

Letlhabile

The setting for today's adventure was the rural township of Letlhabile in the North West Province of South Africa. This place was much different from yesterday's township of Laudium, which is considered a more wealthy township. Letlhabile was marked with crowds of shacks made from thrown together sheet metal built on what amounted to big patches of dirt. While Laudium is in the Guinness Book of World Records for having the most Mercedes in a small community, a common mode of transportation in Letlhabile was a donkey cart. Our job today was to continue working to get this clinic completely on the SOZO patient management sytem, as up to date it was way behind with only about 400 hundred of the 4,000 patients on the system After about an hour and fifteen minute drive from the FPD headquarters, we arrived at the Letlhabile clinic to the sight of swarms of patients packing themselves into this small rural clinic. There was a pervading sense of hopelessness that seemed evident at the clinic amongst both the patients and the clinic staff. The space and the manpower of this clinic just didn't seem to have that capacity to handle these huge numbers of sick patients. It gave us a really good sense of the magnitude of this AIDS epidemic that has been tearing apart the country of South Africa for years. Anyways... shortly after arriving on the site our team hit a speed bump when the facilities manager of the clinic stopped us and asked us what we were doing there, having no idea who we were. After an hour or more of discussion, we finally got the go ahead to start working. From here on, despite a brief lunch break at the local KFC, our day consisted of searching through piles of patient files to find the information needed to enter these patients into the SOZO system. Necessary data included things such as a patients name and address, the date of his first visit, the date he started ARV treatement, and his baseline CD4 counts and HIV viral loads. The work was tedious and much of the time very frustrating. Ineffieciency seemed to be the word of the day. These files were just piles of scattered medical information that were thrown, on a good day, into big file cabinets. After several hours of work, our team of 7 was only able to piece together 70 patient files! For solid work to be done at clinics like Letlhabile and for treatment of over 4,000 patients to be successfully carried out organization is paramount. We seemed to agree that thse clinics are in desperate need of a motivated, intelligent clinic manager, whose job is to be availabe on site at all times to manage all aspects of patient treatment. The number of people capable of this type of postion seems to be in short supply around South Africa, so these organizations make do with the resources they do have.



All complaints aside we had a great day, and we really learned a lot about the treatment that goes on at these clinics. As we flipped through mounds of treatment records, we could really see first-hand how the system of treating large numbers of patients with HIV using ARV's works. After a day of hard work we are looking forward to a day off tomorrow, and we are excited about what new opportunites await us.

You might be in Africa if.......

4) You eat lunch at KFC (the largest fast food franchise in the country) and 4 out of 5 co-workers don't know what KFC stands for.

5) During said lunch you get asked to try some cow stomach. KFC is expanding their menu.

6) Everyone speaks English but no one understands your accent.

Laudium -- Where the journey began

As was said previously, today we learned a lot about public health, and that happened at the FPD clinic in the Laudium township. The day started out sitting in on an upper level management meeting at FPD headquarters in Pretoria where we got to see public health management in action. Basically the FPD presents a case to USAID, who funds their operations on the ground, to demonstrate what they are doing to effectively improve the HIV/AIDS treatment, and how the funds they are receiving are being used effectively. The topic of the day today was SOZO. As was explained in the previoius blog, SOZO is an electronic patient management system, that is an attempt by the FPD to move away from the existing paper based system and move to a more organized, user friendly electronic system that compiles data in a format that is actually usable. After the meeting we travelled with an FPD employee, Sive, to the clinic at Laudium. This was a very busy clinic that sees roughly 2,000 patients a month that is already completely on the SOZO system, so the task of the morning was to learn how to use SOZO. Sive, gave us a crash course in how to enter patient data into the system. It was interesting to see the system in action, and it became apparent very quickly why the electronic system was so much more efficient than the old paper-based system, the trick is just to convince clinics to put the effort into making the switch. Although SOZO is probably not the end all be all of patient management, and there are definitely improvements that could be made, it is a huge step in the right direction. Tomorrow we're looking forward to being put to work on a different FPD clinic that hasn't made the switch to SOZO to implement the system there. The second part of the morning was dedicated more to the treatment side of the clinic. We sat in with the one doctor at the clinic who saw all the HIV patients passing through the clinic. Her workload was amazing. Throughout the whole morning there were 50 plus patients in the hall waiting to be seen at all times, and apparently she sees roughly 200 patients a day. It was intresting to see the treatment methods that she used to tackle the huge patient load, and it seemed that the focus seemed less on careful individual care to each patient, and more on getting as many patients through the door and on an ARV regimen as possible. This is inconsistent with what we're used to in America, but the sheer number of HIV+ people here makes such an approach a necessity. As I said, we had a great day, and we really learned a lot. We look forward to getting put to work tomorrow. Until next time...

Let's define some Africa AIDS relief buzz words

One of the things we have been doing the last couple of days is just getting a feel for the system down here, figuring out who does what and how do they do it. So we thought we would take a minute to describe some of the major players in the AIDS relief effort in Africa. We are certainly not the official authority on these things, but these definitions represent our impressions after a couple of days of this stuff.

1) PEPFAR: (President's Emergency Plan for AIDS Relief). This is the name of the money that drives everything down here. It started under W. Bush as a 5-year $15 billion grant. Obama expanded the grant 5 more years and increased the commitment to $48 billion to treat AIDS, Malaria, and Tuberculosis globally. http://www.pepfar.gov/about/index

2) USAID: This is the name of the organization of people that run several of US aid grants around the world. Win Brown, who we are staying with, is employed by USAID and works in the Southern Africa branch. It is essentially the people behind the money.
http://www.usaid.gov/locations/sub-saharan_africa/countries/rcsa

3) Partners: These are the NGO's (non-government organizations) that implement the AIDS relief plan. That is USAID people pay "partners" with PEPFAR money to actually do the education, prevention, diagnosis, and treatment. Clinical partners are the people that USAID pays to run clinics. For what it is worth, the general consensus out here seems to be that the PEPFAR dollar is the easiest money you could ever make, so if the recession is hitting you hard, move out here and give it a try. However, after seeing the weight of the AIDS problem and the incredible of numbers of people that the government pays to treat, I tend to think the government is necessary despite the inefficiency.

4) FPD (Foundations for Personal Development): The largest clinical partner in South Africa. They manage roughly 87,000 patients, 10% of the 870,000 patients treated under PEPFAR in South Africa. We went into a FPD clinic today in a township called Laudium (Loe-dee-um). Incredible experience.

5) ARV's: Anti-retroviral drugs. These are miracle pills. They seem like they literally bring people back from the dead in 5 days. They are the basic form of AIDS treatment right now. Pretty incredible stuff. They allow people who would otherwise die in months to live relatively normal lives (minus taking pills every night).Truly amazing stuff.

6) SOZO: I don't know what this stands for. It is an electronic medical records system that FPD is implementing in all their clinics. It is not EMR in to the fullest extent; there are still patient charts in paper form. It is an extremely ambitious attempt to electronically track the progress of every patient treated by FPD and the intent is for SOZO to be expanded nationally to be implemented in every PEPFAR clinic. We were trained on how to enter patient data today and will be working on that all day tomorrow.

There is no way you didn't learn something new if you read this far. Isn't that a great feeling!
We are learing so much out here and enjoying every second of it. Today was one of those days where the world just got bigger, and our view of the capabilities of public health got 92 times bigger. Awesome stuff.

Apartheid Museum

This afternoon Randi took us to the Apartheid museum in Johannesburg. Apartheid is the Africaner word for separation, and it refers to the period from 1948-1990 when a white, Africans minority ruled the country and oppressed the African natives. It was in many was similar to our Segregation in the U.S., except more violence and more hatred and more upheval. The museum was truly incredible. What stood out to me the most was the unbelievable capacity of people for cruelty, violence, and hatred on the one hand and the equally incredible capacity of people for forgiveness, resilience, peace, and determination.

We are who we choose to be in many ways. In small ways, every choice we make can promote justice, peace, forgiveness and hope or dehumanization, hatred, violence, and injustice. We choose every day.

Quote from some jet lag reading:
"And to expose our hearts to truth and consistently refuse or neglect to obey the impulses it arouses is to stymie the motions of life within us and, if persisted in, to grieve the Holy Spirit into silence." A.W. Tozer.

That we would first see what is True, and then do something about it.

You might be in Africa if........

1) You live in a house with a talking parrot. Yes it is true, his name is RayRay (pictured left), and we get the privilege of hearing from him every morning bright and early around 6am. As soon as that cover comes off the cage he is chirping, or more like speaking jibberish, better than any travel alarm clock you can buy.

2) Your house has iron grates over every window, doorway, or entrace hall which must be locked every night by order of the embassy. So much for the late night run to the fridge when the jet lag sets in.

3) You go a museum and your tour guide introduces himself with a click. That happened for us this afternoon at the Apartheid museum in Johannesburg; his name was nmh(click)asud.

Jet Lag

Ladies and gentleman we just wanted to take a moment to talk about jet lag. For all you non-believers out there, jet lag is real and it is a beast. Bed time comes pretty early around here, about 9 o' clock, and after a long day it's not too difficult to catch a few hours of sleep. Then it hits you. 3 am rolls around and you find yourself wide awake. Not only awake but with more energy than you've had all day. What do you do? First you pray that something just woke you up and this is not what you think it is. You pray that you are actally still tired and have a couple more hours of sleep in your system. Of course the truth of the matter is that like it or not it is morning. Not actually morning, the sun will be in bed for 3 more hours, but it is your morning. Might as well embrace it. You aren't falling back asleep. What ensues is a cycle of reading, journaling, and praying. Mom always told us that if you pray when you can't sleep Satan won't like it and he will put you to sleep. Well in South Africa, Satan just laughs his butt off while you are wide awake wishing you were asleep. So you go back to reading and journaling. We have probably read a combined two hundred pages between the hours of 3 am and 6 am. That is a modest estimate.
Honestly though we have had a great two days as we work off the jet lag to simply relax, read, talk to Win and andi (they are neat people), and get our feet under us. It was certainly needed. You never get that kind of time at Vandy. Great to unwind. That was certainly a goal of the trip.

Greetings from the other side of the World

Hello friends. Will and John are officially bloggers!

We will try to update this site from time to time about what is going on here in South Africa so stay tuned. So far I can say we are really excited to be here. The Browns (the family we are staying with) are truly an awesome family and have been so great to us. We have just been getting our feet under us so far and plan to go into some AIDS clinics on Wednesday, May 11.