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.