My time volunteering in South Africa has been incredible so far, visually, emotionally, mentally, and even physically. I don’t know where to start with the sheer wonder of the landscape. After the 13-hour plane from New York and several connections, I felt like I had stepped into Florida. With palm-like trees and ocean breezes, this was nothing like the Africa advertised on television. After a sojourn at a nearby hostel playing a game called batong, like bocce ball, and watching cricket, we made our way exploring the area.
As we entered the townships I saw the first signs of visual poverty here. Shacks with dirt floors, the poignant smell of urine and body odor, kids playing in garbage heaps, garbage and glass cemented into the rocky, dirt paths leading to some of the houses—these sights and smells defined poverty for me. Despite American advertisements and news coverage, South Africa is one of the most developed and modernized parts of Africa, and although shantytowns exist, most of the area where we stayed had highways, cities, shops, supermarkets, and industrialized infrastructure. Even stranger is that across the way from the poorest and most dangerous township lies a township lined with standard, government funded housing with pristinely paved roads. The landscape looks like an old American suburb, except without the white picket fence and smiling families, child in hand. Dogs lie as guards outside houses as kids run up and down the street while some mothers wash clothes or sit inside with their families watching television.
Amazingly, despite living in almost destitute conditions, practically every house I visited had a sound system and television. Satellites poke from the shacks’ roofs, and one day I saw a house with cardboard lining the outside wall. Yet only minutes away by car lies an amazing downtown area with stores lining the streets, and a pristine beach waiting for the feet of tourists and their open checkbooks.
Our work project here involves studying public health through an NGO called Plettaid. We followed around home-based caregivers and record psychosocial data regarding the patients’ moods before and after our arrival. Unfortunately recording the patients’ moods can be difficult, especially with the language barrier. In the townships, the two main languages spoken are Afrikaans and Xhosa, and while some of the people know English, many do not. Often I find myself entering a home and feeling like an intruder because I am unable to communicate with that person. Other than a simple hello and goodbye I know little of either language, and the clicks in Xhosa make it especially different than other dialects.
Every day we report to one of the clinics depending on where the patients live. Everyone was assigned a different clinic, so while I am with some of the people in the group, others work at different clinics. We wait there every morning as residents file in and sit down. It is usually pretty full during the week, and after our caregiver arrives we either visit patients at their homes or go to another clinic with a patient using van transport.
Moments of Learning in South Africa
The walls of my clinic are lined with signs and promotions regarding HIV/AIDS- free condom signs, family support organizations, and responsibilities and rights of the patients jump out from the white painted walls. People fill the waiting area to see the sole Sister in the clinic. On one of my first home visits, a talkative man asked me about America and where I lived. What struck me was how he talked as if all of America were rich, and if all of the country looked as it did on television. I assured him it didn’t, and it made me think that when I first came to Africa I thought of the moving images of impoverished children clothed in rags peering at me through the screen. But all of Africa is completely different- within each country, and within each region and even cities, the landscape changes. Shack towns to standardized, white government housing to supermarkets and tourist filled beaches—just like the US, Africa does not resemble television commercials.
Another huge part of the experience in South Africa involves immediate signs of both globalization and westernization. From American Dracula movies to huge sound systems to blaring Rihanna pop music, I have found that even halfway around the world I can’t escape American culture. Nike sweatpants, Hong Kong tee shirts, even a Washington D.C. sweatshirt that one of the caregivers wore. I saw a man with an Eminem hat, Lil Wayne emblazoned across a man’s wall outside his house, signs lie everywhere. Inside one patient’s house, an older woman with high blood pressure, a poster of the pop star Jennifer Lopez resides right over her bed, and in that same visit I heard Pink Panther music from the South African radio frequency.
One of the most striking and stunning forms of globalization, and especially the world influence of corporations is the Coca Cola logos paraded next to store names. Little food stores and barbershops litter the townships, and many of the food stores have their names flaunted next to the global Coca Cola logo. My caregiver explained to me that they pay less to have their signs made by the Coca Cola Company, so as they advertise their store name to township families Coca Cola reaches its arm further across the world.
One of my most poignant and shocking experiences of the public health aspect of the trip here involves my proximity to HIV and TB patients. We visited an AIDS patient who weighed about 26 kg, or about 70-80 pounds. As I helped to lift her from the wheelchair into the van to see the Sister at another clinic, I felt every bone in her chest and her breath shaking with pain and discomfort. At only 39 years old, she lived off ARV treatment and looked as if she were in the final stages of the disease. Incredibly weak, swelling in her chest, legs and arms as skinny as twigs, she looked at least twice her age. I learned that they discovered the disease late, and that her CD4 count was already low when she began ARV treatment. The second time we saw her she looked worse. Her stomach swelled with fluid, and as we took her to the clinic to drain off more than 2L of fluid, she started to fade. At first I thought she felt tired, but the Sister and nurses called the ambulance to bring her to the hospital.
Another lady in the room could barely speak from a stroke, and threw up right next to me. In the next bed, a young couple sat next to their young son with epilepsy. A few days later I found out from my caregiver that the AIDS patient had passed away in the hospital. I didn’t cry, I didn’t feel sad or depressed, just a bit shocked. I didn’t know her that well, and couldn’t talk to her, only lift her into the van and accompany her in the hospital. HIV/AIDS is the leading cause of death in South Africa. Because her cause of death was HIV and TB, she must wait longer and pay more for her funeral policy. Normal deaths involve a waiting period of six months while a TB or HIV related death involves a 1-2 year waiting period. Openness and testing are highly encouraged. Yet, cultural messages are counterintuitive, with phrases like “Do you eat sweets with the paper on?” which discourages sexual intercourse with a condom.
The public health system here involves aspects which are incredibly helpful and affordable to the people. Home-based care is provided free to the people, along with visits to the clinic and medication such as antibiotics or ARVs. But there are also complexities and weak points. One of the controversial ways to support the patients is a disability grant, money given for healthy living and supporting oneself and their family if needed. Yet underlying addictions in townships such as alcohol and cigarettes lead some to abuse the disability grant to buy alcohol, leading some to intentionally grow sicker in order to receive the grant. When one becomes well they need to find a job to support themselves, but the scarcity makes finding a job difficult. And the cycle continues. My media project for this volunteer program involves the reasons and factors behind one’s health decisions. Unlike my prior assumptions upon arrival, laziness and ignorance play almost no role in the South African health crisis.
Follow Tom throughout his journey on his personal blog.