Hello to all from the deepest, darkest Africa…well, not really the deepest and darkest, sometimes I forget I’m in the third world with all the malls and fancy cars around Joberg. I’ve been here almost two months now, which I can hardly believe. Between dial-up internet and lack of cheap phone cards, I’m afraid I’ve been incommunicado as well. I keep starting emails with the latest and running out of steam halfway through. Sadly, I’ve resorted to setting up at the local McDonalds, which is one of the 2 places in town with free wireless internet – sad state of affairs since as an American I feel the obligation to stay as far away from McDonalds as possible to avoid any stereotypes (that and not being a huge fast food fan).
After getting settled, spent a lot of August driving around South Africa with work, Kwazulu Natal one week, the Northwest Province the next- two provinces I hadn’t been two before. RHI is also currently going through a sort of coup de etat, trying to break away from the Academy of Family Practice, the organization it’s been working under, so it’s exciting trying to figure out how to do that – lots of politics and egos involved apart from figuring out the logistics of setting up as a separate entity.
A few weeks ago, Bayanda (another member of the Rural Health Initiative crew) and I set off to take a tour of the rural hospitals in the Bophirima District of the Northwest Province – about 4 hours due west of Johannesburg – to get a better picture of the rural hospitals there to assess their needs and suitability for RHI-recruited doctors. I had never been to the Northwest, which is on the border with Botswana, so I was excited to see it. Bayanda, her 9-month old son Mila, Mila’s nanny Madisa and I piled into the car on a Sunday afternoon and set off on the N14 to Vryburg in order to make a meeting with the district health officials early on Monday morning. The Bophirma District consists of the municipalities of Greater Taung, Kagisano and Molopo, Moshaweng, Lekwa Teemane, Mamusa and Naledi…African names that this American tongue butchers consistently and my American brain has a hard time remembering, the letters all just seeming to jumble together. Despite the richness of the names, the Northwest is actually a dry (now that it’s winter) and empty space where the wind is often your only company on the straight-for-miles roads. Reminded of the Texas Panhandle (maybe because I had just finished reading an Annie Proux book set there and the windmills sparked a resonance), we drove for miles across the flat landscape of grassland and small signs signaling turns down dusty roads to unseen farms, until eventually even the road signs stopped directing our way on the N17 about halfway there and we had to resort to the old fashioned method of asking people alongside the road which was the way to Vryburg, our ultimate destination and base of operations for the week. “Bieslesvlei, Delareyville, then Vryburg” a withered and dusty man told us at the stop street in a one-horse town (or half-horse town, if there is such a thing, it consisted of a bar) near Coligny. One defining characteristic of the roads in Africa is there are always people walking, day or night, although where they’re walking to or from is often a mystery given how far the nearest settlement seems to be.
Following the signs to Bleslesvlei, then the signs to Delareyville, we rolled into town just after dark and pulled up to the International Hotel, what made it international I don’t know since it looked unlikely that anyone besides me would go out of their way to leave their country and come here. But quaint and decidedly Africaans, it was nice to have a place to stop and unload. The International was one of those hotels where the carpet is blue and the furniture is from the 1960s, but it was clean and safe, so we were happy. Bayanda had told me horror stories of the hotel she and Saul had stayed at during their last trip to visit hospitals in Limpopo. After unloading, we forayed into the dining room. Old faded pictures and stories from the turn of the century lined the walls – apparently an outlaw had once set up camp here and escaped through the stables when pursued by the law. We sat down at one of the four tables there and
We had coordinated our visit with the district’s annual review of hospitals being conducted that week. On Monday morning, Mr Modise, an employee of the district health office, accompanied us to Ganyesa, where the roving management team was meeting to begin their hospital and clinic visits for the review. We were warmly welcomed by the District Director, Mr Konrad Mothlabane, who introduced us to his management team that included hospital CEO’s, Clinical Managers and officials at the district office, all gathered around the boardroom table. While we had thought we were just there as observers, Mr Mothlabane had other ideas and escorted us to the front of the room and sat us down at his right near the head of the table. He gave us a brief presentation of the hospitals and health centres in the district before we grabbed a quick bite of breakfast (idyllically unaware that these pieces of hasty toast would be our only sustenance for the rest of the day) with the group and left on our tour. Mr Modise kindly agreed to be our “chief marshal” and escort us to and around the hospitals for the three days we were in the province.
Ganyesa Hospital
Our first stop was Ganyesa Hospital, just outside the small village of Ganyesa (if you can call it a village…mostly it was just a gas station and a small collection of shacks). Ganyesa is a real rural hospital, with nothing as far as you could see on either side of the grounds, although the hospital was tidy and neat and the staff lacked the desperate air we found at some other rural hospitals. A nice young doctor that grew up in the area showed us around. As he told us, there’s really nothing to do for fun around, the nearest town being Vryburg where we came from, about 100km away. One of the doctors’ seems to have taken up breeding Dachshunds, since about 20 of them – puppies and adults all running hairy-scary about - accosted us as we strolled by the doctors’ houses.
Tshwarangano Hospital
Our next stop was Tshwaragano Hospital in the Kudumane district. After much debate, we decided to take a “short cut” via a gravel road and two hours later arrived at the hospital - saving kilometres but not much time and comfort as our teeth still chattered when we alighted from the car. Tshwaragano Hospital is an old mission hospital on the very edge of the province. It’s in desperate need of an upgrade, the buildings were literally falling down around the hospital. The present hospital buildings and staff are struggling to accommodate the patient load as the hospital has 214 beds and is a referral centre to about 28 clinics and there are only four doctors on staff- pretty grim. This is partly because the government is moving the provincial borders and as of next year, this hospital will be part of the Northern Cape Province, upon which time hopefully the hospital infrastructure can be upgraded.
Kagiso Health Centre
Without another precarious gravel road to cut distances down, we only made it to Ganyesa and Tshwarangano on the first day. But we also briefly stopped over at the Kagiso Health Centre close to Tshwaragano Hospital. This almost-new health centre is currently run by nurses as there are no doctors to work there. It was planned to be upgraded to a hospital but those plans have now been shelved because of political quagmires. The centre is eerily empty as brand new equipment lies around wrapped and waiting to be used and waiting room chairs sit empty. With the health crisis in the rural areas so grim, it is depressing to see such a facility just sitting there empty when it could help so many people fully staffed.
On our second day, we were scheduled to visit three hospitals – Vryburg, Schweizer-Reneke and Taung Hospitals.
Vryburg Hospital
We started in Vryburg, where we were conveniently staying, so the hospital was just down the road. The Vryburg Hospital is a sweet little facility that is fully equipped for a rural hospital – and it’s close to town. As at the other facilities, we were shown it all, the female and male wards with AIDS and TB patients silently suffering with little privacy, paeds and maternity wards with tiny preemies all bundled in together in incubators, as well as casualty/OPD, X-ray, physiotherapy and the forensic medicine room where rape victims are seen and evidence taken. The hospital has also recently started an ARV programme, whose waiting room was full here - as it was everywhere we went that distributed ARV’s. While the government is slowly rolling out ARV’s to AIDS patients, they still only reach about 20% of the AIDS victims in the country and in order to enrol, patients must prove that they can stick with the treatment and attend counselling sessions. When the nearest hospital is 50 miles away, it’s not an easy feat.
We briefly pulled the doctors of the hospital away from their rounds for tea. The hospital presently has four doctors - one Cuban doctor (the SA government recruited a slew of Cuban doctors to come in the 1980s), an Indian doctor, an Africaans doctor and one medical student doing his rural rotation. They all voiced their concerns about staffing levels and the isolation of their practice. The Cuban and Indian doctor had been working in the district for 10 years. For a long time they only had two doctors working at this hospital, and at times have had only one toiling away on his own.
Schweizer-Reneke Hospital
About 70km from Vryburg is Schweizer-Reneke Hospital. This hospital has been struggling with staff and for a time had no doctors, just nurses. But when we arrived, they had recently received a boost with the arrival of three Congolese doctors and three Iranian doctors. The government has just recruited about 40 doctors from Iran to come and work in the rural areas in South Africa (it seems that Iran has a surplus of doctors). We met one of the Iranians as he came through in route to sort out a bank account, having just arrived at the hospital the day before. He looked out of place with his snazzy shoes and psudo-suave demeanour. Trying not to focus too obviously on his obvious toupee, I heard him say that all the doctors under 30 had received a letter three years ago looking for doctors in rural South Africa, and now here he is. He seemed fascinated by the idea that I would leave America to come and settle here. “Why?” he asked, “would you leave the opportunity in America to come here? I would love to live in America.”
Taung Hospital
Taung Hospital was the last stop for the day. Taung is a lovely town. The hospital is the largest in the district and has very close links with Wits University. It is a modern hospital with lovely wards and grounds, including a tennis court for the doctors to get some exercise. They have a large and comprehensive ARV unit and have recently started a food garden which the patients are actively involved in (these are the kind of health projects that RHI gets involved in). A very enthusiastic Indian doctor showed us around the facilities along with the head matron (nurse). While the Indian doctor held my ear with complaints on how funding for RHI could be better and the ideas he has for future projects, we toured the wards, at this point used to the sight of patients in their beds and the doctors and nurses at work. Taung even has tele-medicine facilities, a TV with camera housed in the radiology department that can be linked up with other medical centres around the province, although we learned that because none of the other facilities’ cameras have been working, they are considering just moving it to the board room to use for meetings.
Our last day was dedicated to the Christiana- Bloemhof complex of hospitals.
Christiana Hospital
Christiana Hospital is a small on the outskirts of the small town of Christiana. It had one doctor on duty when we arrived. His Indian colleague had gone home on leave for a few weeks. Due to the fact there are only 2 doctors on staff, the hospital can only run one ward and the casualty/OPD. They do not have x-ray on site and have to refer their patients 50km away to Bloemhof Hospital, where they transport all the patients that need x-rays once a week. Just pray you don’t break your leg on a Thursday if the x-ray day is Wednesday.
Bloemhof Hospital Further along the N12 is Bloemhof Hospital. Boemhof is a very small 15-bed hospital with a general ward and small maternity ward. The hospital is along a national road and therefore regularly receives patients involved in accidents along this stretch of highway. They recently had no doctors after the two doctors here resigned, apparently two young guys that just couldn’t take it anymore and up and left both at the same time. When we visited, we met the newly-recruited Iranian doctor (now the sole doctor at work here) on his second day at work, touring the pharmacy and trying to figure out what drugs were available to him here in this strange country in this hospital on the edge of nowhere. As the head matron told us, they were having some language barriers - the mix of African, English and Iranian accents and dialects must have been an effort.
Came back to bustling Joburg after Bloemhof. My new endeavour is learning how to rock climb. Been bruised and battered, but haven’t fallen off a cliff yet.
Off to a hospital in Limpopo, on the border with Zimbabwe, this week.
