Sunday, March 8, 2009

Epically Late, Epically Lengthy and Here For Your Reading Pleasure

Well. Hello there!

Yes, yes, I do know what the date is. No, I haven't been in a state of frozen animation for the past three weeks nor was I abducted by aliens (though not for their lack of effort…) The truth is, the absence of a blog post has been due mostly to the fact that we can't use the student laptops for personal projects/watching movies etc this month. The fearless leaders decreed it and it was so. Sadly, the internet here is incredibly slow, I didn't want to hog the one computer in the hostel for three hours, the internet café is open at awkward hours and is, if not as distracting a place to blog as the living room of the hostel where the computer there sits, too distracting for me to make the effort. So, you ask, why is this blog magically appearing now? That's for me to know and you, well, not to.

Anyway, if I remember correctly, last episode left off with us about to embark on an epic journey: 59 hours of plane trips and layovers and bus rides on our way from Chiang Mai, Thailand to Plettenberg Bay, South Africa. There may have been some cliffhanger about how I was going to blog about sustainable agri-something-or-other, but do forgive our producers, sometimes they get overzealous. We've long since moved on to all Public Health all the time.

So how was the 59 hour extravaganza? Well, long, clearly. Two nights sleeping on the floor in airports is always a thrill. But I can inform you that VAT tax refunds are a pain, the Dubai airport is incredibly overairconditioned which makes sleeping on the tile floor next to impossible but that they totally and completely make up for it by being the hub for Emirates Airlines, the clear favorite for World's Best Airlines as far as anyone TBB is concerned. I made a LIST of why Emirates is better than all others. THAT'S how good it was. And I will share it with you now:

· Each seat has a personal touch screen TV on which you have the option of playing video games, listening to music, getting updated on the flight progress or the latest BBC headlines, watching the plane's surroundings through the forward or downward cameras (nice for those in the section of four middle seats…like me…always) or watching any of probably 200 movies.

· There is a cupholder separate from the tray table AND it has an inner ring that can tilt so that your cup is upright no matter what the angle of the seat in front of you is.

· The ceiling over the aisle is dark with little lights in it that look likes stars.

· Even in Economy, you get a menu for the meal and the meals are quite good.

· There is a place every few seats to plug something in so you can charge whatever electronic device needs to be charged…like, say, an iPod that's been traveling for a day and a half.

· There is also a place to plug in a USB cord. Think of the possibilities.

· Internet access, although in Economy this isn't free.

· A little Do Not Disturb type sign that says Wake Me Up For Meals, one that says Wake Me Up For Duty Free and one that says, in fact, Do Not Disturb.

· And, get this, a phone in every seat so you can call any other seat for free! You bet we took advantage of that.

And the other nice thing, which really is more me finally getting good seat luck than anything to do with Emirates airlines other than that they fly a 3am out of Dubai which is, accordingly, not full is that I was, on our 2nd Emirates flight, seated in a middle bank of four seats with Dave and, oh wait, no one else! I was exhausted and needed desperately to sleep and it was incredibly comfy and like a gift from the airplane gods. :-)

Well, now that I've extolled the virtues of a commercial airlines without payment of any sort (where is my business sense?) I'll get on with the featured programming: South Africa.

Ok so here's what's up. We're living in a hostel, not with host families. The girls are all nine to one room of ten bunk beds and one rather large shower, but there is space enough to move around, a table, a desk, a little kitchen with a fridge, a microwave, a sink and a water heater. Surprisingly, the one shower thing isn't too much of an issue and although our room usually looks like some sort of massive natural disaster has taken place and left behind piles of clothing, magazines, the occasional Q-tip, I can deal with that. It's still possible to walk around without stepping on someone's stuff…unlike in the boys room. They're all five in one room too, but is more like a little corridor with beds (and no private bathroom…hahah!) and, as the average TBB male is messier than the average TBB female, it's only possible to get a few steps into the room before crushing someone's already wrinkled shirt. But in general we don't venture into that abyss. We just relish (politely and without rubbing it in) in the fact that Finally the girls have the better room. Yay!

The hostel has a living room area with very comfy couches, a TV on which we watch movies, a computer with very slooooooooow internet and a table. There is also a KITCHEN!!! And we can use it. Hallelujah! I've already made noodle kugel, challah, French toast and many eggs in addition to the dinner John and I cooked for everyone last Sunday night. (Dinner rotates between ordering in, TBBers cooking and going out…Our menu? A starter of a salad bar and charoses, then honey Dijon chicken breasts, sun dried tomato, pesto and goat cheese chicken rolls and noodle kugel and a desert of snickerdoodles and (store bought) ice cream…The snickerdoodles were too floury but everything else, if I may be so immodest, was really quite yummy).

But really, what are we DOING here? Well, I shall explain. We're in Plettenberg Bay working with an NGO called Plett Aid. Part of what Plett Aid does is send Home Based Care workers into the townships surrounding Plett. These are people (all women, at the moment) who have had three months of training in how to care for the sick and who go around on foot from house to house checking up on their assigned patients, changing bandages, taking blood pressure, arranging for clinic visits and if necessary pick ups in one of Plett Aid's two available vehicles. They are also often called on to help with DOTs, that is, Directly Observed Therapy (I don't think the S stands for something…but I'm not positive). DOTs is for patients who sometimes, for whatever reason, can't be trusted to take their meds. A care worker will show up at their house every morning, sometimes very early, and literally watch them swallow their pills because the cost of not completing a course of meds is high not only to the patient, but the everyone around them and, eventually, everyone everywhere. Take Tuberculosis for example. TB is a disease closely assosciated with HIV/AIDS. You or I may have been exposed to TB (this is what they test for at the doctor's office with the little prick on your arm) but we aren't terribly likely to come down with the disease as long as our immune systems are strong and we are otherwise healthy. The TB is dormant and we aren't contagious or sick. Because HIV/AIDS weakens the immune system, it is much easier for TB to become active and very dangerous. But TB is curable. There are all sorts of drugs available (well, ok, availability is an issue, but there are all sorts of drugs) to fight it. The problem arises when a patient starts taking the drugs, but doesn't finish. Then the mutant TB, the few bugs that are resistant to those drugs, can take hold and multiply and the patient, before he or she knows it, has a case of MDR-TB or multiple drug resistant TB. Tuberculosis isn't contagious once you start medication, but otherwise it's highly contagious. This patient can easily spread the MDR-TB and MDR is, for obvious reasons, much harder to cure that your plain old regular TB. Some places around the world are even starting to see something called XDR-TB, or extreme drug resistant TB. It's scary. Anyway, that was a very long explanation for why DOTs is needed in many communities around the world including in the U.S. You want to treat everyone who is ill, but you need them to be responsible about meds and not everyone is…some people need a little encouragement. Hence, DOTs. And THAT was a very long way to get to an explanation of what it is that we're doing here is Plett which is shadowing Plett Aid's Home Based Carers (HBCs).

We're working two to a carer from 8am to 1pm. Noah and I (China revisited) are working in a township called Kwanokathula (mostly, that's pronounced how it's spelled except that the "th" is just a "t" sound) as are John and Alexandra. We work with a black woman named Pumza; J and A are with Margaret.

But before I continue with that train of thought, more explanation is required. Bare with me:

South Africa was settled by the Khoi-San people who were mostly conquered by the Zulus who after about 150 years were conquered by the Dutch and then the Dutch by the English. This bit is really complicated and that's all I'm going to go in to. At some point, Indians (from India) were brought over to help with labor. This has resulted in a very mixed racial background for many South Africans, but in the common vernacular there are three options: Black, White, Colored. Black people are, as far as I can tell, direct descendants of the people that lived in South Africa before the Dutch showed up. In the North and East of South Africa this mostly means the Zulus, but here on the Western Cape it means the Xhosa (that's "click + osa" where the click makes you also hear the letter K…they speak Xhosa which is a click language and is so SO much fun to listen to and incredibly hard to mimic…the Zulus speak Zulu etc). Colored people are of a more mixed background: Indian, black, white…it's unclear. They generally have a bit lighter skin and speak Africaans, a derivative of Dutch. White people are of European descent. That one is pretty clear cut. Anyway, there was a lot of racism in the country which eventually, beginning officially in the mid 20th century, manifested itself in a legal system called Apartheid from the Africaans for something like "Separatness." Under Apartheid, where people could go, where they could live, what they could do and whom they could marry were all legally restricted. The colored and black people lived in neighborhoods called townships (separate ones) that often had no electricity or running water. They were basically slums. Apartheid began to fall apart around 1990. There was much violence and rioting and much death. It was a scary time according to everyone I've talked to. In 1994, Nelson Mandela, newly released from Robben Island, a prison in which he'd languished for upwards of 20 years, was elected president and Apartheid officially ended. The ANC, the African National Congress, has been the most powerful party since then and it has done many MANY good things in an incredibly difficult period of time. Still, it's run may be ending. As I type, prominent members are splitting off in a splinter party called COPE (Congress of the People). There is also opposition from the Democratic Alliance, or DA. A presidential election will be held later this month where the ANC candidate, Jacob Zuma, is favored to win. In another lovely twist, he's up on trial for charges of rape and his defense can be summarized as "I didn't do it. She wants money." and occasionally "She was sitting provocatively and my Zulu culture required me to have sex with her." The jury is out (not yet literally) on whether or not he's guilty, but the charges don't seem to be interfering with his campaign. I don't really know that much about politics here in South Africa and my summary was rather rudimentary but it's fascinating stuff and I'd love to spend some time looking more closely into it.

So today, people still live in the townships but thanks to the ANC most have running water and electricity (at least here in the Western Cape) and there are a lot of small cement government-built houses, although not even close to enough to go around and many people are still living in rudimentary scrap wood and scrap metal shacks called shelters. Many others, however, are better off.

OK. So. Back to where we were before that most recent tangent. I'm working in Kwanokathula which is a primarily black township, although there are colored people. There are also a lot of immigrants from neighboring Zimbabwe which, if U.S. news organizations have been doing their jobs and you've been watching, should not be all that surprising. Anyway, the care worker Noah and I shadow, Pumza, is a 36 year old Xhosa woman who has been living in Kwanokathula for five years now. She has a one year old, Lilita, a five year old son and a fourteen year old daughter. The daughter lives with Pumza's sister in the nearest big city, Port Elizabeth, where she goes to school. Initially, I was shocked that Pumza had a fourteen-year old because I was prepared to guess that she was 24 herself. Age here is really hard to judge, much like in Ban Huay Hee, but in South Africa I find myself always guessing younger whereas in Ban Huay Hee I erred in the other direction.

Pumza has been a careworker for only four weeks and for two of those Noah and I have been with her. Before this she was many things: a housekeeper, a grocery store clerk, a nurse in an elderly home, and she probably won't do HBC for too long. It's hard work and she's already in school for early childhood development. She wants to start a cresh (like a pre-school and kindergarden) or even go to school to be a nurse. Pumza is, in short, really awesome. She can be quiet or commanding. She can be like a big sister or a friend or a mother. She has a slightly mischievous sense of humor and an ear for neighborhood gossip. And she'll stick herself in your business and make it her own – a good quality for someone doing HBC.

English is the most common second language in South Africa (a country with, I think, eleven official languages) and Pumza learned it in school as did many of the people we run into in Kwanokathula. She mixes up gender pronouns, which is incredibly confusing until you realize what's going on and begin to pay closer attention to the person specified at the beginning of the story. Aunt + he = she. Edward + she = he. She also adds "ne?" the Xhosa version of "you know?" to the ends of her sentences as in "She was very naughty, ne?" I love this. All in all, communication is not that difficult. Particularly after more than three months in Southeast Asia. I find myself picking up little bits of the speech patterns – I don't use contractions and I speak more slowly when talking to Pumza – which makes things easier still. Sometimes I translate from Noahese to Pumzaese, but mostly communication is good all around. Having spent so much time and effort trying to figure out even the littlest things in Ban Huay Hee, I was stunned at first to see how much I could learn about Pumza and Kwanokathula in a matter of hours. I had to retrain myself to ask questions after so much time trying to wonder only about things I could ask about through hand gestures and my rudimentary Chinese or Thai or Bawkinyal. Language, my friends, is a wonderful thing.

So we shadow Pumza. We are also simultaneously supposed to be conducting a survey for Plett Aid about how well their service is doing. Noah and I haven't started yet because the first week was about getting to know the patients and the second week was just incredibly erratic – we didn't really have a normal day of visiting patients, but we'll get right on it next week.

So on to the township and the patients. I'll give a quick rundown of what it is I'm seeing.

Kwanokathula is a nicer township than some. Qolweni (that's a different click that also sounds k-ish + "olweni"), the township Lily and Renee work in, is mostly the shacklike shelters. Kwanokathula has some of those, but there are also government-built cement block houses and every now and then some houses that have been built up and added on to so that they are big and nice and comfortable. There are even two or three big brick houses being built. Everything is one story, so big is a relative term…so is nice…but there are houses I wouldn't at all mind living in. And then there are houses that define tiny and stuffy and brittle and ramshackle. Most of the shelter-type housing in Kwanokathula are shacks that have been built on the property of people who live in government houses. Those people rent the shacks out to newcomers. After living in a community for a few years, you're entitled to a government house, but the government can't seem to build them fast enough and people end up in the shelters for decades. Clearly there is a range of housing and what's fascinating is that there aren't good and bad neighborhoods. A nice house with a well-kept garden could stand right next to a shelter (some are standalone and not connected to houses) or to a particularly rundown government issue house. Your home is what you can make of it.

Kwanokathula is mostly a residential area, but there are some little stores selling food and salons for doing hair. There are also South Africa's version of Cabinas or places to go to pay and use a phone. Some of these stores are in houses or additions to houses but many, mainly the salons and phone stores, are in those giant metal dumpsters you see outside construction sites in the states. It's pretty ingenious. Apparently, most of the salons are owned by Zimbabwean immigrants. Interesting.

The other thing that it's important to understand is this: much in the same way that within Kwanokathula a nice house will be sandwiched between a small cement cube and a shack, in Plettenberg bay a nicer township will stand directly next to an almost entirely shelter township which will be less than a mile from huge, fancy, state-of-the-art real-estate developments. Plett is a beach town vacation destination for wealthy South Africans and Europeans complete with two polo fields and beachfront property. Those fair-weather visitors can easily choose not to look over the next hill and see the poverty and disease in their temporary backyards and many do. This sort of behavior is easy to condemn on the surface until you realize that pretty much everyone does the same thing. How often do I go to South Central really? What do people say about USC? Yale? Bad neighborhood. But how many people really make it their business to do something about it? Particularly when it's just where they vacation. So I don't describe Plett to condemn any of it's inhabitants. It's just to give an idea of where we are and what it might be like to live in Qolweni and work as a maid in a five star hotel just a few miles away. And maybe to make us all look at our own communities more closely. (Which, incidentally, is exactly what we'll be doing in TWO WEEKS in New York and then DC).

So now, finally, to some patients.

After hanging out outside the clinic where we get dropped off in the morning (and where we meet no shortage of interesting people ready to talk about anything from racism to beer), Pumza came to pick us up and we were off. After a 25 minute or so walk to the other side of Kwanokathula we arrive at our first patient's house. (Pumza covers Phase 3 and part of Phase 2, Margaret covers Phase 1 which is where the clinic is. One more sidenote: neighborhoods are named for when they were built, so Phase 1 first, then Phase 2 and then Phase 3. Right now they're building Phase 4. The thing is, though, that it's WHEN and not WHERE so there are three sections of Phase 3 and they aren't all that close to each other…the upshot is we do a LOT of walking). The house is cement and larger than the government issue ones because the left half of it is a store. We walk up the four front steps and Pumza enters. Noah and I hang back, unsure of what we should do. Pumza explains to the woman inside who we are and what we're doing (she calls me Bianca and by the time I realize it's too late to correct her and I sort of like the name anyway) and invites us to sit down in the two metal chairs in the little corner that serves as a kitchen. From a room in the back of the house a large black woman walks out slowly and with much effort using a cane. Pumza talks to her for a few minutes and then we leave. She tells us, after we've left, that that was Julia (Ju-LEE-a). She is on RVDs (this stands for retro-viral drugs, also called ARV's or ART for anti-retro-virals or anti-retroviral-therapy, and Pumza writes it on her diagnosis sheet instead of writing HIV/AIDS in case the paper falls into the wrong hands…there is still a stigma around HIV/AIDS here) and recently had a stroke. A few days ago we went back to her house and made it farther inside. We sat for half and hour or so on a beaten up faux leather couch that serves to divide kitchen from living room. Julia's sister was watching TV and Julia's daughter and the sister's son were playing on the floor. Pumza was sitting next to Julia pulling the clenched fingers on her right hand gently apart, teaching Julia to do that as she watched TV and the like. The stroke affected the entire right side of her body making it difficult for her to speak and walk. Pumza said the stroke was due to the stress of hiding her HIV/AIDS status and that this is fairly common. As strokes go, Julia didn't seem too badly off.

Our second patient was Petras. We ran into him on the street, wheeling himself along. One of his legs was amputated after a car accident. His remaining leg, the right one, is a little swollen at the knee and twisted so that his right foot rests on the support intended by the wheelchair manufacturers for the left. He is also HIV positive. He's a very friendly, cheerful guy and Pumza mainly helps organize transportation for him to get to the clinic when he needs to. I always enjoy running into him.

Third was Edward. His house, though not particularly nice-looking from the outside is big and airy with big open windows and wispy chiffon curtains and is full of mismatched couches and cabinets and trinkets. Despite all of this though, Edward was dying. He had cancer. From what I gathered, he had prostate cancer, had had surgery, but the cancer had spread anyway – to his kidneys and lymph nodes – and there was nothing more anyone could do. It seemed that he'd had the best medical care he could get almost anywhere. He was 95 years old and it was just his time to go. His daughter, who I originally thought was his wife, was there to take care of him. She was warm and friendly, but obviously under stress and dealing with a lot of emotional pain. When we visited, we'd help her move him from his wheelchair to lying on one couch or another or back to the wheelchair. He was so thin that he weighed almost nothing. He could wrap his hand (which looked overly large compared to his body) all the way around his thigh. Pumza would help feed him to give his daughter a break and once, to give her time to shower, we just sat with him in the living room. Mostly it seemed, Pumza was moral support, more for the daughter than for the father, and that support was incredibly important. Edward died on Thursday the 26th, just hours after we saw him for the last time. I could tell he was worse than before. His eyes weren't focusing and his raspy whisper made only one attempt to escape his throat. But he died at the ripe old age of 95 in a perfectly nice house full of light and air with his daughter there to take care of him. This death was not the kind of death you hear about when you talk about people dying in Africa and it certainly isn't the norm, but it was heartening to know that there are people in townships who die with dignity and as much comfort and support as it is possible to have. I tried, once, to imagine what his life must have been like. He was alive before apartheid was institutionalized and after it was dismantled, long before TV and before any township had electricity or running water. I wondered what he thought about his country, about racism, about the future of his grandchildren, about these two foreign students coming into his home. I still wonder and I always will.

Incidentally, Pumza forgot to tell us that he died. I asked about a week later and she said "Oh yes. His memorial service was yesterday." Then Friday, a few days ago, we were shadowing Margaret with John and Alexandra because Pumza had to take her youngest daughter to the doctor (she's been sick for weeks and I'm really worried about her, but if anyone will get her good medical care, it's Pumza) and Margaret said she was going to a funeral later where everyone would dress in black and white and form a giant human cross. Turns out it was Edward's funeral. So while death is sad, this death, from the outside at least, was as unsad as a death could ever be.

Our fourth patient was a middle aged man with TB and HIV/AIDS. His leg was painful and he was going to go to the clinic. We've seen him once since then and it seems much the same.

Fifth up was a girl named Nandipa. She is seventeen, has epilepsy and is mentally disabled, the latter probably a result of the former. She speaks mostly nonsense words, drools all over herself and smiles almost all the time. She is like a grown up two year old. Her mother wasn't there the first day, but on the next visit she was (her brother was there on the third visit). Nandipa's mother's name is Eunice. She is a strong woman and cheerful, taking everything life gives her in stride. Still, she told us, she worries about leaving Nandipa home alone but she sometimes must because Nandipa's brother works and Eunice can't be home all the time. Nandipa can't be at school although there is a school for disabled children, because it is only for kids up to fourteen years old. Eunice worries that Nandipa will be raped. She can't know for sure that it hasn't happened already. Nandipa was shaking hands with everyone in the room – her mother, me, Pumza, Beth (who was with us that day) – everyone except for Noah. Her mother said Nandipa is afraid of men. She isn't sure why. She said it so matter-of-factly that it was even more startling. Rape was just one more dangerous fact of life and it's true. In South Africa, one in five men ADMIT to having raped a woman and one in four poor girls can expect their first sexual experience to be "coerced." There isn't really much we do for Nandipa other than check up on her to make sure she's still as OK as she was the time before, but I always enjoy going to see her.

Patient number six was Mandisi, a man probably in his mid thirties with a huge and wonderfully friendly smile. He, too, had TB and HIV/AIDS. He lived in a nicer house although he has since then moved to a shelter in Phase 3. I think he moved because he's gotten well again. Indeed, he never seemed ill when we saw him. He isn't skeletally thin and doesn't cough much. We couldn't find his new house the first time we looked because the address we got had the last two numbers flipped (we got the address from one of the women in the original house who I assume was a sister because he didn't inform HBC that he'd be moving which really annoyed Pumza). We spent thirty minutes looking for XX37 which was just not there…there was a XX36 and a XX38 but no XX37. Then, the next day, we were just walking down the street and he called out to us (from XX73) which was incredibly convenient and coincidental and yet not that surprising with all the walking around Phase 3 that we do. Pumza was literally on the phone with Ann at the HBC central office talking about how she couldn't find him. The shelter he lives in now is stand alone and two rooms. He lives there with another man and woman, maybe a brother and sister-in-law? But as shelters go this one is ritzy. The inside is all white with cabinets and a table and a refrigerator and TV (although the TV isn't the ritzy part…it seems that every house and shelter has one in Kwanokathula because there is electricity). It is neat and impeccably clean and the walls are well-built from sturdier wood, not piecemeal with bits of scrapwood and cardboard and corrugated tin. Still, it's close quarters.

Our seventh patient was a thin woman, probably in her mid twenties (but again, me and guessing ages here…) who has HIV/AIDS and TB. She spends most of her day at home sleeping and I don't know much else about her.

Our eight patient was a man in a wheelchair, maybe about 55 years old. He was friendly and spoke enough English to have a conversation with us. His wife told us, though, that at night he sometimes wakes up crying because of the pain in his legs. I'm not sure what his diagnosis is. I always enjoy visiting him as well. The first time we went to his house we ran into a large, well-dressed black man who had driven there in his car. It turns out he is the pastor at the local Methodist Church (they have pretty much every possible denomination somewhere around Kwanokatula). He stopped to talk to us for a while. He asked what we were doing and we explained. He said if we were studying health care we should go to Zimbabwe where we were really desperately needed. Then we started to talk about Mugabe. He said he liked Mugabe. He was a true African man – kind of an African's African type sentiment. He said he had been confused about what Mugabe was doing until he recently read something that said that Mugabe wants to step down and let another democratically elected leader take over, but the people around him won't let him because their jobs all depend on his being in power. He didn't seem to blame Mugabe at all for the massive crisis in the country. He was intelligent and articulate and this newspaper he'd read allowed him to understand how a man he admired so much could be President of a country in the middle of such a disaster. I didn't agree with his theory, necessarily, but I truly understand the need for a way to understand what is currently happening in Zimbabwe and I see where that reasoning is appealing. We've seen him around a few times since and he always waves. I love running into people for the second or third time and recognizing them and having them recognize us and feeling like I'm not as much of an outsider as I was a few weeks ago.

Ninth and last for that first day of visits (on any given day since then we've visited a maximum of 5 patients) was Michael. He had a clinic appointment for March 10th but he had to work that day so Pumza was going to arrange with Ann to fix the timing. We haven't seen him since then.

Our tenth patient is Andile. He wasn't around the first three times we visited his house, but the fourth time's the charm, right? Anyway, Noah and I were prepared to agree that he was about 24 but it turns out he's 42. He's very tall and very thin and is another HIV/AIDS and TB patient. We talked to his brother and nephew for a bit when we visited him the second (successful) time. I don't know much more than that.

Our eleventh, and currently final (although Pumza just got a few new patients assigned to her I think) patient is Marie. She is a big colored woman (she understands Xhosa but doesn't speak it and Pumza understands Africaans but doesn't speak it so they can still communicate) and lives in a tiny tiny shelter that backs up onto one of the less nice government-issued houses. There are two other shelters on the same property, but her's is the smallest and shabbiest. She lives with at least five other people including a fifteen year-old daughter, a girl of about four and a newborn baby. There are nails and pieces of glass and all sorts of trash on the dirt path that leads to their door (which Pumza cleaned up one day, as well as giving the daughter a couple of dollars to go buy bleach and soap to clean up their house which the daughter first refused because she was too lazy to go to the store which in the end took her about five minutes…there was a huge fight and the woman who owns the main house complained that Marie and her family were bringing disease into her home because they didn't like to wash themselves or their clothes which, while harsh, was probably true…I mentioned to Mandy that Pumza had helped clean and Pumza got a little talking to because she isn't supposed to help clean for patients…I felt bad that I'd gotten Pumza in trouble because she only did it because she couldn't stand to see little children living in such squalor, but at the same time Mandy is right and Pumza isn't a maid she's a home based carer…). The poorly built and slightly leaning house is wallpapered on the inside with cardboard. There is room for a bed against one wall the head and foot of which touch the two adjoining walls and room for about four people to stand close together. There is one small window to let in light and air but it doesn't do either well. Marie has TB as do two of her children. She is still breastfeeding and hasn't been able to walk since her pregnancy. She has no government ID and so can't file for a welfare grant which she desperately needs. We spent all day Wednesday at the Police Station and community center trying to get her one, but to no avail. She needs a relative with an ID to come vouch for her. As if the first visit wasn't enough of an ordeal. We were supposed to go two weeks ago, but the ground outside her shack was too wet for her to walk on so Ann left in the car and said she'd come back the next week. Last Wednesday Mandy came to pick us all up in the car and Marie, Noah and I sqeeeeeeeeeeeezed into the back seat with Pumza in the front and drove the short distance to the Police etc. complex that we'd walked by on the way to Marie's house. It had taken ten minutes for Marie to walk the twenty or so feet from her door to the car so once we got to the station Pumza had Marie walk the ten or so feet to a cement ledge that she could sit on and went inside to get the ID business in order. She came out five minutes later saying that the woman wouldn't come out to talk to Marie; Marie would have to walk down the long path to the office. If we had called, the government service would have sent someone to Marie's house, but since we were there already they wouldn't even bother to send someone outside the complex. Thirty minutes and two breaks later, Marie made it to the office. She and Pumza talked to the woman behind the desk, gave her the form Marie had already filled out and the passport photos she'd had taken and brought in. In addition to needing another person to vouch for her, she needed not only the name and address of the school she'd attended but it's phone number. The problem was that it had long since closed. I hope they'll let this detail slide when we get her father or sister to say Marie is Marie. While she was sitting in her plastic chair by the desk she peed – all over the floor and herself. Pumza and I helped mop it up and no one made a big fuss about it, but I was thinking later about an article I'd read in the NY Times a few weeks ago about a pregnancy complication not uncommon in poorer countries called a fistula. It's more common in younger and thinner women whose hips aren't wide enough to have children, but it causes incontinence and issues with the legs. I can't diagnose Marie and I know nothing about her medical history or much about fistulas but no one seems to know what's wrong with her aside from the TB and it's frustrating. At the very least, next week we should be able to get her an ID and she seems to be getting more motivated to help herself the more we visit her. When we came to pick her up last Wednesday she was dressed and sitting outside of the house as opposed to the first (failed) time when she was still in bed. She's a good person in bad circumstances and HBC is actually making a difference for her.

Alright. That's the end of the patients summary.

On another note, I haven't taken any pictures in the townships (and pretty few at all until yesterday when we went to monkeyland and birds of eden and a pretty beach) so I don't have anything really to post online (and with the slow internet and no access to student computers for personal use I couldn't anyway). I think sometime next week, our last week (!), I will take some photos of Kwanokathula and ask a few of the patients I feel more comfortable with if I can take their picture. We aren't really supposed to have valuables with us, but honestly Kwanokathula seems pretty safe, especially in broad daylight when we're with Pumza, and some other people have been taking pictures for their media projects. It's been nice not having a camera though because a camera automatically makes you a tourist and that is the very last thing I want anyone to think I am. Still, I want just a few photos to illustrate and remember.

Speaking of Birds of Eden…We went yesterday first to Monkeyland to see their free roaming monkeys which were pretty adorable and where we had our first legitimately good and thoroughly intelligible guide of the trip. Then we went across the way to Birds of Eden which is a giant netted enclosure for all sorts of birds. Unexpectedly, this was the most terrifying experience of the entire trip for me. How is that possible you ask? Oh, oh but it is…You see, right when we entered the enclosure, this little colorful parakeet type bird landed on Dave's shoulder. We shooed it away and it went to John. John encouraged it a little, because hey, it's cook to have a little bird on your finger. As we walked on, though, it followed us. I landed on Zach's shoulder, then back to John's. Then it divebombed me, landing in my hair and I shooed it away. I was rattled by the surprise attack, but I regrouped and continued on through this supposed Eden. All was well until, ten minutes later, John and I were separated and left behind by the rest of the group while I tried to take a picture of a pretty teal parrot. Suddenly, the bird divebombed me again. John shooed it off of me and it went to sit calmly on his shoulder. We walked on for a minute or so until it divebombed me again, landing on the right side of my head and biting to hold on to my ear for dear life. John got if off again, but it wouldn't go away. It was only happy sitting on his shoulder and when he tried ot shoo it it would attack me again. We proceeded to move through the exhibit, trying to leave the bird behind every now and then, unsuccessfully, and then rescuing me from its subsequent attack. Finally, John put it on the ground and told me to go ahead, he wanted to leave it there. The path we were on (the only path) led to a bridge which in turn led to a gazebo in the middle of a little pond. John's reasoning was that the bird wouldn't be able to fly over the water. I said it was a bird. He seemed to think this didn't disprove his hypothesis so I agreed and walked to the gazebo, never turning my back on the Killer Attack Bird. It stayed put until I was on the gazebo bit and John turned to leave. Immediately it took flight and at high speed headed right past John straight towards me. I ducked and John ran to get it off of me. The old couple sitting on a bench near us watched, bemused, as I shrieked bloody murder. We continued on to the other side of the pond, me dragging John along (he wanted to look at the birds which were actually pretty cool and I wanted to get to the exit as soon as possible so someone that worked at Birds of Eden could take the bird) and we ran into Beth at a little café where there was also a group of tough-looking tattooed Americans sitting and drinking coffee. John took the bird into the bathroom to try to leave it there, but it followed him back out and again divebombed straight at me. He shooed it off and it flew happily onto the should of one of the tough-looking Americans. I high-tailed it away before it could change its mind. When I got outside to the blessed freedom of NOT Birds of Eden, I found that my ear was bleeding from where the bird bit me (although to be fair, not that badly) so Sandy checked with the woman at the ticket booth who said that all the birds are checked for diseases and so I didn't need to go to the hospital or anything of that sort. Plus I've had all my shots so I'm probably alright. Still, I was thoroughly shaken and I started laughing and crying all at the same time. Then Beth started laughing at me because I had completely fallen to pieces. I was entirely aware of how ridiculous I must look, but I swear the Killer Attack Bird was one of the most terrifying things that has ever happened to me. It just kept attacking and there was literally nothing I could do to make it stop and nowhere to escape to in the immediate vicinity. I don't expect any of you to truly understand the terror of the Killer Attack Bird, but I swear to you that I flinch a little every time I see a small bird or a shadow that moves like one flying overhead. As I type this, the fan in our room keeps moving the flap of a book in the corner of my eye that's sitting right near the door and I'm tensing up. I kid you not. I just saw it again and I looked over and my heart skipped a beat. I've been traumatized.

The last topic I'll address right now is media. I'm a solo group this month and despite the fact that we have peer review tomorrow I'm not yet totally sure what it is I'm doing. I've interviewed the three people I intended to, but I still have to figure out how to put the pieces together because the interviews didn't go exactly as planned and my original formatting idea won't work. We had a grand total of ONE WEEK from start to near finish (peer review requires a "near finished" product) for media this month which was a bit tight and all day yesterday we were out and about on this our only weekend to work on media. Still, it'll be alright. It'll get done. We'll see how well it all turns out.

Some of the media projects from Thailand are up, although mine is not. I did in fact turn it in on time while were were still in Thailand, but Sandy wanted to upload them all at once so she waited until we got to South Africa where, it turns out, the internet connection is not very good and video is too much data to upload despite her best efforts and hours of time. I guess it'll go up in the U.S. When it does I'll let you know. We were pretty proud of our video and think it's interesting so, you know, we would all sort of like people to see it.

Anyway, I'm getting severe bloggers fatigue and the fluttering book is thoroughly freaking me out so I'm going to sign off. Apologies for emails I've not responded to, but I do read them all. It's just that the internet here is so frustrating that I can't deal with it for very long. It should be better for the first two weeks we're in the U.S. (until we head to Virginia and our non-wired retreat for two weeks), but don't take that as an excuse not to email. I still love hearing about what's going on with everyone. I'll be home soon (!!!...well, ish…) and I need to be up to date!

Much love,