Wednesday, 1 June 2011

10 years on

The door flies open. Lele peers in.

"You must come out here and see. They are doing a play!"

I finish up my case file annotation and come to the doorway. The waiting area is in chaos. A gang of school children are manhandling a couple of marimba's to the space in front of the consulting rooms, a team of nurses and counsellors are creating a stage area. Patients look on mutely. Some with interest, others - presumably feeling proportionately less well - without.

"What is going on?" I ask.

"It is 10 years since the clinic started. 10 years since MSF first started the HIV treatment programme and proved that it could be done in Africa. So the staff are celebrating. They are doing a show or something."

The sister in charge of the clinic has moved to the front of the crowd of patients. She calls for silence and then gives a short introduction. Lele translates for me.

"She is saying that this is a very important day. 10 years ago people were dying. And 10 years ago right here is where people began getting treatment..."

Lele is silent for a while as Sister talks further.

"... she apologising for the delay in seeing the doctor," she mutters.

I become aware of a insistent pulling at my trouser leg. I look down and see a 5 year old boy. He tugs and points at my stethoscope. I place it in his ears and whisper "Molo" (Hello) into the other end. He grins.

"Molo!" he shouts.

Sister introduces another lady. She is dressed in a colourful cape and immediately starts shouting and singing loudly in Xhosa, all the time swirling and running up and down the waiting benches. She is a Praise Singer.

"She is praising Ubuntu Clinic and God," Lele explains. There follows a rapid stream of Xhosa - I catch "35kg" and "85kg". "When she first came here 6 years ago she was very sick and weighed just 35kg. Now she has been on ARVs for 6 years and she is 85kg." Everyone cheers and applauds.

The play begins. Sister introduces the cast in English. Thabo Mbheki - played by a counsellor - nods solemnly. Manto - a previous health minister who resisted ARV treatment for so long extolling instead the virtues of vegetables - scowls at the audience as she booed loudly. Dr Rath - a quack who marketed his own vitamin pill as a substitute to
ARVs - is played by the best known doctor in the clinic in a colourful clowns wig to great hilarity. Scripts are read, large crowds of nurses and counsellors play the parts of patients and pressure groups. There is dancing, chanting, singing. The school boys play their Marimbas with impressive skill and enthusiasm at appropriate points.

And I am moved by the story. By the suffering and ignorance and denial people experienced. By the commitment of those - many of them here - who fought and campaigned for treatment. And by the enthusiasm and zeal they continue to demonstrate for those suffering in their communities. And for the joy in what they have achieved. It is only the tip of the iceberg but there are thousand of people on treatment in the city now - healthy, working, raising their families. And it is because of what started here.

Tuesday, 17 May 2011

The next patient is in her mid-20s. She sits gracefully on the edge of the chair and looks at me.

"How can I help you today?" I ask.

"It is this," she says, hands clasping her belly, "I look like I am 4 months pregnant!"

"And are you? Have you checked?"

"Oooh! Yes. MANY times - and always negative. I have been talking to my friends and they say it could be the HIV treatment."

"Yes - that is true. You are on one of the older drugs, the one called Stavudine. That can make fat appear in different places on your body, and sometimes disappear from other places. Some people find that it makes their face thin." I suck my cheeks in briefly. She laughs.

"I used to have a VERY round face, now it is thin!"

"I suggest that we change that drug then. We have more drugs available in the public clinics than we did when you started and the one I will use has less side effects. Is that what you would like?" She nods enthusiastically.

As I do the paperwork I ask, "If you don't mind me asking, how do you feel about having HIV among your friends and family. Do you tell them? Do they know?" She grins broadly and pulls off her jumper. Underneath she has a T-shirt, upon which is printed in 6 inch letters 'HIV POSITIVE'.

"Everyone knows. I am not embarressed. It is important that we are not ashamed, then other people will test and get treatment."

"That is brilliant. I used to work in rural South Africa, up in KwaZulu-Natal and there people were very unwilling to be open. There was a lot of stigma about HIV."

"I used to think like that, but when I got my diagnosis I joined a group for people who were HIV positive and when you discover that they are normal people just like you, and that they have been on treatment for 5 years, or 10 years and are well - it makes you realise it is OK! So I make sure everyone knows!"

Thursday, 7 April 2011

Otherwordly isolation

I lean across the reception desk and catch the attendant’s eye. “Sawubona,” I say, dusting off my rusty Zulu. I see you.

“Sawubona, ninjani?” she replies. I see you, are you well?

“Ngiyapela.” I’m fine. She grins at me.

“You must be a doctor.”

“I am! How did you know?”

“It is only the doctors around here who use Zulu. Even if it is only the greetings.” She arches an eyebrow.

“I used to work here, at Hlabisa hospital up the road. I have a few other Zulu words, you know like ‘Does it hurt?’ and ‘Take a deep breath’.” She laughs. And then launches into an excellent impression of an elderly Zulu lady rattling off a series of complaints, waddling across the reception area clutching her back in mock agony. She gets it exactly right.

I have come up to KwaZulu-Natal for a few days. Tonight I am staying in the Hluhluwhe-iMfolozi game park, 20 minutes or so from where I used to work. Awarded my entry ticket, I drive into the park. The sun is low in the sky, the kills bathed in amber light. I take it easy driving the 30km to the camp. Just a few minutes later I pass a rhino, slumped wearily on his side in a mud puddle. Just beyond him two giraffe lollop languidly along the hill brow.

I arrive at the camp in the dark, headlights on. The stars blaze gloriously overhead in the darkness. It is hot and sticky. My accommodation is a rustic thatched single room rondavel. After the urban sprawl of Cape Town this is other-worldly isolation: the darkness, the stars, and the sounds of life rising from the trees below the camp – cicadas, baboons and barks. I stand there drinking it all in.

And then go to the camp's award winning restaurant where I have an all you can eat dinner buffet.

Monday, 28 March 2011

World T-Shirt day

"The T-shirts are here!"

I am in the clinic room with a patient but hear the cry go up from next door. The floor of the flimsy prefab building creaks and gives with the sudden influx of nurse and counsellors to the room beyond.

Today is World TB day, and everyone who is anyone has a special T-shirt. Swing a cat in the clinic waiting room and you would hit half a dozen different NGOs: feeding groups, research groups, patient support groups, medical charities. And today each has their special T shirt and we are no different. I sign off my patients paperwork and they wander off. I slip next door and join the throng looking for a shirt. "Here, these are mens. Try medium," says Thandi. I do. It hangs rather loosely below my waist. Sister Manke eyes me critically.

"Ah, Ed. You are but a small man." I glare at her but she does not notice.

T-shirted up, we load into the cars and head off in convoy through Khayelitsha to the soccer stadium for the World TB fayre, hosted by the City of Cape Town. AnyNGO who is anyNGO will be there. The outside has rows of new palm trees and tastefully cobbled walkways - a World Cup face lift. The inside is more in keeping with the environs. We all make our way in. It looks like around 10-20 organisations are represented. The biggest queue is for the Provincial Dept of Health tent where free blood pressure and blood sugar checks are on offer. The queue to the free "sputum testing" is a little shorter.

A drama group are doing a sketch. Lots of running and coughing. The watching crowd laugh and cheer appreciatively. "What is happening?" I ask one of our Xhosa nurses.

"He has TB but hasn't taken his medications for a few weeks and is getting sick again." The charactes engage in animated conversation with each other. I catch "MDR" and "TB" a few times and get the gist.

The compere applauds them as they end. "Weren't they amazing?! Now, who can remember what the sketch was about?" A lady rushes up and gives her answer into the microphone. "Very good - yes, you must take your medication if you have TB or you will get MDR and get very sick!" he affirms. The prize is a... you guessed it... T-shirt. The woman takes it, studies it briefly, and then looks grumpily at the compere. They exchange a few sentences. "What do you mean 'It isn't your size?'", he cries into the mic. "This shirt is like a condom - one size fits all!"

Monday, 21 March 2011


The waiting area is full. Children are running up and down between the benches, their mothers (and some fathers) watching them as they wait to be called into a consulting room to see a nurse or counsellor. A woman stands in front of them talking loudly in Xhosa. She bangs her palm with the edge of the other hand, as if emphasising her point. She appears to be delivering a lecture. As I get closer I recognise her as the sister in charge of the HIV clinic.

I slip into one of the consulting rooms used by one of the clinic Sisters. “Molo Sister Sibisi”

“Molo Doctor. Ninjani?” She has just given a vaccination to one of the anti-retroviral patients – a flu jab. She applies a dressing, and the man thanks her and slips out.

“Sikhona,” I exhaust my meagre Xhosa. “What is Matron talking about out there Sister?”

“She is giving them a talk on disclosure.”

“Disclosure to their friends?”

“No doctor, to their children. This is parent-child clinic day so the HIV positive parent comes with their positive child and we see both at the same time. The thing is, many of these parents do not tell the child that they are positive.”

“That the parent is positive?”

“No doctor, they do not tell the child that the CHILD is positive for HIV.”

“But how?! The child is on tablets and has been coming to clinic for years.” Most of the children here will have become HIV positive as a result of infection during, or shortly after, birth. Whilst there are treatment regimes that can reduce the rate of infection in pregnancy dramatically the mother needs to know she is positive (and many do not - or do not act on the result) and drugs need to be available at the right time.

She shakes her head sorrowfully. “Yes doctor, but there is a lot of stigma still. And they tell the child that they are taking the tablets for flu. And then one day when the child is 11 or 12 they want to know why do they take the tablets when their friends do not. And then it is very bad, because when the child finds out they often get very cross, and they stop taking their tablets, and then the virus comes back and they can get very sick. So Matron is telling the parents they must tell the children they are positive.”

“But that must difficult as well. A very young child will tell their friends and then might get into problems at school.”

“Yes doctor – both ways have their problems. But we think that the truth is the better way. Nothing good can come from secrets.”

Tuesday, 15 March 2011

The race

The city is quiet. The sun, just up, bathes the mountain side warm orange. I pull the bike out of the car and pull on my borrowed cycling shoes. A large 4 wheel drive pulls up behind me. The man leaps out and lifts his racing bike off the back. "Good luck," he grunts at me in Afrikaans accented English as he cycles off.

I climb on the bike and wobble precariously down the street as I try to figure out how to lock the cycling shoes into the pedals - and then promptly over balance as I try to work out how to remove them at the traffic lights. "Guess the whole idea of the race is not to stop," I mutter, embarressed.

Wobbling through town I head towards the Civic centre. I join a stream of professional looking cyclists - all in the full kit, with expensive racing bikes. There will be 44000 bikes on the route today - am I the only idiot on a mountain bike?

As I turn the corner the starting area comes into view, the atmosphere electric. The dawn light is grey here, but the buzz of people, the gathering cyclists and the pounding upbeat music quicken my pulse. I find my starting "pen" - along with 2000 others. I fall into conversation with two men waiting with me in the toilet queue.

"So where have you come from?" I ask. They look at me.

"Don't you know us?" says one.

"We're famous," says the other.

"Sorry," I say, a little flustered. "I'm a Brit." They laugh.

"So are we," the South African accent they had previously used has vanished. "We're accountants from Pretoria."

The loudspeaker calls out group to move onto the starting pen. We all cycle on, everyone has fallen silent in anticipation.

"5, 4, 3, 2, 1 - go" shouts the speaker. And we all wobble off.

The route leads out onto the motorway. Everyone is taking it easy at present. There is a low murmur of conversation and gears, and rubber on the road. We pass the University - resplendently neo-classical - and follow the mountain foot south. It is 8am, and people are up and dressed, lining the sides of the road, and hanging over bridges. "Come on!", "You're doing great!". Some people have set up gas braai's and are cooking breakfast for family and friends. We hit the first hill - and the locals have concentrated themselves along it to shout encouragement. I cannot stop myself from grinning, waving and thanking strangers and I drop a gear and pant up the slope.

2 hours later and I am just over a third through. The route winds through the coastal towns and is now hugging the shoreline of the National Park. The sun beats down - down directly overhead. The riders are not talking now - just the whir of gears, the crash of the waves and the the cries of the birds.

Nearly 4 hours in. Over two thirds. I push past the refreshment station - hundreds of cups of coke, and a tent advertising massage. A couple of cyclists have had a puncture - they are pulled off the dirt to the side of the road. Three young children from the Township we have just past have rushed up to help him - one holding the bike, whilst the others look on avidly as the cyclist rapidly changes his inner tube. Up ahead four more young kids are cheering - they are holding out their hands for a "low five" - I reach out and we slap palms.

Four hours, 20 minutes. I have managed Chapmans Peak - the highest point, and the exhilarating run down to the beach resort of Hout Bay, but now I am bored. Every pedal move is an effort. But finally - 4h 50min - it is the end.

I phone a friend and we have beer. But there are certain parts it is definitely not reaching.

Saturday, 12 March 2011

Yes Man

I am at the head of the pack, with three other blokes. We have been running for over an hour now. I feel a warm glow of achievement – I am keeping pace with real trail runners! They are chatting animatedly. One of them turns to me, “So do you run often?”

“No...” I gasp.








I think I am about to die. “And is this your first time with CRAG? How did you hear about it?” Crag – Cape Runners Against Gravity – is a trail running group that meets each Wednesday at different parts of the mountain for a 90 minute run.




We are nearing the end now – we can see the car park. My three companions reveal their extra gear and storm ahead. I slow to a stagger.

10 minutes later the entire group has re-gathered and – you have to love this about South Africans – chilled beer is produced from the cars. Conversation turns to other outdoor Cape Town activities. This weekend is the big bike race, the Argus, a 110km circuit around the Cape peninsula – including all its hills and famous Chapman’s Peak. “Are you doing it Ed?” asks someone.

“Oh no – I have only been here 3 weeks so it is too late.”

“It’s not!” a friend from work, also testing CRAG, interjects. “I phoned and international people can sign up right until the day before.”


“Yes – do you want to do it? I will if you will.”

“Nah – I haven’t trained and I have no bike.”

“My housemate has a bike you can use. And I haven’t trained either. Go on.”

“I did it last year with only 10 days training,” says one of the other runners. She looks reassuringly normal. But you cannot tell with these South Africans. “You should do it.”

I open my mouth to refuse because surely to refuse is the sensible thing to do. But then a scene from “Yes Man”, discovered whilst channel hopping late at night last week, comes to mind. The protagonists life is made infinitely more varied by saying “Yes” to every and any opportunity. “What would Jim Carrey do?” I wonder.

“OK” I say. “Why not.”

And so here I am, Saturday night. I have a bike (mountain – infinitely unsuited to a long distance road circuit), padded shorts (in which I look a tit), a variety of energy drinks. None of which can make up for the fact that the longest cycle I have done in the last 6 months was 2 miles. Up the hill to work.

Check out the route here.

My target? To stay out of hospital. And not to face the ignominy of being put on the truck back to Cape Town when they clear roads of stragglers prior to reopening to traffic at 1730.

7 hours or less. Wish me luck.

Sunday, 6 March 2011

Single malt

The coffee has been served and people are making their excuses and heading off. We shuffle around the restaurant table, closing the gaps. I am sitting next to Sister Nene.

"How are you doing? Did you enjoy the food?" I ask.

"Oh yes - and all the better for it was free." The evening has been a work social gathering. A waiter comes up with a glass which he hands her.

"What are you drinking?"

"Whiskey," she replies, a little indistinctly.

"What kind?"

"Normally I like Jamesons. I don't know what this is like. It is something called 'Glenfiddich'."

"That's very good."

"I know. It is a single malt." She reaches for the water jug and eyes me conspiratorially. "I like a little water with it," she whispers and pours half a pint of water into the glass. I watch in horror. "It takes the edge off it and brings out the flavour." As she lifts to drink the light catches the drink - not even a homeopathic amber tinge remains. "Ah - it is excellent."

Wednesday, 2 March 2011

I'm not in Kansas

I am driving back along the beach front towards the city centre. It is late and dark but the air is warm, the window down and I hold my arm out relishing the 70km salty breeze that rushes over it. I am returning from dinner with new friends from work. Dinner in a Mexican restaurant on the African coast - or the "Atlantic seaboard" as locals call this area of the city which makes it sound like Florida. And it could be, superficially. The BMWs, the beautiful people jogging along the promenade, the high end restaurants.

The elevated roadway curves around, brushing the city centre. I glide down to a six lane junction. There is a queue. I cannot see quite why - the lights are green. The car in front of me moves slowly forward. Then, illuminated by its headlights I see a withered figure in a crumbling, bent wheelchair. The chair is in the middle of our lane. On either side cars hurtle past to join the Freeway up ahead. Unperturbed the figure reaches up to the window of the car in front. Its occupant passes a few coins. Nearer now I can see that it is a man. His legs are withered useless sticks - heritage of childhood polio. They are folded, contorted rather, in a way no normal limb could across the seat of his chair. The lights turn red. He pushes his chair across the traffic lane to the next car. Its occupant remains cocooned within - there is no response to the silent appeals. He pushes his chair on to the car behind that, the one beside me.

I instinctively look straight ahead - as if I have not seen anyone or anything. Perhaps he will ignore me. In the rear view mirror I see he has moved to the car behind me, pushing his broken chair with his broken body, hands up in a gesture of supplication.

I look at the lights, willing them to change, cursing them for their slowness. Cursing that I cannot blame laziness, drunkeness, or drugs as the root of this man's destitution. Cursing that perhaps the only way to make myself feel better about myself, about him, is to give him something.

The lights change, the abrupt red-to-green flick that is a continual surprise to a British driver more used to the excruciating politeness of a UK traffic light. I pull away, accelerating off to the freeway. In my rear-view mirror, a chair now silhouetted by the headlights of the cars behind, sits folorn and vulnerable in the middle of the highway as the cars hurtle around it.

Sunday, 27 February 2011

First day at the office

“You will have to sit in the back,” Rachel says as she opens the car. She grins ruefully. “The front door is stuck. I keep telling my husband we need to sort it out but he is Johannesburg a lot at the moment.” I clamber into the back seat. The interior of the car is like a furnace; my shirt clings to my back. It is 7:30am but already hot. Rachel revs the engine and we move out of the parking lot.

“Where are you from Rachel?” I ask as we pass the boom-gate of the medical campus and onto the highway.

“Zambia. I came a few years ago to study at UCT. And then I stayed.”

“Why did you leave?”

“I did my medical school in Zambia but there are not many opportunities for graduate study up there. And my husband had more opportunities down here.”

“Do you think you would ever go back?” She smiles and shrugs.

“I don’t know. Its home but what would I do up there? And the children are in school here. They didn’t like it much at first – it took a while but now they are happy.”

“What made school difficult?”

“Oh – just settling in, you know. It was hard at first because most of the black kids were Xhosa and would speak Xhosa to them but they didn’t understand it. They hung out with just the white kids at first because they spoke English. But now they are settled and have loads of friends.”

We are on the freeway now, heading out towards the airport and beyond that, Khayelitsha. I am being introduced to the clinic – and vice versa. A concrete fence shields the road from the huts behind. I notice one spot where a few posts have been removed creating a gap. A gap just big enough – it would seem – for a cow. For tethered by a rope a few metres from the road two cows stand grazing on what little grass grows on the verge, untroubled it would seem by the vehicles hurtling past at 130 kilometres an hour. We leave the freeway and few minutes later and follow the road into the township. The central reservation is beautifully landscaped with palm trees, rocks and scrub. It leads to a gleaming new building that looms incongruously among the tumbledown shacks. “Visitor Centre”, a sign proclaims, a heritage of the World Cup and the tourist interest in township life. Rachel points out landmarks to help me find the clinic when I come on my own. Turn right after the shipping container that has been turned into a hair salon, go through the next “Stop” sign and then turn right at the BP garage, NOT the Caltex garage. The clinic is after the Shoprite store.

“I would come a few times with someone else before you make the journey alone,” she says to my alarm.

“Why?” I say nervously. “Is it dangerous to come alone?”

“Hmm? Oh. No. But you might get lost.”

Tuesday, 22 February 2011

We step out of the air conditioned halls of the airport into a blast of Cape heat. It is nearly 30 degrees and I am wearing jeans and walking boots. I have been met by three friends from Hlabisa days, gathered in Cape Town for a wedding. We are chatting animatedly in the car as we leave the airport complex - developed massively for the 2010 World Cup – and I am struck by how glitzy and new everything looks.

10 minutes later and we are hurtling down the freeway towards the city. Table Mountain looms ahead of us, cloud pouring over its edge like the head on a hastily pulled pint. As the road curves the towers of the city centre buildings bristle at the mountain foot. I turn to look at the road side – I had seen it before but I am still startled: the glass of the airport buildings has given way to the shacks of the Townships and informal settlements that line the freeway. Thrown up with scraps of wood, corrugated iron, and plastic sheeting these are no temporary shanty towns. There are street lights, webs of cabling dangle from central pylons dispersing electricity to each dwelling, and one shack wears a precariously positioned satellite dish. At the edge of the road stand around 30 or 40 huts, each big enough to accept a person standing.

“What are those?” I ask, puzzled.

“Toilets” our resident Capetonian replies. “The shacks don’t have their own plumbing.”

As we approach the city the Township becomes more developed. Shacks give way to one room bungalows with water and waste plumbing. A large billboard by the highway shows a smiling black family and the tagline “From shacks to civilisation”.

My friends drop me off at my home for the next few months, a flat in a Cape Town suburb belonging to a family friend in the UK. I wave them off and lug my bags into the building. I walk into a reception area. “You must be Ed? We were wondering where you had go to!” says the smiling woman behind the desk in heavily Afrikaans accented English. The reception area is decorated with pictures of times past and several high backed chairs placed around a table are occupied by a group of white haired pensioners. A little old lady heaves herself slowly across the hall on a Zimmer frame, followed closely by a nurse. A poster on the wall declares “Are you having trouble getting to the shops?” I am momentarily puzzled, and then realise: this is a retirement complex.

A man comes down the stairs on a stick. “Look at you, young man!” the receptionist shouts at him cheerfully, “using the stairs at your age!”. My apartment is on the 4th floor. I take the lift.
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Friday, 11 February 2011

The return

After 3 years back in the UK I am returning to South Africa. This time to help with a research project in Cape Town. Kick off next week.