Wednesday, 1 June 2011
Tuesday, 17 May 2011
"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
Monday, 28 March 2011
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
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
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.
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
Wednesday, 2 March 2011
Sunday, 27 February 2011
“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.”