Chatsworth Hospice

These past couple days I have been at Chatsworth Hospice, in a suburb not too far from Blue Roof or my house. It is a very nice facility located at the top of one of those famous Durban hills, with an excellent view of the city below as well as the ocean. I was given a very thorough tour by one of the "sisters" ie. nurses. All of these places seem to be run by the nurses. Blue Roof didn't even have one doctor in the whole facility. And this facility had no full-time doctors as well. It is completely donation-based, with all of the equipment, facility renovations, staff, everything paid by donations...pretty incredible actually. Families only have to provide for the patient's personal laundry and medication, but the staff will administer it. Thinking about how expensive palliative care is in the US, the fact that this is made accessible to even impoverished families is amazing. 

The staff is so positive and friendly as well! On Wednesday they had the Adult Day Care, which consisted of breakfast and tea in the morning provided and served by the local Rotary Club, followed by a light exercise and stress therapy session with a volunteering social worker, and finished with lunch served by another service organization. The hospice is located in a predominantly Indian neighborhood, so most of the staff and patients are also Indian, and lunch was biriyani ~ so delicious! I think Africa in general has the most delicious Indian food I have tasted :)

I was really impressed with the attitude of the patients though. There were about 40, almost all female. But they were just so positive! You would never have guessed that they were terminally ill and recovering cancer patients. They were so grateful to be sitting there doing breathing exercises and to simply be in each others' company. It certainly left me with food for thought about the power of attitude and gratitude...

On Thursday they had the outreach clinics, and the sisters go out in pairs to the different patient homes to provide care, ie. tending to bed sores, etc. As my interest is in HIV, I asked to accompany the sister who runs the HIV/TB clinic in one of the informal settlements. This has been the most incredible experience for me thus far. On the way to the clinic, we stopped by to pick up 5 more care givers from the same informal settlement. I suppose they are residents there. The settlements themselves are really something else...huge expanses of land just cluttered with shiny tin shacks made of aluminum sheets, cardboard, wooden boards, sometimes adobe brick, literally whatever they can find. There is also an extreme shortage of access to clean water, and you can imagine what the public health implications are of such, especially with everyone living in such close quarters. It was also very dirty, with no structured trash pick-up system since the whole settlements are not supposed to be there. The social workers in the car with me told me that the government does try to combat this problem, but every time they tear down some shacks, you can be sure that new ones will replace them even before the next morning. The problem is that rampant. And the thing is that it is perpetuated by the government itself, because they've agreed to provide free housing to anyone in an informal settlement. All of them have long numbers on them which correspond to waiting lists for the Housing and Development Project (HDP). The houses they provide are not amazing or large or fancy, but they are free. So people who already have houses even are building settlements in order to receive a free house and land from the government. Seems to be a very difficult situation...

Anyway, so the clinic itself was really interesting. We had to wear special TB masks since we were around active cases of TB. The nurse who I was with was very impressive - she knew every single one of her 200 patients by name! On Thursdays she basically monitors the status of patients and checks to see whether or not they are taking their medication properly, and most are. They come in and sit in a chair about 10 ft away and communicate with the care giver who usually sees them in the settlements, and the care giver then translates the Zulu to English, because the nurses are Indian and so they only speak English. The nurse then just records the status. At the end of the clinic, she assessed to see if any patients were missing and distributed lists to the care givers to follow up with patients in their zone. It is a pretty efficient system. However, I am starting to notice big linguistic disparities between the health care providers and the patients. The providers all speak English, while most of the patients only speak Zulu, and this affects their ability to make informed decisions about their health care. This is something I plan to pay attention to in the clinics to come.

Outside of clinic we did not do too much these past couple days. I have other projects going on and am continuing to work on the study in Kenya, but that has been difficult due to limited internet connectivity. I have honestly never felt so immobile in my life. I can't even go for a run with my ipod due to the high crime rate here. It makes you appreciate the small things. It also makes me think about neighborhood safety as a major limitation for families in terms of access to nutrition, ie. being able to walk to the supermarket, or being able to exercise. The parks here are strictly off limits to us because they are ironically the most dangerous places of all. Perhaps this is an underlying contributor to the major obesity problem here, which is actually worse than in the US...