Malagazi & Umlazi

Unfortunately I only had one day at the Malagazi clinic, but I made the most of it and learned a great deal. It is a primary level clinic funded by the Islamic Medical Association and is in the heart of Durban’s largest township, Umlazi. I was told by a driver here that Umlazi is home to about 1 million people, which means it is about a quarter of Durban’s entire population of 4 million. It’s huge! I sat with an older nurse for the morning and she saw about 15-20 patients, about half of them young children. Almost everyone had the same flu-like symptoms because it is winter here and that seems to be going around now. They seem to treat each symptom rather than the sickness as a whole, ie. multivitamin syrup for the lack of appetite, paradol for headache/pain, cough syrup for coughing/sore throat, and then antibiotics for the actual bug. This makes me think about the issues with pill burden in HIV care. I can see how the pills all with their different regimens can quickly add up and be confusing, leading to patients defaulting on their medication. Patients on second line HIV therapy take about 9 pills/day. If that is complicated for example by TB infection, and a flu...that adds up quickly. A patient I saw in Kenya was at one time taking 27 pills/day! Thinking about how difficult it is for me to remember just taking my once/day malaria prophylaxis, I can't imagine having to even think about 27 pills...this symptomatic approach cannot be good for HIV adherence. But I was really glad to see this clinic to compare the different sites. I will be at King Edward Hospital next week, a tertiary level facility and the oldest in South Africa. I'm sure seeing the process of patient referral from the bottom up will be very informative. Overall, great experience!

We also had a township tour of Umlazi on Saturday with a driver who grew up there. It was very interesting! Although South Africa has one of the highest rates of crime in the world, and rampant with rape as well, I felt completely safe in this township. You could feel the sense of community and support. The driver also told us about the culture of "community justice," which is the community's attempt to fill in the power/structure vacuum left after the abolition of apartheid. He told us a story about a man who stole someone's cell phone and was forced to eat it, for example. They basically punish those who commit crimes and protect each other. I can see how that could get out of hand, but I also rather admire the strong sense of community and looking out for one another in the face of a failing government and beautifully broken city. We then visited an orphanage started and managed completely by the community, who all pitch in to donate food and clothing to care for about 38 kids.

Last stop was a place called "How Long" park, which is a little oasis in the middle of the urban jungle where a man without any sort of education made his dream a reality during apartheid. Despite the fact that he had no education and could not read or write, nor could he garden, he wanted to create some beauty and inspiration in the township, and so began How Long Park, which is his ongoing project. How Long, meaning How long must they suffer...this was during apartheid. We happened to be there during the 21 year old virgin ceremony of a young girl. Apparently, if a girl reaches the age of 21 still a virgin (or without having kids in this modern day and age), they throw her a party. All the young girls get together and choreograph a dance, and the whole community comes to watch, and gives the girl money. It's interesting how a society that looks so highly on fertility and the bearing of children also has this tradition that incentivizes women to wait...how ironic. The ceremony was very interesting, and the girls were so overjoyed that this group of Americans came to participate :) The donation of money is also a process, because they dance up to you and you stick the bills to the hat the girl is wearing. So much fun!

Then on the way home, one of the students was thirsty and mentioned it to the driver to see if he could stop for water. Instead he took us to the home of one of his neighbors, who were very hospitable and instead served us all cold juice. The house was full of children! We thought there was a family event or birthday or something, but the man said they were all his, and there were 16! We were confused at first, but then remembered the issue about family dynamics here, and indeed they were not all his biological children, but he took care of all of them and they all lived there. It's still amazing to me how much the HIV epidemic has shaped the country. Very interesting stop :)