My debate topic was was health citizenship and I primarily focused on the role of civil society in the governemnt. I argued that in developing countries, where the government does not have the autonomy or capacity to protect its citizens right to health, civil society needs to advocate for their own rights through education of lay individuals, grassroots organizations, and embodied health movements. Through this research I learned about the health system in SA the roll of grassroots organizations, and the history of government in SA. I also learned about "lay" indiviudal participation in social movements, the dominant epidemiological paradigm, embodied health movements, collective action, and the Treatment Action Campaign (TAC) in SA.
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Skukuza |
During the final week we went on a field trip to the Public and Private Hospitals in Nelspruit, a city about 1.5 hrs away from Skukuza. This unique experience provided us with the opportunity to see first hand the work that is done in both settings and provided us with enough background to compare the two.
First, we visited the Public Hospital and met with a doctor and department of health senior specialist who led a question and answer session and gave us a private tour of the hospital. The Nelspruit public hospital had ~300 beds, 6 operating rooms, ~50 doctors including consultants, interns, and medical service doctors, treated ~10,000 patients/month, and served a population of about 400,000 people. Each doctor sees on average, 25-30 patients per day. The patient demographics is middle age/ working class and school aged black africans of low socioeconomic status. In addition, the hospital does not do any major surgeries but has both TB and HIV/AIDS clinics. The doctor noted that the most common diseases are changing as is the common trend in many countries so that there is a dual disease burden; more patients with high blood pressure, diabetes, and obesity as well as the common communicable diseases such as malaria, TB, and HIV/AIDS. During our tour we visited the outpatient wing, the TB clinic, the emergency center, and the mental health center. We also got to see one of the 7 consultation rooms, the mental ward, and the emergency surgery room.
In comparison, the Private hospital had 314 beds, a pool of 110 general practitioners in the Nelpruit area, saw ~ 2,500 patients/month, and serve a geographical area of 90 square km. The average patient demographic is white with an average age of 45-50. Most patients are tourists, upperclass, government employees, or individuals who were injured on the job and had medical insurance. The hospital ran like clock work with a 24 hour pharmacy, state of the art ICU unit, a helipad, and more than 75 specialists. In addition, the hospital boasted being among the top 10 companies in SA along with Coke and toyota. Most of the illnesses seen at the hospital were related to the annual flu. Other clinical concerns included infection control, language barriers with foreign tourists, and diseases spread from foreign pathogens.
The two hospitals were at opposite ends of the spectrum for most things; however I was able to find some major similarities. First, patient care by doctors was quality in both cases, second, both hospitals had procedures for patient referral and emergency center use, and third; people were getting the necessary care and treatment. The three most obvious differences between the two were resources, doctor to patient ratio, and burden of disease.
I have much more to say about this experience and welcome conversation on the topic!
In our (little) free time at Skukuza we went on game drives and walks, explored the camp, played games and went on fabulous sundowner adventures. Due to the wild animals we were not able to go outside of the gates of the park unchaperoned, however we visited the staff camp nearby to play soccer and relax. I went on the game drive the first day and saw a pair of lions, checking off my final "big five" animal (lion, elephant, leopard, rhinoceros, buffalo). As we prepared for the drive at 6:00 in the morning we all bundled up and put on as many layers as we could, walking out of the door looking like marshmallows. Our favorite sundowner spot was on top of a flat mountain with a 360 degree view of Kruger Park.
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The gang on top of table mountain. These ladies were incredible and I am luck to have had the opportunity to meet and spend so much quality time with them! I look forward to keeping in touch and seeing what they end up doing with their passions and talents. |
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Sundowners from the top of table mountain overlooking Kruger National Park. Moments like this make you feel invincible. |
On our free day at Skukuza I ran a half marathon with a number of our lecturers. Last minute, we were able to scrounge up bibs so that a group of 4 of us were able to race. The race course started in the staff village, wound around the golf course and throughout the village, then went out into the national park. Every 100m there were game guards with large guns for protection (however I did not see any wild animals). The terrain was mostly gradual rolling hills with some dirt paths and paved roads which made for a very interesting course. At the end of the race they gave all of the runners free beer... and made us walk to the other end of the race grounds to pay for water. Classic! I never expected to run a race while I was abroad but I am proud to say that I ran a half marathon in the Kruger park.
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Hannah and I pre-race |
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Hannah and I post-race |
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Crossing the finish line... or running the wrong way over the start? |
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The finishers. What a great group! |
The final night at Skukuza we went to the golf club and had a nice dinner and a party. It was a wonderful night and a fabulous final memory.
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Allen and I at the final dinner |
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Dana, Kellie and I at the final dinner |
Having to leave South Africa was extremely difficult. I made so many wonderful friends, established a number of consequential relationships, and found my niche in the research science and anthropological fields. I left knowing that I will return to SA and will always have a network of like minded individuals supporting me in the US and abroad. This adventure was a stepping stone in my journey in many ways and will be essential in my future endeavors. After hearing the lectures and learning about all of the work that public health comprises I would like to work in research. I am most interested in the molecular biology of communicable diseases and how/ why disease affects populations differently. I would love to do lab research on infectious disease as well as field based anthropological research aimed at lifestyle, genetics, and disease burden. I am so great full for the wonderful opportunities that I had, it could not have been more fabulous.
Cheers