~South Africa~
Sitting in my seat as the plane left the runway in Boston, after a week of uncertainty and many false alarms, I was finally able to breath again. Going into this trip I had very few expectations except to keep my mind open and to learn as much as I possible could and I could not have had a more wonderful experience. Below is a map of the region of South Africa that we were in. Througout the first part of our trip we were in the Limpopo Province near Thohoyandou. You can also refernce the map to find the Blyde River Canyon, Nelspruit, and Skukuza. Enjoy!
Tschulu Camp, HaMakuya
The first day we traveled 8 hours from Johannesburg to the HaMakuya Chieftency in the Limpopo Province of South Africa. HaMakuya has a very poor infrastructure and most of its people would be considered to be of low socioeconomic status. In addition, the soil quality is bad and there is very little water year round, especially during the dry season. Historically, HaMakuya was ignored by the Apartheid government... although this was good in some respects (there was less direct oppression by the government) it also meant that the area was not receiving any government resources. Therefore, the region has taken longer to develop than the rest of the country. While in HaMakuya we stayed at Tschulu Research Camp located near the north end of the Kruger National Park. Our accommodations were en-suit tents, shared between 6 students. Each tent had its own bathroom complete with shower, sink, and toilet as well as a porch which we slept on every night under the stars. The facility was on the side of a valley overlooking the Mutale River. I woke up every morning (and sometimes in the middle of the night) to baboons screeching across the river and the cow bells on the cows heading to the river or home after a long day in the sun. The sounds and sights at camp were incredible as were the people that I was lucky enough to meet. The students that I met on this trip were absolutely incredible. Not only did we share a passion for public health but we were also compatible on a more personal level. I was surrounded by southern and midwestern accents and felt right at home. We spent countless hours playing card games, listening to country music, going on adventures, and hanging out.
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| Mutale River. HaMakuya, Limpopo Province |
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| Our porch and en-suit tent. We slept on the porches every night looking at the stars and hoping the baboons would stay on the other side of the river. |
Each day lectures were held in the open air dinning area from ~8:00-11:00 and again from ~2:00-5:00. Some of the lecture topics that we covered while at Tschulu included: What is Global Health?, Intro. to Medical Anthropology, Research Methods, AIDS in South Africa, HIstory of HaMakuya, Ethics and Anthropology, Medical Pluralism, Povert: Is it all relative?. This set of lectures not only prepared us for our entire time in Africa, but also for our home-stays.
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| Our "classroom" at Tschulu camp. We could not have been more fortunate. |
Our time at Tschulu camp was broken up by a four day and three night home-stay. I was assigned to Tschilini Village along with 3 other students where we conducted research on peoples preferences for health care treatment and their reasons for choosing said treatment. Tschilini has a population of about 80 people, has no public transportation systems, is ~6k from the nearest clinic, and has one municipal tap. Our research provided insight into the perception of health care and demonstrated health care seeking trends in the village. Our research was guided by 8 demographic and 16 open ended questions. Each of the 11 volunteers completed a consent form which explained their rights as participants and the details of the research. Our results showed a trend towards the use of clinics for most illnesses with traditional medicine being used less frequently or as a complementary treatment method in coordination with biomedical treatment. Some participants explained that their choice of treatment method depended on the type of illness that they had. For example, almost all participants cited "malaria" as a reason to go to the clinic while many said that they would go to traditional healers for diseases that doctors could not see or would not understand. As a group, we speculated that the increasing trend towards biomedical treatment could be because the clinic is free and individuals have to pay to see a traditional healer. Another explanation could be that as biomedicine becomes the more common approach, supported by the western world, traditional healing lost some of its legitimacy. In addition to conducting formal research on our home-stay we also conducted experiential/ observational research during our time spent with our host mother and the local children. When we were not conducting interviews we were helping our mother do chores such as: carrying fire wood, fetching water from the pump, sweeping, or cooking "pap".
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| Our home while in Tschilini Village. Our host family had two rondavels, round homes, one used for sleeping and the other as a living space with table and storage. Mealtimes were a time to sit and enjoy the company of family and friends around the fire which was also used to cook all meals. |
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| A typical meal of Pap, spinach, and tea taken in the rondavel in which we slept. |
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| Helping our host mother to make "Pap" (a much more difficult task than it appears) |
The home-stay was one of the most challenging and rewarding experiences of the trip. I was constantly pushed out of my comfort zone whether from eating the local food or sleeping on reed mats. Despite the discomfort I felt at times due to the differences, I was impacted the most by the similarities that I noticed between my life and the life of individuals in the village. For example, we all have chores, go to school and the grocery store, have to go to work, enjoy spending time with family and friends, take baths, and play. One of the things that has stuck with me most poignantly is something that one of my lecturers said as he was preparing us for our home-stay. When talking about the children that we would be hanging out with in the village he said, "yes, they are going to have boogers running down their faces and their clothes are going to be dirty... they play outside all day and instead of grass lawns they have dirt ones. So of course they are going to be dirty!"After spending time living in the village I realized that this was all completely true and helped me put many things that would have seemed very abnormal into perspective. There are a lot of assumptions made by uneducated and ignorant outsiders about people that live in villages like Tschilini. We talked a lot about "othering" people by distancing yourself from them whether consciously or subconsciously physically or in conversation. There is a lot that society could learn from communities like the one that I stayed in. For now I will say that there are beautiful people all over the world and its just a matter of opening your mind and letting yourself be surprised. I would love to share more about my experience with anyone who is interested and look forward to questions!
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| Tara and I hanging out with the kids. |
In our free time at Tschulu I ran, we played soccer at a nearby village, we explored the river and surrounding areas, read our course material, and spent time getting to know each other. I especially enjoyed running in HaMakuya as I was free to explore the area surrounding the main road and found a great running route that went through two small villages. I have many wonderful memories of children running a few minutes with me, asking my name, and waving goodbye. I also caught a couple brilliant sunsets on my return as I headed back down towards the river. On one of the last nights we had a camp fire and a guest guitarist played and sang for us. The many good times were filled with laughter, jokes, good conversation, and a little competition.
On July 24th, we had to leave Tschulu camp and head to "Wits Rural Facility" located about 50 km from the west gate of Kruger National Park.
"Wits Rural Facility"
The first thing we saw upon arriving at the Wits Rural Facility was a giraffe chilling in the yard. We soon discovered that giraffes, impala, hogs, monkeys, and zebras were all common visitors to our site. The facility is comprised of many separate research camps and privately owned homes in addition to the research facility that we stayed at and spreads over many acres of land. Surrounding the land there is a large fence with an electric component. I often questioned the competency of this fence as there was always wildlife roaming around but it seemed to provide enough security.We were told that we were safe to walk and run freely during the day in small groups and took full advantage of the extensive road system.
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| Giraffe! One of the many friends we met while at Witz. |
While residing at "Wits" we stayed in cabin style housing with 7 other students in bunk beds. Starting at Wits it was a running joke throughout the program that I woke up in the morning talking and on the move. What can I say? I am a morning person with a lot of energy! Luckily my friends could appreciate and sometimes match my enthusiasm. There was also an outdoor dinning area that doubled as our lecture space. The daily schedule at Wits was similar to the schedule at HaMakuya with lectures starting at around 8:00 am and going to 11:00 then starting around 2:00 and going until 4:00. There was also a number of guest lecturers which provided us with a well rounded idea of prevalent topics related to global health and health in the area. Lecture topics included: building a research smart community, Interface of Animals and Health, HIV, TB, Malaria, Cholera, Health Economics, Bushbuckridge, Primary Health Care, Economic Epidemeology, Ethnobotony, and Ethnomedicine. The set of lectures on prevelent communicable diseases in SA were my favorite of the entire course. They were given by a guest lecturer who is a molecular biologist and researcher for Wits University. I absolutely loved hearing about the work she does, mainly researching infectious diseases.
In addition to the lectures we did a number of field trips while at Wits. The first field trip that we took was to a community health worker center in Bushbeckridge; a semi-urban community about 20 minutes from our facility. When we first got to the office for the community health workers (CHWs) we were broken into groups of 2 students and paired with two CHWs. Our purpose was to shadow the CHWs and learn more about their line of health care in the community. We saw and talked with many patients. Many were on ARVs, some had mental illnesses, and others were recovering from surgery or needed surgery of some sort. The most memorable patient story that I heard was of a man who was on ARV treatment and had TB. In addition, he had lower back problems as a result of the ARVs. When we asked if he had gone to see a doctor he proceeded to tell us about the struggles he had gone through trying to get a doctors appointment and how he felt discouraged by the way his case had been treated. This frustrating, yet common, story exemplifies the burden of insufficient health care in semi-urban centers throughout developing countries. Throughout the morning, we learned that the role of the CHWs as a secondary care giver was to provide emotional support, act as a link between the community and the clinic, and insure that patients were taking their medicine. We also learned the difference between primary care givers (an individual that lives with a sick person and either provides care (active) or does not provide care (inactive) on a daily basis) and secondary care givers; such as the CHWs.
The second field trip that we went on was to a traditional healer in Bushbeckridge. While there we were able to get an understanding of her treatment methods and ask questions about her herbal medicines and the role of ancestors in her healing. We learned that traditional healers are called by their ancestors into the practice and receive all of their knowledge from those ancestors. They are able to diagnose a patient and know which plants to use and how to prepare them from dreams. We also learned that this particular healer refused to use any herbs or plants that she herself did not grow and harvest. She explained that this was because other people might give her bad herbs and that the harvesting process is very particular for each treatment. Finally, she noted that there were certain diseases that she could not treat and would immediately refer to the clinic such as HIV/AIDS, TB, and Malaria.
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| This picture is of the traditional healer that we visited in Bushbeck Ridge. Next to her on the ground are the "bones" she uses to communicate with her ancestors. "Bones" are not actually bones from an animal but are a collection of small trinkets that the healer collects throughout their life. |
The third field trip we went on was to a community garden. The garden is run by three women sangomas (traditional healers) and is used as a nursery for herbs used in traditional healing practices. It is also a reservoir for important plants that are being over harvested in the wild.
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| Rosie in the community garden in Bushbeckridge. The garden is a source of herbs for the traditional healers that maintain it as well as a conservation center for indigenous plants that are endangered due to over harvesting. |
Wits was a great location to stay during the middle of the trip because we had a lot of space. We were able to hang out, relax, and explore prior to the grind of the last week of papers and debates. We also started a tradition of going to the water tower located near our camp for sundowners and stargazing. The view of the landscape and the horizon from the top was incredible.
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| Despite the eerie climb to the top, the view from the water tower was always spectacular. |
On our free day we went to the Blyde Canyon, the 3rd largest canyon in the world.
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| Brianna and I at the base of the Canyon. A lovely day! If only we had more time to climb to the top. |
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| 1...2...3... Jump! While there we found a waterfall and jumped from the rock cliff into a small pool at the bottom. The water was absolutely freezing and took my breath away while numbing my entire body but it was a blast! |
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| Don and I went to the top of the water fall where there was a small pool of water and the source of water for the falls. Always up for an adventure! |
The final memorable experience I had at Wits was seeing a leopard while on a run. I started running just after sunrise one morning, a few days before we left. I was just starting out and running along the fence about 3/4 of a mile away from camp when I looked over to my right and just on the other side of the fence was a leopard. As I was looking at this leopard looking at me then at the fence then back at me I was not so much afraid as I was surprised. I was so shocked I didn't know how to react so at first I slowed a bit remembering that sometimes they say "not to run" from predatory animals then I thought about the fence and its lack of security and kept going. It wasn't until I was around the corner that I started to panic and sprinted back to camp. When I told my classmates and teachers many did not believe me at first but could tell that I was too pumped up to be lying. I hear many reactions, my favorite coming from the program head, Lawrence Kruger who commented, "leopards are interesting creatures... they are very unpredictable and give very few warning signs. They just either kill you or they don't." Thanks Lawrence!
On August 2nd we left Wits and headed for Skukuza in the Kruger National Park.
Skukuza, Kruger National Park
Our hostel, school journeys, was located inside a tourist camping center. Within the tourist center there were multiple restaurants, a bar, and a convenience store. Our housing was a large hostel with 2 big rooms with about 24 beds per room. In my room there was ~16 of us and it was a bit chaotic at times but also quite fun. The amount of stuff 16 20 year olds brings for 30 days is incredible! The schedule at Skukuza was different as we were doing more independent research for our debates and preparing our final research papers and presentations. In addition, we did multiple field trips. The lectures at Skukuza included: Environmental determinants of Health in South Africa, Climate Change and Health in South Africa, Immunization, and a number of shorter "flash" lectures such as; Evidence Based Medicine, Ethics of conducting research in a Clinic, Conservative Medicine, and Urbanization and Non-communicable disease.
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
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