The state of healthcare

I promised discussion of health care system in Guguletu and have been slow to get to writing this. It has been almost a full week since we left Guguletu and I think I hesitate on this one the most because it is hardest for me to understand. I am frustrated enough with the status of healthcare in the U.S. so discussing this is going to be really tough.
The biggest issue is of course AIDS. No question. South Africa has an extremely high infection rate, and it is hard to not blame this on lack of education, lack of government response, and even some cultural factors. I can’t say that the U.S. has always been much better than this, to be fair. However, I can’t help but continue to think that HIV/AIDS is the sly continuation of apartheid here, because it invades the townships but not the white community. The prevalence of AIDS can be linked directly to the lack of education, and the lack of decent education can be blamed on economic disparities that were part of the design of apartheid. As Aaron has described it in the past, where the face of the AIDS victim in the USA is of a white, gay man, in South Africa the face of AIDS is that of a black heterosexual woman.

That said, and sorry if I offend, now I can move on to what is positive. On our first full day in the townships we mend Mandla Majola who is the local director of the Treatment Action Campaign (TAC). Mandla was dubbed “the best grassroots organizer in all of South Africa.” (In fact then-senator Barak Obama came to meet him to learn some of his organizing skills when he started his run for president.) Mandla is pictured here on the right. On the left is Xolani (mentioned below).

TAC can be thanked for the new prevalence of the distribution of antiretroviral drugs (ARVs) to keep people alive. They work very well in helping fight off the kind of “infections of opportunity” that may kill someone who is HIV positive, as long as the ARVs are taken by someone who gets proper nutrition. There is a government health plan that gives a discount for “healthy foods” purchased at the grocery store (hello, USA, we should do this too!). TAC also has helped spread the word about the importance of using condoms (they distribute them for free – in fact there are boxes of free, government-issued condoms in almost every restroom on the UCT campus and even in bars and restaurants). They’ve also been working on supporting people who are HIV positive to know that they can live with the disease if they fight it properly. TAC also works on stigma in the communities. They’ve also been instrumental in fighting the government in court when the issue called for it, particularly on educating pregnant women who are HIV positive on the simple way they can insure the baby will not be HIV positive if they take the proper precautions.

Mandla himself was a very personally interesting story to me… he told us his inspiration to fight came from losing too many friends and family members to HIV. He said he is HIV positive himself and admits he suffers from depression. I asked him how he keeps from succumbing to it, and he said, frankly, “I love sports. I follow rugby, soccer, cricket, tennis, you name it.” (This country is sport crazy, I tell you, and it’s fun to watch rugby and cricket regularly. If only I understood what I am watching.)

We also visited a TB clinic, and another health clinic in Guguletu. The facilities are pretty good considering how many people they serve, but the waiting can be very, very long. There is no such thing as an appointment (and certainly nothing like a Minute Clinic). Clinics are government supported but find that they run out of government-issued drugs often before the next supply arrives. We brought some basics with us: bandages, topical ointments, Tylenol and ibuprofen. They were very appreciated. And when we left we scrubbed down with Purell.

JL Zwane supports a theatrical performance group called Siyaya, which does dramatic presentations in clinic waiting rooms illustrating the importance of getting tested for HIV, using condoms, being faithful. The performance was sometimes racy, sometimes funny, and sometimes scary (and not always in English, but we could follow it). They sang as well. It was very successful at least at entertaining those waiting to be called in to see the nurse or doctor. Siyaya performers pictured first, then the waiting room at the clinic.

To illustrate the story of AIDS in the township let me introduce you to Lydia and Neo. Lydia is HIV positive and has been very sick. With the help of ARVs she is strong again and is able to take care of her son Neo, who is 6 and is also HIV positive. Lydia has no family other than her son. She lives in a shack out back of some distance relative, and it’s a difficult situation because these relations will not let her in the house and bleach everything she touches. Neo is also very sick and has other complications that require surgery, but he can’t have the surgery until he gets stronger. Edwin and JL Zwane have helped Lydia by building her a nicer shack, and Jane Letourneau at Open Arms helped by getting Lydia some much-needed glasses (she’s losing her site as a complication to the ARVs, I think). We had the honor of going with Lydia when she got her glasses. It was heart-warming to see how such a basic gift made a huge difference in her life. Jane, you would have loved it.


I heard today that the H1N1 virus is on the verge of being declared a global pandemic. Again, sorry if I offend, but if it is a pandemic we sure have a lot to learn about how to treat a pandemic. AIDS is almost completely preventable but still it is allowed to rage on. This makes me angry.
Let me say some things about the township so that my friends don’t completely think it is a cesspool. There are marvelous people there. Edwin, Spiwo, Johanna all are amazing people. Xolani (koh-LAH-nee) our driver in the township is another example of grace and kindness under difficult circumstances: he took in his brother’s kids after the brother died, and he has a son of his own and they all live in a shack that flooded while we were there (and he never complained). Our Mamas and their friends have tremendous heart and spirit and every one of them is involved in the church or the community center in several ways, and this is in addition to raising their children (and grandchildren) and having jobs. I will remind myself of this every time I think I am “too busy” to help when my community is in need (sorry Marc, this means more volunteering is in my future).


And I want to say something preachy before I finish (and then I’ll return to blogs about the beauty of Cape Town): never underestimate your ability to help people, no matter how large the problem may seem. Recycle you clothes by donating them. Pull a few jars of peanut butter out of the pantry when the food drive happens. Read with the kids at school and show them that they can succeed and that there are other adults they can trust. Welcome people into your home, church or community. Let kids know they have value by coaching, teaching, greeting them by name when you see them. These are all very small things. I saw the incredible power of small things when in Guguletu. The impact of a pack of McDonald’s toys on kids who have few toys. The excitement over new socks. The gratefulness for a package of rice and some fish sticks. The smile that comes from being shown your picture in someone’s digital camera screen. It is my hope to be grateful every day for the small kindnesses I have been shown by the people of Guguletu. I thought I was bringing them so many small things, but they gave me so much more.