Melissa: Peer2Peer training

A few weeks ago, Joshua and I were selected to become peer educators in the Stellenbosch University HIV awareness program. The program- Peer2Peer- focuses on prevention methods, including voluntary counseling and testing, awareness sessions and condom distribution. Their vision is: “By 2012 there are no new infections on campus. University management, institutional units, staff and students are working together to enable leadership, health seeking behaviour and quality education needed to effectively respond to the challenges of HIV and AIDS in South Africa, and the African continent.” As Peer2Peer educators within this program, Josh and I will receive training before participating in clinic outreaches, mentoring sessions and individual or group interventions. The biggest outreach hosted by the organization, the Grow Up and Get Tested campaign, is held annually in March so unfortunately we will not be able to participate in that. However, there are many other ways to get involved.

We had our first training weekend two weeks ago. We began on Friday with activities meant to break the ice between peer educators. For instance, a sticker was placed on each of our foreheads and we had to ask questions to discover who our new persona was. Josh successfully figured out he was Marge Simpson, while I didn’t manage to figure out Christiano Ronaldo (shame on me, I know). After a few other exercises and a pre-training questionnaire, we discussed our role at Stellenbosch. Peer educators are educators, activists, referral resources (able to provide names of locations, as well as directions and a name of a contact) and role models.

We next explored personal attitudes regarding values and gender. Much of being a peer educator is recognizing personal viewpoints and learning to express these clearly, while at the same time understanding how to put personal beliefs aside when dealing with people who have different belief systems. As an exercise, the group of around 40 trainees was asked to stand in the middle of the room. One wall became “agree” while another was “disagree.” We were then asked to bodily respond to a series of statements--Virgins can be sexually active. Men and women cannot have an equal say in decision-making. Heterosexuality is a choice. If a man is diagnosed with an STD he should be forced to test for HIV. After the group split into “agree” and “disagree,” individuals were asked to explain why they chose that particular wall. The answers were extremely interesting and varied as a result of the wide range of cultures represented in the room. Everyone was able to listen respectfully and some people were even persuaded to cross the room and change their response.

On Saturday morning we began by trying out a webCT course on HIV that will be compulsory for all first-year students to complete, beginning next year. The course consists of a pretest, informative module, and a posttest. While the module itself was interesting and informative, Josh and I suggested many improvements, most of which involved grammar or punctuation. We both felt that if the course was going to be affiliated with Stellenbosch University, it should look and sound professional!

Next was a session on HIV/AIDS. To share a few of the scary facts we learned:
-There were an estimated 33.2 million people living with HIV in 2007 with 2.5 million from new infections during that year.
-Of these 33.2 million, 22.5 million are in Sub-Saharan Africa.
-In South Africa, the Western Cape (where we are) has the lowest prevalence. It is 1.9%, while in other regions it is as high as 16.5%.
-Africans have a prevalence of 3.4% while other race groups are below 1%.
-In the 15-24 age group, females have 8X higher incidence (6.5% compared to .8% for males). This is likely due to multiple partners (one infected male infects multiple women) and women sleeping with older men in return for gifts.
-The age of sexual debut is 11. This refers to penetrative sex not due to rape or molestation. (This was particularly shocking to Josh and me. Eleven?!)
-More than half (57%) of sexually active females 15-24 have never used contraception.
-66% of people believe they are not at risk for HIV.
-51% of HIV positive respondents thought they would probably not or definitely not get infected with HIV.

After a quick lunch tea break we returned for another session, this time on how HIV/AIDS works.
-HIV= Human Immunodeficiency Virus
-AIDS=Acquired Immunodeficiency syndrome.
-HIV/AIDS can be spread through semen, vaginal fluids, blood and breast milk. Saliva and tears contain negligible amounts of the virus. You cannot get AIDS from mosquitoes or an animal bite.
-In the body’s immune response, phagocytes patrol and look for intruders. When an intruder is recognized, it sends for macrophages, which then confiscate an antigen. CD4 cells recognize antigen and attack the HIV. Next, antibodies are produced, slowing down HIV and making it an easier target for phagocytes to find.
-During the first 12 weeks after infection, the viral load increases as the HI virus replicates itself, killing CD4 cells in the process. This is the window period. Antibodies have not been produced, so if you are tested in this time it will be a false negative. Also, you are most contagious in this time.
-After 12 weeks, antibodies are produced and CD4 count goes up. There is then an asymptomatic period that can last 8-10 years, but CD4 cells continue to die slowly. Eventually, there is a tipping point, where there are not enough CD4 cells to manage your immune system. At this time opportunistic infections, especially TB and Meningitis, begin to appear due to a weakened immune system.
-South Africans qualify for government provided ARVs when their CD4 count drops below 200. They continue to take ARVs for the rest of their lives.
-AntiRetroviral (ARV) treatment suppresses or prevents the replication of HIV in cells. This allows CD4 counts to increase and the immune system to rebuild itself.

For lunch, the Peer2Peer program provided everyone with food from the Neelsie Student Center. We ate outside with new South African friends from the program. The lunch discussion revolved around the issue of race and how it is acceptable conversation in South Africa while almost taboo in the United States.

On our return to training we were placed into same-gendered groups and asked to discuss what sexuality meant to us. To do this, each group traced a body on large pieces of paper. We then drew what could be seen with clothes on in detail. My group’s body (Phobe- a homage to Friends) was given extremely good nails and facial features, as well as numerous pieces of jewelry. Next we were asked to draw everything that could be seen with clothes off. People were a little hesitant to draw at this point, but we soon got over it. Next came labeling parts of the body that everyone was self-conscious about. This was easy. Our labels included: fat legs, skinny legs, love handles, weird hands, ugly feet, crooked teeth, big calves, arm flab, scars, birthmarks, strange toes, acne, big breasts, small breasts, too short, too fat, too thin, too black, and so on. Less easy was labeling of areas of the body that give pleasure. Girls were again reluctant to begin, but eventually proposed labels that ranged from forehead kissing to ear licking to foot massages to the general area of breasts, etc. Upon finishing the posters, each group was then asked to explain their poster to their group. I was amazed at how explicit and open everyone was willing to be. There was laughter and teasing at some of the labels (especially the boys’ groups for some reason!) but it was a very safe environment.

On Sunday the training focused on living positively with HIV. We were first informed that yesterday everyone was infected with a rare strain of a disease. To counteract this, we must take medicine (a piece of sugar coated candy) every 6 minutes. My table set an alarm every 6 minutes and everyone would remind everyone else to take it. While at first we were so aware of the time we did not need the alarm, it came in handy as we began to be distracted by other things. The trainees were shown several videos about people living with HIV/AIDS. One was a televised support group comprised of doctors and also people living with the disease. One member of the group was a hemophiliac man from Stellenbosch who contracted HIV during a blood transfusion at age 6. His parents did not tell him until he was 15 and he came out at age 19. Now 23 and married, he was subject to discrimination in Stellenbosch due to his status. That just goes to show how great the stigma around HIV is. A white, straight man is HIV positive, but didn’t contact it through sexual means and he is still blamed by the conservative community. Other videos included a video of a white HIV+ Afrikaans woman who gave birth to an HIV+ son, a documentary-style video about a reporter trying to trace who gave a woman HIV, and interviews with positive black HIV+ role models. By the end of the day, we had a better idea of the different responses to living with HIV, as well as an idea about how difficult it is to remember to take medicine at a certain time. How terrible it is that those on ARVs have to take pills for the rest of their lives!

The weekend was long, but extremely interesting and informative. The second training session is this coming weekend and I am excited to learn more and become better prepared to discuss the topic with others. We'll keep you informed. Also, if you have questions, just ask!

Who knew bell peppers and butternut squash were so tasty?

For those of you who might have been wondering about our abilities to provide food for ourselves, rest assured that we are doing quite well! We do our best to buy the healthiest food at the lowest price, and what we end up with is usually delicious! Below is just a glimpse into the wonderful world of cooking with Drew, Josh, and Melissa...

Josh: Kissing Festival and a Few Other Photos

I just wanted to reaffirm how much I love the uniqueness of this country. Two weeks ago, Drew, Melissa, and I went to "Salaam" (river) by the corner of the Unversiteit van Stellenbosch's campus. There, the administration and Student Representative Council had organized a massive attempt to break the world record with regard to...yes...most couples kissing at a time. The event was absolutely insane! Over 7,600 students packed into an area just a little bit wider than the length of a street. All participants received free umbrellas (nice ones, too, I must add), listened to a music concert while all the Stellenbosch students were herded in, and then the kiss itself lasted for the duration of one song. While we did not reach the world record--It stands at 7,000 Parisian COUPLES--we did start an exciting, or at least an extremely interesting, tradition. Eventually, the Universiteit van Stellenbosch will grace the pages of the Guinness Book of World Records.

The couple you will see is Stacey and Jacques, my South African friends from my Global Governance course. They're probably the coolest people we've met yet.

I'll also include a couple of bonus shots. There is a picture of Drew holding his Nashville, AR, newspaper so that he can issue an article to his hometown paper. The other bonus shots are two photos of the African market in Cape Town.

Melissa: Soundtrack of My Life. Track 8. Michael Buble.

In the first post on this blog, Joshua wrote that the three of us would reside 8800 miles away. I couldn’t understand at the time why this figure seemed to bother my mother so much, why knowing the exact mileage made the distance real. It was just a number, and a pretty exciting number at that! I would be miles away from what I’d known and since I could still call, email or webcam, the distance was never truly important to me. But when I heard last week that my pastor, David, had passed away from cancer, the distance became almost tangible. 8800 miles stood between me and my family. 8800 miles between me and the hugs I wanted to give Alex and Bonnie. 8800 miles from the hugs I needed to receive.

Another aeroplane
Another sunny place
I’m lucky, I know
But I wanna go home
Mmmm, I’ve got to go home

I knew before I came to South Africa that David’s death was a very real possibility as he had been battling cancer for multiple years and it wasn’t looking good. While most of my goodbyes were happy, saying goodbye to David was extremely difficult. He made sure I knew how proud he was of me and how he knew this journey would challenge and strengthen me. I think both of us were teary by the end. Neither of us said it, but we knew that our goodbye might be the last we said. Two weeks ago I woke up crying from a dream where David had died and found ot soon after that he wasn’t expected to live for much longer. I thought that I might get to speak to him by webcam, but unfortunately never had the chance.

Let me go home
I’m just too far from where you are
I wanna come home

Last Sunday night I found out in an email that David had passed away. I just sat in my room and cried. I tried to find someone online to talk to, but I could not find anyone that I thought would understand. I didn’t know my roommates well enough to share this with them, and while I could have gone to Josh or Drew, it didn’t feel right. I needed to speak to someone who knew Pastor David so I wouldn’t have to explain how deeply I felt about him. I didn’t want to try to explain why I was so upset even though I knew it was coming.

And I’m surrounded by
A million people I
Still feel all alone
Oh, let me go home
Oh, I miss you, you know

I managed to speak to Katie, my roommate from Missouri State, the next day, which was helpful. I don’t think I ended up really saying all that much, but she had met David and knows me, so she could understand the situation. Katie has this wonderful gift of knowing when to just listen and this gift translates to communication via messaging systems as well. There were a lot of times when I just sat looking at my computer screen, typing and then deleting things without sending them, but knowing that she’d sit on the other end and wait without rushing me. Once again I thanked whoever it was that matched us as roommates. (I love you, Katie.) The rest of the week, while better, was more somber than usual. I found myself declining invitations to go out, staying awake longer than usual and being in an unusually irritable mood.

Another winter day has come
And gone away
In even Paris and Rome
And I wanna go home
Let me go home

On Thursday I was given the option of watching David’s funeral via webcam. At first I felt apprehensive about the idea; it seemed as though I would intruding in some way. However, the more I thought about it, the more I wanted to be part of the service. As I was so far away, the whole idea of David being dead wasn’t completely real; I needed to see the casket to have closure. Though there were difficulties with the webcam and I ended up only getting to see parts of the service, it was still nice to get to hear Muriel preach and see that everyone was coping. It also helped that during the service I was led to Psalm 90. At one part it says, “So teach us to number our days that we may get a heart of wisdom. Return, O LORD! How long? Have pity on your servants! Satisfy us in the morning with your steadfast love, that we may rejoice and be glad all our days. Make us glad for as many days as you have afflicted us, and for as many years as we have seen evil. Let your work be shown to your servants and your glorious power to their children.” (Psalm 12-16, ESV.) The passage became a source of peace for me, illustrating how God is so much bigger than any of our lives. If I need reminding, I simply look at that verse.

So that is a brief update on me and what’s been happening. Life –the good and the bad--doesn’t stop because I’m in South Africa. Part of my growing process will just have to be learning how to deal with these situations. And really, just because I’m 8800 miles away doesn’t mean I’m alone. A special thanks to all those who made that very clear.

Drew: SLCD Reflective Journal 2

I went with Renee, our Pennsylvanian friend, to the African Market here in Stellenbosch determined to find a chess set. Luckily, too, I found one. And not just any set, but a hand-carved stone set with pieces supposedly made of verdite and malachite (probably not, but they sure do look cool)! I also managed to purchase an amazing painting. All total, it was R400, just about US $55!





So eventually Josh or Melissa will put some pictures on this site, or at least write an article or two of their own. For now, though, you will all just have to settle with reading my analytical masterpieces... and as always, the actual names of people have been removed from this post and in their place you'll find [job title].

Service Learning in Community Development
Reflection Journal 2: 12/08/08

Monday, I arrived at 11 and left at 1, giving me two hours to view operations on a day which I will not normally be present. However, I felt it was important to attend the clinic because of the stark differences between a Monday/Wednesday and a Tuesday/Thursday. [PharmD 2], a pharmacist who spends two days per week at the Idas Valley clinic, was there and taught [my partner] and me how to enter records into the computer using their software system. As she worked with us, I think we both became aware of a situation that we feel could be improved throughout our service-learning. They are presently trying to move all records onto the computers, a daunting, if not impossible, task. Yet they seem to have been making much progress in terms of entering most of the patients into the software. However, most of the computerized records are not fully updated and many do not contain important test results and prescription regimens. As many of the physical charts are in poor condition, there is a possibility of loss or damage to the physical records and without electronic backup, ill effects could surely follow. As these realizations came to mind, I felt slightly apprehensive. If someone’s chart was to disappear for whatever reason, their health could be in jeopardy. It would fall upon the doctor and the patient to remember the complex drug combinations, and any lack of adherence to a regimen increases the chance of developing resistant strains of the virus. Thus, if we could perhaps work with the clinical staff and develop more computer literacy in regard to the medical filing software, it would speed the transition and enhance the effectiveness in using electronic records. This would lead to an increase in security, confidentiality, and kas;a, as well as providing a safeguard against a possible deterioration in the clinic’s ability to provide appropriate medical services to all who need treatment.

Tuesday was spent mostly in Observation again with [Sister 1]; the last hour was dedicated to entering more records into the computer. [Sister 1] has been the person with whom we have had the most contact and I would say that my conversations with her were the most important aspect of this week. We had discussions on topics ranging from equipment at the clinic to weekend excursions, proving our acceptance more or less into this community. She does her best to be encouraging and informative, and I felt secure in my role and confident in my service following my exchanges with her.

A third “incident” happens all the time, and as such, I will not mention a specific example but rather the general occurrences and associated feelings. Each time a patient’s chart is brought to us, we proceed to gather the necessary information. However, due mostly to the language barrier and also to the limited time we spend with patients, it is hard to develop any sort of dialogue or relationship with them. By the time they adjust to us as new staff in the clinic while we are concentrating heavily on doing our jobs correctly, it is time for them to leave the room. I will not say that it is frustrating, but I do not foresee much interaction with patients other than providing a medical service. Thus, any development project will almost necessarily be geared toward the facility and/or staff.

Routine tasks, simple procedures, and busy work all make up a large proportion of my time at the clinic thus far. I would therefore like to make two comments in this regard. The first is my appreciation of the staff who willingly allows us to participate in their daily work, providing us a hands-on yet limited introduction into medical practice. This works well: we have not been thrust into any situation that is in anyway mentally or physically challenging or risky while still having the chance to learn and work in a clinical setting. These baby steps are a highly suitable approach and the set limits give a structured entrance into our future profession. Proceeding, my second thought on these tasks has been that they provide us with sufficient time to acquaint ourselves with the staff we are helping. Between each patient or observation or chart we engage in small-talk that allows us to develop friendships, ascertain the existing needs and goals of this community, and gain practical knowledge in the realms not only of medicine and community development, but also language acquisition and cross-cultural communication.

We are still very much in the critical contact-making phase of development. Learning is taking place on both sides as familiarity is enhanced. As they get to know us and work with us, each staff member shows more interest in our presence as pertains to academic study as well as community development. If this solidarity increases, I predict they will respond well to any attempts at furthering development we might suggest.

Coming from a medical environment where everything is extremely organized and strictly managed, it is slightly unsettling to see such a specialized clinic operate in such a relaxed way. Some sisters often forget to wear gloves, there are occasionally multiple patients in the room simultaneously, and the condition of the charts and lack of electronic data are examples that alert me to differences between the private, sterile environment in US clinics and this government-funded clinic. In no way am I suggesting that this clinic is doing anything 'wrong' or 'bad,' but differences exist and can often impede adaptation of the community development worker. Thus, a healthy realization of the environment in which one works is, I feel, a good way to begin to get to know and accept the community and it will ultimately help them get to know you.

In the previous postings I mention a certain “community” and would like to provide specific qualifiers and contexts to this oft used term, although none are wholly accurate. The physical locale of our SLCD is the Idas Valley ARV Clinic found in the section of town east-northeast of campus. In strictly geographical terms, following this logic, the community is a site housing a pharmacy and a primary care, ARV, and dental clinic and encompasses all those who travel to this place. In a professional workplace classification, it would denote those doctors, nurses, and other trained personnel who work together as a team in pursuit of a common goal (improving the quality of life for HIV victims). It could refer to the fostered sense of kinship between patients and their caregivers, and could also be extended to include all patients who ever attended the clinic. By examining and combining these last two, one could say that the community extends even further to the surrounding township clinics to include patients receiving treatment from the traveling doctors. Community could also refer in a hierarchical way to include the governing body of the clinic, its source of funding (government), and any inspectors assigned to assess effectiveness. My view, though, scales down the scope in this case to those persons with a vested interest in the day-to-day operations of the clinic. I feel this includes the full-time clinic staff, auxiliary workers including doctors, nurses, and pharmacists who periodically spend time there, and also the patients. I hesitate to include a collective “patient” as part of the community, for there seems to be few commonalities between patients other than their present affliction and view of the clinic as a kind of sanctuary, and if such commonalities do exist, this is neither the setting nor is there the desire to create any solidarity amongst themselves. However, they too have a vested interest in the clinic, and it was established initially for patients and could not exist without them. Also, the workers involved directly with these “patients” (such as counselors, reproductive health workers, and the medical staff) lend to the overlapping of various social fields, which ultimately merge into a community field and as such, patients are included when I speak of the “community.” Individually, also, each patient forms relationships in the clinic and are the members who stand to learn and gain the most.

Drew: Brief Note

In July, I posted a day-by-day list detailing activities and travels in an entry entitled "My Long Overdue Posting". I have now gone back and added to that post a list (although somewhat vague) bridging the gap between when it originally finished on July 23 and now. To access it, scroll really far down OR click the arrow by the "July" tab on the right hand side of the screen and then click the name of my post. Just FYI! We love and miss you all!

Drew: SLCD Reflective Journal 1

So a few of you have been waiting to hear from me in regard to my volunteer work, that very evasive subject that I promised many times would be worthwhile as a reason to come to South Africa. Well, it would seem that fate is once again on my side. After a brief power struggle with Murphy, my Service Learning in Community Development (SLCD) supervisor managed to find a perfect fit: an ARV clinic. ARV stands for AntiRetroVirals, the medication used to slow the progress of HIV. At the end of each week, it is policy that students should submit online an in-depth summary of their community work, complete with details, feelings and emotions, and reflections over newly attained knowledge about the micro environment in which we work that can be applied on a macro level. Thus, I have decided to post each of those journals on this site.

Josh has told me numerous times that posts of this nature are too long, a tedious read, and undesirable for most of the readers of this blog. However, I believe that most of you who check this blog from time to time feel that we do not post frequently enough; this should satisfy you and help to provide a picture of a very important aspect of South African life.

Service Learning in Community Development
Reflection Journal 1: 07/08/08

Let me first begin by mentioning a meeting that took place on August 5 with [Teacher], [My partner], and me. While the other students in the course knew of their placement sites last week, things did not work out as planned with the hospital and there was a time of uncertainty as to whether or not I would get to serve in a medical setting. After hours of hard work and multiple annoying emails from me, [Teacher] succeeded in securing for us a placement at a local antiretroviral (ARV) clinic. After informing us of this opportunity, she proceeded to discuss very important concerns she had regarding the site and wanted us to know both the entire situation from the outset and what our feelings were in response to her concerns. These included our safety, first and foremost, as well as an extra time commitment and possible dress code, among others. Of course, I was excited to learn the details of the community and environment in which I would be working. Before I move onto details of the actual site entry, I want to briefly discuss a few thoughts I had in regard to this meeting. First, I thought it was very respectful for [Teacher] to meet with us and explain her hesitation to let us work in the clinic out of concern for our health and, by asking for our feelings, give us a choice in the matter. Also, she provided us not only with detailed observations that she made while at the clinic making arrangements but also many historical, political, and otherwise relevant information that helped to paint a very real picture in our minds of what the experience might be like. Community Development theory places a great importance on the initial entry into a site, and planning for that entry is a prerequisite. This meeting served that purpose well.

At 8:00AM on August 6, [My partner] and I met at the gate to our residential complex. We walked to [Teacher’s] office while discussing our anticipation for the day’s holdings. Who and what would we encounter? What would we be doing? And as a spoiler for these questions, I can say that we were not disappointed. Saying this, however, might suggest that we were content, if not enthusiastic, about what we discovered throughout the day, and to this end I attribute such positive emotions and satisfaction with the details of the functional aspect of our service, not with the people, conditions, afflictions, and circumstances. No one can be happy seeing patients with HIV, but they can be content knowing that they are getting to perform a service.

Upon our arrival, we met with [Doctor 1], the ARV clinic doctor. After briefly discussing if there was a uniform to wear or dress code to follow, [Teacher] left and we began talking with [Doctor 1] about what we would be doing. She was very relaxed and pleasant to speak with; she seemed mildly excited to have the opportunity to show us around and tell us the many practical medical aspects she was going to teach us! She also stressed that she was not going to strictly demand that we follow any set timetable of volunteering at the clinic and that she would not ever just place us in any area and ask that we do one task over and over without our consent. And while the former is definitely not going to happen (schedules are always needed, in my opinion) and the second may or may not always be the case, she did a good job of making us seem welcome, like she was very willing and open to having us join in with their work.

Following this, she showed us around the clinic and also introduced us to all the staff. The first person we met was the pharmacist, [PharmD 1], who during her studies had spent a semester in Montana. We also met [Sister 1], a humorous nurse who does the initial observations on patients before the doctor sees them. We were also introduced to the counselors (who work with patients on adherence and education), as well as taken to the opposite end of the building which houses a small primary care center (at which there is no regular doctor). All total, the building is occupied by the ARV clinic, a small dental office, the primary care center, and the pharmacy. [Doctor 1] took us back into the pharmacy where [PharmD 1] greeted us and spoke of a few opportunities we had to accompany her to some of the surrounding clinics in the townships.

After the introductory phase, we were placed with [Sister 1] so that we could spend time seeing the first stage in patient care – observations. While here, we learned the fine art of taking bloed druk (blood pressure) with a sphygmanometer and a stethoscope, which we will get to actually perform tomorrow. We also learned how to read urine tests (and say the Xhosa command for something along the lines of “go to the bathroom, pee in one of the cups, and bring us the sample”; more than likely, though, it is probably just the command for "pee") by comparing any color changes to a chart and looking most commonly for proteins, glucose, blood, and occasionally a low pH or the presence of leukocytes. We also experimented with blood glucose levels by pricking our fingers with lancets and testing the blood, as well as learning the significance of weight and weight loss as a primary indicator of health in HIV patients, methods the clinic uses for family planning and birth control, and how to read and record information in the charts. After all of this practice, we began seeing patients. We only watched, though, and were careful not to interfere with [Sister 1]'s work. [My partner] assisted a little bit toward the end of our time with [Sister 1], and I chose to stay inactive because the small room would have been overwhelming if all three of us were moving about and taking turns with the observations. However, between patients we would joke about how tomorrow she was going to have a nice long break because we would be doing the work! I also began a conversation with her in which I just started asking about her history in the nursing profession, how long she had worked in the clinic, what fields she had practiced in, and so forth. During her 38 years of nursing (she is 60, which we would both have sworn she was no older than 45), she has worked in wine farms, hospice care, hospitals, and various clinics. Her insight into many things, I think, will be valuable because of her history in many aspects of medicine in the South African way of life. She was very friendly, and seemed to enjoy our company and, at times, entertainment. Her new goal for the next few months is to teach us Afrikaans, and she is certain she will succeed if we see her often. This is the entertainment about which I mentioned: she would tell us words and we would absolutely butcher the pronunciations! I look forward to spending more time over the next many weeks with [Sister 1] not only for guidance and wisdom, but also as a friend.

Following our wonderful 2 hours in the observation room, we moved back to the examination room with [Doctor 1]. We first saw a female patient who had a cough and had lost 10 Kg during the last month, which is unusual considering she had been started on ARVs and that usually causes a slight increase in weight. The chances were, [Doctor 1] explained, that the patient had some sort of infection and began asking a few questions to the patient. Following this, she had the patient lie on the table and examined her as she explained what she was doing to us. JACEL (like jackal) is an acronym for immediate things to note and stands for jaundice, anemia, cyanosis, edema, and lymph nodes. After this, she started at the head (checking head/neck for stiffness, a sign of meningitis) and worked her way down the body including listening to her breathing with a stethoscope and checking for abdominal discomfort. She discovered that the patient’s right lung sounded distressed, and then instructed us to listen to each other’s breathing and then that of the patient’s. Our conversation at this point focused on making sure to check the basics, and one sentence she said in particular referred to even checking that the patient eats. Not eats three balanced meals each day, or maybe a few too many unhealthy items, but eats at all. Sure, we hear similar messages in our theory class and in news stories and is predominant in the average American’s preconceptions about Africa, but actually hearing the doctor say this really served to make the meaning of this concept clear: that poverty is absolutely real and it is absolutely affecting so many people, to the point where each patient may or may not even have any food to eat. [Doctor 1] then scheduled the patient to have an X-ray next week at the hospital (the clinic doesn’t have an X-ray machine) to check for a lung infection and then said that “hopefully it was tuberculosis.” In this case, tuberculosis would be a much more easily combated illness than some of the other potential opportunistic infections.

The next patient was seen only very briefly as a checkup appointment, and then our driver from the international office arrived to pick us up. We scheduled our time for tomorrow with [Doctor 1], and we confirmed with her our times on Tuesday and Thursday of each week. She would prefer that we arrive at 9:00 instead of 8:00 because the clinic would be much slower and she did not want to “waste our time,” another courteous gesture on her part which I think shows both her willingness to work and accommodate us and her wonderful, delightful personality.

I must say, today’s experience was an eye-opening one, for sure, and also a very exciting one. [Doctor 1] and [PharmD 1] want to teach us many things about the actual practice of medicine, [Sister 1] wants to teach us Afrikaans and let us do some of her work, and everyone else is very nice and has the potential to be (we did not get to interact much with the others, but we will eventually get to) just as welcoming, enthusiastic, knowledgeable, and accommodating! Of the three goals of contact making in community development, I think that important progress was made in terms of getting to know a few members of this medical community and also in terms of their acceptance of us. Because we were not there for too long, I cannot profess to adequately know any specific needs the community has identified, but these will come in time. They do not have X-ray equipment and there is a problem with adherence (patients failing to take their prescripted ARVs and thus developing resistant strains of HIV), but many more needs might surface and it is premature to focus on just the ones noticed immediately.

Service Learning in Community Development
Reflection Journal 1: 07-08/08/08 - Part 2, added after online submission

August 7, 2008 - I went to the clinic this morning and after briefly letting the Tanya know that I was present, I went immediately to Observations with [Sister 1]. Donning a pair of gloves, I practiced taking blood pressure on [My partner], anxiously awaiting my first patient. When a stack of medical charts were delivered to the room, I let [Sister 1] take the first one. Again, the routine is simple. A patient goes first to the bathroom and micturates in a cup. Upon bringing the sample to us, we place a strip in the urine and look for the presence of different molecules/cells while they return to the restroom to dispose of the urine. We then get their weight by asking them to “trek asseblief jou skoene ait en staan op die scaal (take please your shoes off and stand on the scale – literal translation).” Then we take their blood pressure, and, if they are diabetic, we take their blood glucose level. During this process, there are a few things for which we have to look out. The first is a very high or very low blood pressure, but this is not often seen. The most important thing, though, is to compare their present weight with that of their previous visit. If they lose more than 2 kg, we are supposed to alert [Sister 1], who then makes a note for the doctor. Sadly, several of our patients today had lost weight, an ominous sign in their struggle against HIV.

All total, we spent 4 hours in the Observation room seeing patients and entertaining ourselves when no patients needed our attention. At one point, too, [Sister 1] felt so confident in our abilities that she decided to take a break, drive downtown, and buy herself a sandwich because she was hungry! I must say, she is quite the character. She is determined to teach me Afrikaans by the end of the semester and teaches me new words and phrases. She also has a motivational calendar (the ones on the roller that you flip every day to a new phrase) and has me read the day’s saying, which of course is written in Afrikaans, so that I can practice my pronunciation. At the end of the day, too, we were invited to attend Friday’s support group for those aged 15-25.

August 8, 2008, 9:00 AM– I waited for nearly 45 minutes before anyone showed up to the clinic for the support group. However, [PharmD 1] was there and, while waiting for patients to arrive, we had a wonderful conversation about her semester spent in the Montana, our experiences thus far in Suid Afrika, her desires to move to either Canada or the US, and the history and purpose of the support group. Let me mention a quick note here: this is a perfect example of one of Suid Afrika’s most challenging problems, called the Brain Drain. Because of the uneducated masses voting for the African National Congress (ANC), whose socialist policies and corruption are quite evidently detrimental following Nelson Mandela’s presidency (under his rule, things were much better…). Now, though, most of the highly educated professionals realize that things would be so much better for themselves should they emigrate to another country, and as they have the resources and luxury of doing so, they relocate, leaving the country with fewer and fewer professionals to meet an ever growing supply of needs. It’s sad, but true.

After a while, two people showed up for the support group. One was a male; the other was a female. Only these two showed, but it turned out to be a pleasant experience for us all. We were able to chat with them in a very intimate setting, getting to know them and talk of our lives and interests.

He really enjoys music, plays in a band, and writes his own songs (he’s actually invited us to a concert in a few weeks where his band will be one of several opening for a larger band). She is a quiet, friendly girl who speaks Xhosa, Afrikaans, and English, and thus will serve as a translator in the support group should others choose to speak in one of those languages.

Also during the hour while we were all together (we had to leave at 10:45 for an 11 o’clock class), [PharmD 1] and our two new friends planned how the support group would work, including setting the agenda and laying out a few rules. Unknown to us, this was only the second week of the support group and thus we have the chance to help get things going.

Melissa: Overview of Classes

What looked to be a simple assignment—read a packet and answer seven questions—turned out to be an extremely lengthy and complex undertaking. Each question had multiple sub questions and the words “analyze,” “compare,” “evaluate,” and “discuss” abounded. After working on this assignment off and on for the past several days, I submitted the final paper this morning in my History 244: South Africa -Colonization and the Rearrangement of Societies class. It was seven pages and 2200 words long! (It should be noted that the research paper I am required to complete within the next month is only 4000 words.) The class is enjoyable, despite the heavy workload. Taught by an American who likes to discuss Obama and They Would Be Giants songs (Istanbul, Not Constantinople…), the class is conducted completely in English. Initially I was going to take a different history class, but after the lecturer taught primarily in Afrikaans I found my current class a pleasant alternative. We are presently focusing on the Trans-Atlantic Slave Trade and its debilitating effects on African development. Yesterday we attempted to answer the question: Did racism ‘cause’ or ‘result from’ the Atlantic Slave Trade? In other words, were blacks enslaved because they were seen as inferior, or are blacks seen as inferior because of a history of enslavement? Interesting arguments can be made for both sides. Similar to most undergraduate classes, this course has three lectures a week, as well as an additional tutorial taught by a graduate student. It is during these tutorials that assignments are collected and tests written. It is also a time for discussion and questions on the assigned additional readings.

I am also enrolled in Theatre 178: History of Western Theatre. We will study theatre and theatre conventions of Western drama by examining key texts (Major Barbara, Mother Courage and Her Children, Medea, etc). At the moment the class is examining Ibsen’s A Doll’s House. Professor Hees, who regularly reminds me of Bill Morgan, also teaches primarily in English. His favorite phrase, heard numerous times in each lecture, is “The text is not the play.” He also tends to answer questions about his lectures with “Did I say that? Well, I’m glad—that’s precisely what I meant.” There is to be an essay in this class as well, though Professor Hees told us not to worry about it yet--“I’m sure I’ll tell you about it sometime before it’s due!” The professor of my 178 tutorial is equally amusing, performing large sections of A Doll’s House in an outrageous melodramatic style. I will never be able to read the alternate ending to the play without the memory of Schalkw running around the room as he played both Nora and Torvald, as well as read stage directions aloud in a voice worthy of movie trailer voiceovers. As an added bonus to the amusement this class provides, though only a first year class at the University of Stellenbosch, this class will transfer back to Missouri State as a 500-level course!

Professor Hees is going to take over my other theatre history class, Theatre 354: History of South African Theatre, after next week. At the moment Professor Hauptenfleish is presenting an overview of South African theatre forms, genres, productions, actors, purposes, and so on. The material is fascinating, but the lecturer regularly lapses into Afrikaans and I miss information, only picking up a date or a name now and again. Though I may have lost a few facts along the way, after beginning with the indigenous forms of drama, we have made our way through time to the current discussion of how theatre was affected by apartheid. By the 1970s, new laws extended to theatrical activities and racially integrated casts and audiences were effectively illegal, although some innovative individuals managed to get around these limitations. Playwright Athol Fugard began a members-only “club” that only happened to consistently present contemporary plays that commented on apartheid, performed by multi-racial casts to multi-racial audiences, while British Donald Howarth wrote Othello Slegs Blankes (Othello Only Whites) for South Africa. Othello, being a black man, could not be portrayed on stage alongside white Desdemona, so Howath made a statement by simply writing him out! After Professor Hauptenfleish concludes his history lectures next week, Professor Hees will begin a study of significant texts from South African history. The reading list includes Ubu and the Truth Commission, Saturday Night at the Palace, The Island and Die Jogger, which I have yet to find an English translation of.

In Theatre 178: Acting, I am performing a scene from Mourning Becomes Electra by Eugene O’Neill. The play is based on Aeschylus’s The Oresteia trilogy and involves the Oedipus Complex, the Electra Complex and Freudian psychology. Fun, I know. In the scene, Lavinia Mannon (myself) confronts her mother, Christine (my partner Estelle), about her adultery. The scene is one long power struggle, with each character strategizing on how best to get the upper hand. In a recent tutorial, Professor Du Preez compared it to a chess game between two masters: all action is strategic and precise, any weakness is preyed upon by the other. In pure Naturalistic style, at one part in the scene my character seemingly absentmindedly fiddles with a chess set laid out on the table. Though presented as an idle gesture, the symbolism is really quite unmistakable. While rehearsing the scene today, Estelle and I both got goose bumps as the mutual hatred between our characters fueled exciting, organic acting discoveries; we’ve decided it’s our goal to make everyone in the audience shift in their chairs on seeing the distorted relationship between mother and child.

My final class is Afrikaans, a night class on Mondays and Wednesdays. After spending several days discussing how the class will learn this semester, we have finally begun to learn the actual language. We’ve covered pleasantries, colors, pronouns, articles of clothing and various other words. Josh (Jaco) and Drew (Gert) are in the class with me (Treintjie Taalyart). Though the boys are always the first to volunteer, I have not become comfortable speaking aloud in Afrikaans. While I’m doing better comprehending written and spoken Afrikaans, verbal communication is challenging. Most of my difficulties will likely solve themselves when I get over my self-consciousness and become more willing to make mistakes. Though the classroom environment is very relaxed, in typical perfectionist style I concentrate too much and think too hard, ending up making more mistakes than I would if I just lightened up. I’m far more eager to practice my Afrikaans when I am out of the classroom and around other Afrikaans speakers. I’ve begun saying simple sentences in Afrikaans to my mainstream theatre friends and then learning how to pronounce everything correctly! Today I learned the very important pronunciation of ‘hoor,’ which means ‘hear.’ A small vowel modification or slurring of the word can easily turn ‘hear’ into ‘whore,’ so you must be careful!

Though I have more work than other international students who are not taking mainstream courses, and though I will actually have to take finals, I am pleased with my decision to take the classes I have chosen. Not only do I get to learn side-by-side with South African students, but I also will have the satisfaction in succeeding in difficult courses, some of which are taught in another language!