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.