Tuesday July 7
Today started with a lovely sunrise. Today we were introduced to the ACTS centre for AIDS and TB treatment.
Our tour was 90 minutes and it was very inspirational. Marieke Cats gave us the tour.
Dr Margie and Harry started the ACTS clinic in 2001 in a small way, in response to a vision from God for the relief of the AIDS problem in South Africa. Newly installed in power, the black government had really not addressed, even denied the AIDS problem, and they wanted to do something to address this huge gap in the health of the black, rural population of South Africa. They received a parcel of land, where they currently are, and started working. The immediate impression of the grounds were of a facility that was well-built, well maintained and visioned brilliantly. They started working out of ASM and gradually started to fill out the vision of supplying help with AIDS. Margie had been working as a health care worker, signing death certificates for aids in larger numbers and turned to specifically addressing the AIDS pandemic.
In 2004 the Anti-retro viral medications, highly successful in the western world for over 10 years, were made available to the South African situation. And then ACTS really took off. People started coming large distances to be treated, and many from within the Masoyi community came for treatment.
One current story from last weekend was of a lady’s daughter coming for a short stay (no bed for the night – our equivalent of day surgery visit) she had been refused treatment at the TEMBA hospital because the doctors were on strike. They came as a last resort because the daughter was desperately sick from AIDS. The vision of mother and daughter hugging each other with the daughter saying “I’m dying mum” is one that just cries out for action. By Monday they had a bed available and the daughter commenced treatment on a 6 month treatment on TB, and even by the end of 5 days was looking MUCH better.
TB is an infection that usually attacks in patients that already have a low white cell count – as in AIDS infection, so a virus that normally would not even touch a healthy person will come in full attack because of their reduced defences.
Problems of health care:
1. Coming too late, because they work until they are too sick
2. Traditional beliefs – like Sangomas – witch doctors etc getting between swift intervention and the patient.
The different buildings that they have at ACTS
1. Clinci with 7 doctors with consulting rooms
2. Short stay building, supplying oxygen, drips, smaller interventions, also as an intermediate wafting for hospice entry here or elsewhere
3. New building with three sections
a. Paediatrics – with doctors and Occupational Therapists visiting weekly
b. Mother / Baby section – to help to keep pregnant ladies from infecting their newborns. Just one baby has been born infected and we spoke to Gillian about all the success stories later in the visit. it is a good program based on good information, ARV’s for the mum, and really the greatest part is education
c. Cervical cancer diagnosis – this is a small operation at the moment, but they have the ability to do laser burning of the cancers. They are very excited about this new facility, because it is the first in South Africa outside a hospital situation. Often the hospitals are so overcrowded that delays occur and the cancer grows lots and is more fatal because of the delay. Wonderful!
d. Waiting Room
e. Prayer Room
4. Pharmacy building – this has been a lifeline to the community, and the US Aid funding has been incredibly beneficial. They have a very large staff with this part of ACTS – 90 staff are employed and 80 from the local area, making them a very large contributor to employment. Staff started as a gardener – one example was a staff member who started as a gardener – and he worked, but also trained as a aide, so he has really a set of skills that will enable him to get a job anywhere in south Africa. Redeeming not only the sick, but the population as well. A lot of the people work here with only primary education because of poverty, or many reasons
5. Tuckshop – was a tree with tables under it, but it has created a meeting point for the workers and is important to camaraderie.
6. Training centre / admin building – also is an important in-patient unit with an 11 bed hospital that they are very pleased with. It provides palliative care and – a place for people to die in dignity and respect, but is also supplying more hospital care. The 11 beds they try to keep filled with short stay people as much as possible, for starting with ARV treatment so education can help with things when they are on the outside. Outside the hospice – often aren’t clean – the government ones, so this is a good in-between service. It is no longer a place of death because of this.
7. Counselling cabins. These are great series of cabins – that we have pictures of. They are small, separate and private, beautifully built, that enables people to be counselled about the ARV project. Education is really at the key, so it provides for indepth counselling – deal with traditional beliefs, prejudice and family issues.
8. External projects – there are three of these – there is a mobile testing unti, that goes house to house,. Semi-porable for going to shopping centes farms, schools – educcationing in the face of shame and fear that surrounds the condition of AIDS. Prayer point – that fear will be taken away and more can be effectively treated. Counselling groups also are important, for +ve people to meet with peers to talk through these issues – they are not alone. Thirdly there are HBC units – nurses with 2 care givers – providing post-care counselling services, and this is nearly all in the Masoyi community.
9. On-site lab – world class and supplied in a container with to-be-assembled equipment out of Taiwan.
General questions – they beds are full every day and there is a 5 day average treatment. They don’t do much booking on Mondays, so that people can get into the system. They prefer short stays, seeing more popele and then supplying a secondary home care support system.
Bubesi is another centre, similar to theirs, started by funding from Richard Branson.
There aer 3-4 different ARV regimes, and only one is inexpensive, so defaulters are very ‘expensive’. Defaulting is where people do not complete the courses correctly and it can occur because they are feeling healthy again as well as because they don’t have money. They charge a small amount for the service, but even this small amount can sometimes be too much, particularly for people who don’t tell anyone else – they try to get treated secretly for fear of of the shame of the process.
A lady Hillary Grey could be a hep for Anne Hoyt in her AIDS work. Need to talk with Hillary if I can.
Measure the advanced level of HIV – it is a slow working virus, and can take 8-10 years to become symptomatic. ARVI’s drastically improve the quality of life but AIDS is chronic – it cannot be cured. It costs 60 / month, plus transport – eg from an area lie Bushbuckridge.
• Get to the bottom of the problem
• Find support for the defaulting patient
• Overcoming the stubbornness of people – not really trusting white people
Defaulting on TB medication is also common. For the workers there, it is very frustrating because the treatment is incredibly reliable as a cure if taken for the full 8 month course. Once the patient feels healthy – and a 40kg woman can increase to 60kg in just a few months on good nutrition and medication regime – but then they try to find a job and forget about the mediation or they don’t get enough to take it whilst away and they fell healthy anyway.
We visited the toga facility in a container that was heavily funded – some things need to be sent out to Jo’burg but they are far more independent now.
We saw the admin buildings and Marieke showed us a nearby area that was cleared by volunteer teams just like us. They said that it was such an encouragement and a tremendous help, so that they can apply the funds that they get for extras like a playground equipment. Mostly the staff just don’t have time for projects like that, so it becomes an action point for a future feature (I suppose like our playground project in Cork, with materials that were purchased over a year ago).
Problems with grief. The African tragedy is that there are great psychological scars because death isn’t dealt with. Kids will be taken from situations and given to relatives to avoid dealing with the death, or near death of a relative with AIDS. Consequently they never have any sort of dealing with the lost parents, and it leads to a homelessness even while in a home situation still. So the trainers at ACTS are trying to implement things like memory boxes that can contain poems and knick knacks so that people can give a proper treatment to their grief.
We visited an open treatment area. An airborne disease like TB spreads in enclosed spaces, so one of the great things about the South African environment is that they can have chairs in open, areas so people can spend time after treatment not co-infecting others. Open planned clinics are becoming highly desirable in these sorts of facilities.
They operate the hospice on a first-come first serve basis, which might sound heartless, but they try to leave gaps in scheduled bookings so that new cases can be seen on Mondays and Fridays.
We visited the –ray room which is used for TB diagnosis, one of the indicators for AIDS as well as Kapose’s Sarcoma –a very hard to treat skin disease, almost like leprosy, and a ulcers in the mouth.
They collect data and participate in world programs for AIDS research using a software called ‘therapy edge’ – and part. With USAID. – they get access to Dave Spencer and Dr Levine, world famous AIDS doctors in Jo’burg – they can come out and teach their specialist knowledge and they try to get in specialist radiographers as well for in-service training when possible
Prayer points: –
• Their interaction with government instrumentalities.
• Funding will end sometimes and they need to go with governments in a constructive relationship
• But that ACTS independence, or quality of care isn’t compromised
• Pray for the staff
Wow – that was long!
We left for our different sites, Jenny, Keith and Geoff to help with new kids coming in and old kids leaving at the Farm Camp, and the other team going to Cork. The trip out was with Jackie again, and we had a great day. The kids were slow coming, and we sent out home-based care teams, that ended up joined – so that all the young ladies in the group would get a taste.
First we had a time of playing with the kids that had arrived early, and there was an extended game of netball that was with the girls, and Leyton. A lot of fun and photo opportunities. We decided on delaying the feeding until more arrived. It was only when we hit 50-60 registered kids that we started feeding them.
The HBC team left and got back over 3 hours later – in fact they never got back, we went out in the bus to rescue them. They had an extended time visiting the homes of widows, orphans and visiting a very poor church with no roof or chairs. They are just 8-10 people, so can’t afford more. That was Agnes and Susan’s church. They also visited the houses of Agnes and Susan – these ladies are comparatively rich and we will probably get a better feel for this when we post their diary entries.
Worming was underway. We had good experience from the Joy experience, so compared to that we were a well-oiled machine. Vicki was on pill distribution, Sharni was on drinks. Steve and Sharon were on kid’s done ID and mouth opening to check that the pills were swallows / chewed. Little kids and older boys seemed to find swallowing the pill the hardest. As before they were given peanut butter sandwiches and chips in 55-packet bags to hand out. The sheer size of the exercise was seen in the buttering of 80 loaves of bread. It was hilarious to see the Hands at Work tables last night, full of teams of people from Aust.. and the US each trying to butter bread from 25 kg canisters of peanut butter yuck. More than one has commented that they will never eat peanut butter again, and Jenny confirmed how hard it is to clean peanut butter of tons of dishes, knives, spatulas and plates.
Anyway the kids started rolling through and it was going very well, and kids started appearing from nowhere. Leyton was in charge of the chips and Jared and Pat were handing out the sandwiches and directing them out the door to the back deck.
My job was overall do-er of nothing and chief of photography, both jobs taken very seriously ! Especially with my long 200mm lens, I was really privileged to try to capture the joy on the kids faces.
We had already had puppet shows and other presentations to the cork kids, and therefore just mucked around with them.
We got our total up to 150-odd kids out of 230, and that (we found later) was due to the fact that the HBC team was rounding up kids that didn’t know about the worming session and some of the early kids as well were telling their neighbours as they went home.
The US team came in and it was good to catch up with them. They wanted to see the facilities at Cork and the playground equipment. We all participated together, and packed the truck, but still no HBC team, and it was pushing 3 o’clock! A call confirmed that they were at Susan’s house, and with Simon knowing the way, we put the tools in the car, all jumped in the bus, and picked up the very weary, and hungry passengers. All I can say is they better write some diary entries, because there must be some astonishing experiences among them.
We then proceeded to Sara’s house, the widow from Mozambique who mum and Sharon wanted to help. We passed on a little parcel, and had seedlings for planting (I might have mentioned this already). We tilled an area perhaps 2.5 x 4.5 metres – close to the size of our vege patch at home, and with 4 bodies that took a total of around 20 minutes. We said goodbye with some photos, and all saw 4 African young men looking on the whole time. We were praying that they looked at what was happening and were inspired to do the same, and hence become part of the solution of welfare in South Africa, but more likely wondering what white men were doing, under the guidance of women, tilling a field for a widow foreigner. Part of the tragedy of Africa, a part that we can just pray is remediable.
We jumped in the bus, and got back in pretty good time, not even stopping at Hazyview. We got back in and had around 30 minutes before a debrief session.
Debrief Tuesday 7th
Jenny was in the camp team, and reported an easier, quieter day than before. She had talked to an African girl about the Zebra and Wildebeest – in particular she asked if the girl recognised the Wildebeest – and the girl said that she didn’t. Isn’t it interesting that an Australian child in the ‘naughties’ would know all the wildlife that is peculiar to their continent of Australia – Koala, kangaroo, echidna, platypus – but that is a luxury that African kids don’t enjoy, except for perhaps the ‘initiation’ animals – the big 5 – that are the 5 hardest animals in Africa to kill, and the hard-to-miss Giraffe.
Jenny also saw the remnants of the time when it was a tobacco plantation – the drying rooms and other paraphernalia and equipment that was still around from those days.
Geoff reported a quiet day, making some beds, helping in the kitchen and getting some rest in the afternoon and reporting that Keith “Snores during the day as well!” nice quote.
Keith and Geoff both talked about Weston’s huge shed. It had storage as well for a lot of the materials that are used on-site at Hands, and all the cabinetry going into the new houses that are springing up. The size of the shed was around 4x the size of the main hall at hands, which makes it stupendously big. We are having a Bry (SA BBQ) on Saturday, so we can all see for ourselves.
Weston also uses his facility to teach young men about cabinet making and woodwork. He is such a gentle bloke and so huge – more than one of us have talked about him as a big, gentle bear, but a bear with the biggest smile.
Emily had mixed emotions during her home visit – visiting an orphan looking after 3 sisters. She was in year 10 – same as Emily – and was obviously very smart with good English skills – and has sisters with AIDS, such a devastating thing for someone so young. This girl had a mum, but who was very sick with AIDS, and even like that, was looking for work. This is the reality for 1000’s of families, but it hits home seeing one in-your-face like that. You speak for all of us Emily
Jarna – reported that she had gotten married off a few times, and that Tim had been asked to be the approving Father-in-law. On the serious side, seeing such driving poverty in real situations like that, just drove her to tears.
Lou found her experience hard to put into words, but ‘incredible’ was a start. She found a situation where 13 kids and one adult were living in one house, in an area so small that you wondered if they could physically lie down at one time. This started a discussion about poverty with respect to our plenty.
On the same topic, Keith raised the bright spot of Stanley, who works at the farm, who was able to drag himself up by his will to be better, when people were telling him that he didn’t deserve an education, or should be working at home instead of learning the skills to escape the subsistence trap. In Stanley’s case he had a contract out on his life, and he had to quietly leave for a number of weeks so that it would pass by, purely in resentment & envy for his success by others in the village. WOW.
Till: her big impact was an 18 yo girl with a baby looking after 5 kids in total – again the same age as her, and holding a 1 month old baby – her sister’s baby. The comparison with herself was inevitable, and the descriptors were something that we could all relate to – selfish, complaining, that everything is just handed to us, whereas they have to fight with everything they have just to survive. It is a compelling comparison, one that was agreed by everyone at the table.
Tamara: General agreement with the others, and was making the comment about the huge responsibility of being a kids who looks after kids. Not just baby-sits like the Aust. Context, but like a parent with all the love and selfless care that this implies, in particular with the work ethic of a mum.
Jared: kids our age, but with more pressure, less assistance, driving home the point of just how fortunate and well-off we are in Australia. So tough with wondering where something as downright basic as the next meal will come, and even with the next meal available – having to prepare it.
Tamara chimed in – Our concern is pleasure, their concern is survival.
You can tell from all these comments, readers, that our young people have not only bridged the gap as they have talked, encouraged and lived with these lovely young men and women, that they have provided an insight for the rest of us, particularly parents, about life, and it has been our privilege to listen to it.
Tim: Listened to a parent talk about life on the land in Cork. A standard block of land sells for 200 Rand – around $30 – and they pay that to the chief of the village, and on the anniversary, a rates-like payment of $45 was due – about $7. That means that 14c/week is what it costs to live on the land. Many people are unable to pay this, and they would get warnings for a year or two, but at the end of 5 a decision would be made about whether they would be evicted for not paying their part in the society. The fee is paid to the chief of the village, who is elected.
Sharni: The overall feeling it gives me is of my own selfishness. I had choices that I was making before I went away – do I get standard tools for my work, or do I do a custom kit of the colours that I hand pick, and I was thinking of either buying my own car or of a hand-me-down from my boyfriend Nathan for nothing.
We then talked as a group about how hard it will be to observe certain parts of life in Australia, one part the sheer waste. How easy would it be to pack things into bags and ship them off.
We had a lovely dinner, for the second time with the US team, and it was good to see the mixing of the tables, Tim off with Chris to talk mission theology in the African context (just a guess, but probably accurate ), and everyone just enjoying a casual debrief.
Over and out!