Katutura State Hospital

I have been struggling to write this blog for the past few days. I am not sure how to approach this content without it sounding sensationalized or pitiful. I'm not entirely sure if it's possible, but I gave it my best shot. Here goes:

Christa and I spent last Friday morning at Katutura State Hospital, one of the public hospitals serving residents of Windhoek and surrounding areas. Christa practiced as a nurse at Katutura State for 27 years before resigning to commit all of her time to Mount Sinai Centre. Visiting the hospital was quite surreal and in many ways not what I expected. From what I understand the resources and manpower at private health facilities are significantly greater compared to public health facilities. The private health facilities are essentially serving a limited number of people, likely upper-class individuals such as high-ranking government officials and expatriates. Their financial resources already afford them better health than the vast majority of Namibians. Public health services are available to everyone else who does not have the financial resources for private health care. And their health needs are signifcant. Additionally, many doctors and nurses don't want to practice in the public sector because they are significantly underpaid and under-supported. Working in a private practice or private hospital means better pay, meaning they can pay off their student loans while earning income to support their families. However, they are not reaching the individuals with the greatest health needs. Those who work in the public sector must do so out of sheer compassion and committment to the well-being of their communities. One interesting thing I learned is that the public hospitals have flats (apartments) on their property for their doctors and nurses. Doctors and nurses can live their for reduced prices in order to assist them as they pay off student loans.

In retrospect, I think my visit to Katutura State was not what I expected because Windhoek is more of a westernized city with restaurants, movie theaters, running water, wi-fi, etc. We're not in the middle of nowhere with no resources and a government that has run amok. But on the other hand, Windhoek is also a city of disparities. I have heard that national independence was supposed to alleviate some of these disparities by providing more jobs and better wages. That didn't happen. This disparity is very clear in their public sector health facilities.

We were greeted at the security gate by a guard with a large rifle across his lap. Although I don't see all of the security guards with big rifles it is not uncommon. My boss' son said that many of them don't know how to properly use the rifles and end up shooting themselves in the foot. Good thing he's nearby the hospital. Christa and I walked up to the main entrance and there are people sitting alongside the wall, many with casts on their legs and crutches. We walk inside the hospital and there are no decorations or chairs, and really horrible lighting. It looked completely desolate. There's a security guard standing inside, a line at the reception window, and the casualty unit is on the immediate right. We went first to the pediatric clinic. They don't take appointments so people just come and hope to get in to see the doctor. We went back through the rooms of the pediatric clinic a bit. I felt a bit awkward about this as you could see the patients (there were no doors on the rooms, only walls on the sides to separate them from the next room). Christa would stop to talk to the nurse while the patient was sitting there. I guess patient privacy is different here! I talked to a couple of the nurses working in the pediatric clinic to hear their thoughts about working in the public sector, government support, etc. It was clear that they didn't have all of the necessary resources and supplies. The nurses are not very well-supported either, often working alone for extended periods of time. The nurses that I spoke with also expressed concern that the people who are making the decisions and policies do not know what is going on at the ground-level. They just make decisions based on what they think is best or whatever the trend might be.

Next we went to the ARV (antiretroviral therapy) clinic where people who are HIV-positive or at risk of becoming HIV-positive can go to receive services (i.e. testing, counseling with the social worker, etc.). The ARV clinic is divided into two sections, one for adults and another for children. We visited the children's ARV clinic where we saw some of the Mount Sinai Centre kids there for follow-up appointments. Up until 18 months of age, babies are tested for HIV with the DNA PCR virologic test. Blood is drawn from a spot on their heel and placed in five different spots on a paper which is then sent to the lab for testing. It was amazing how quietly the kids sat in the waiting area, while there was nothing to do, no toys to play with, pictures to look at. And they were all there for the same reason: HIV/AIDS, something I think that majority of the kids don't grasp. I asked one of the nurses in this department at what age they start explaining to the kids their HIV status. She said age 10. I didn't get around to asking what kind of counseling support they have for kids. Do they tell the kid, "hey you're HIV-positive" and then send them on their way? We also visited the maternity ward. I know that for some HIV-positive women, a c-section may be recommended to reduce the transmission of HIV from mother to child during birth. Christa informed me that the hospital does not have the resources to perform c-sections. They cannot afford the anesthesiology or instruments necessary for a c-section.

One thing that really struck me as we visited the various clinics was that there were a lot of staff sitting around, not doing much of anything. I know that this is not the case, but it was very startling to see the nurses sitting around with newspapers while patients waited for care. Perhaps it was because they were waiting on a doctor for a consultation. It just struck me as odd given the sheer need for health services and yet the nurses seemed so laxadasical about work. I know that what I perceive may not be the case. There is definitely a cultural context around work and work ethic here that I have not entirely put my finger on.

I also have to say that it was hard to visit the hospital. I think that, as a white person, and a white woman, I receive many looks of skepticism. I can respect this as they don't know what my intentions are, they don't know me, and what not, but it doesn't make it any more comfortable. I was glad to be with Christa. I think that gives me some sort of validation, especially as she knew all of the staff at the hospital.

I will end this on a positive note. Visits to the hospital are relatively cheap, approximately $1.50 - $2.00 USD. However, this is still a significant cost to many of the families who visit the public hospitals, especially if they have to go regularly for care. Despite the limited resources at the hospital, they never turn a patient away from care or treatment because of their inability to pay.

Harnas Guest Farm

I arranged a last minute camping trip over the 4th of July with some friends at the guest house, Amanda and Mark, and Amanda's co-worker, Kaylin. We went Northeast of Windhoek, to the Kalahari area, a part of Namibia that Chad and I will not get to. We camped at a wonderful guest farm, Harnas, that I heard fellow travellers talk about. Apparently Brangelina (that's Brad Pitt and Angelina Jolie, Dad) is a big supporter of Harnas. Harnas rescues and fosters injured and abandoned wild animals, including baboons, lions, giraffes, oryx, cheetah, leopard, cows, mongoose, bat-eared fox, crocodile, etc. etc. They also had 47 cats and probably a dozen dogs. Upon arriving we set up camp and watched springbok and oryx wander around. There was also a giraffe, Klippie, who had free reign of the place. Klippie was not afraid of people and came right over to visit the campsite, smell around the kitchen area, and even nuzzle my sweatshirt on the table. We were a bit alarmed because it's a big animal and we didn't want to scare her. While Klippie is definitely an animal to be respected we did find out later that we could pet her. She was orphaned and Harnas took her in within her first week of life. That afternoon we went on a feeding tour and watched the volunteers at Harnas distribute meat to the various animals. The cheetahs were amazing as they were prowling around the fence purring and talking like cats, waiting for their hunk of meat. I also enjoyed the baboons although I understand they can be quite dangerous. I was allowed to hold their hand through the fence. I extended my hand, somewhat close to the fence, and they would come over and reach through the fence to touch you. I was literally sitting there and the baboon and I were stroking one another's hands. Their hands do look very human-like with knuckles, nails, and all. They also pulled on my fingers with their very strong grip. It was incredible! We also saw 5 six-month old lions and 3 year-old lions. They were all raised by dogs who faithfully stayed in the pens to supervise.

That night we started up a fire at the campsite and began to prepare dinner. In celebration of the 4th of July Amanda brought some crazy blue lollilops and a small book from the U.S. Embassy with some of Obama's speeches. She was unsuccessful at leading a read-along but definitely had the spirit for it. The dark sets in very quickly and because you think it is much later than it actually is you tend to retire to bed early. Perfect for a granny like me. That night we slept with numerous interruptions as the baboons and lions talked throughout the night. I think next time I won't set-up camp right next to the baboon area. They are crazy!

I also got some practice driving in Namibia, a manual car on the left hand side of the road. I was the only one who knew how to drive manual so I was the designated driver. Fine by me as I like driving. But it was a very tedious afternoon after we first got the car. We ran a couple of errands in town and tried to get comfortable with the car. This was probably not the smartest idea. Driving in town where no one pays attention, drivers pass you, and run red lights. It definitely made my driving look like I fit right in though! Driving to Harnas was a much smoother experience and it was wonderful to get out of the city and see some new sights.

Puccini Guest House

I have received a couple of requests to see my accommodation at Puccini Guest House in Windhoek. I have included a couple of pictures: my bedroom, the courtyard area, dining area, and my lovely neighbor/partner in crime for the summer-Amanda.

Activity Days

The last two Saturdays have been filled with activities at Mount Sinai Centre for the formula milk babies and the food hamper kids. These are the days when Christa and other volunteers distribute the formula milk or food hampers, weigh the babies and kids, and take general health notes. The babies in the formula milk program are all under one year of age and 74 of the 77 babies are HIV-negative. The story is a little different with the food hamper program. Christa serves kids from one year of age all the way up to 13 in this program. More than half of the 107 kids in this program are HIV-positive. Christa provides food to them because the antiretroviral therapy is hard on their stomach and has certain nutritional requirements. Unfortunately, due to a hiccup (which may actually be a larger hiccup) there was no money to purchase food hampers for the kids last weekend. They are coming back to the centre tomorrow in hopes that the hiccup has smoothed out and their ration of food for the next month has arrived.

Christa and the other volunteers also address any problems that the women are having at this time and provide counseling and referrals as necessary. There was a pretty serious case two Saturdays ago when Christa overheard one of the women telling the other women that she doesn't want her baby anymore. The other women laughed, thinking she was joking, but Christa could tell that the woman was serious.She pulled her aside to a private room to talk and the young woman confided that the father is not doing anything, she doesn't have any money, and she doesn't trust her family with whom she lives. Christa makes a plan to bring her a grill and some money. The young woman will use the grill to prepare some food to sell. They will see how she fares and if it is a viable option for her to make some money. With a plan in place the young woman leaves. Christa asks me to stay another minute and says that the mother has previously been checked into the hospital for psychiatric problems. She wanted to talk to the young woman privately because such desperation and depression, along with an outright confession - "I don't want my baby anymore" - strike fear in Christa. Young women in these situations have been known to kill their babies and leave them in a dumpster. Christa is trying to show this young woman that she can do things to care for herself and her baby. I guess this scenario is not that uncommon among the poor women in this region. I was dumbfounded the rest of the day. But I was incredibly relieved that these women have someone like Christa to talk to. Christa takes a no-nonsense approach with these women, encouraging them to be honest and open. But her no-nonsense approach comes off in a manner that is warm and reliable. It is encouraging to see.

We also finished a three-day training with the Ministry of Health and Social Services on Tuesday. The training provided a 101 crash course on HIV/AIDS, co-occuring infections like tuberculosis, condom usage, family planning, and a discussion on adherence to their antiretroviral therapy. Some of the clients of Mount Sinai Centre participated in the training as well as church leaders and community members. The Ministry of Health and Social Services showed up anywhere between 1-2 hours late each day but the participants waited patiently. I would have been gone by then as I'm sure most Americans would have. It really is "Africa time" here -- meaning things happen when they happen. Overall the training seemed to be a success. There were approximately 30 participants each day and I was amazed at their level of participation and their openness. Sometimes their questions were a little too open and gave the rest of the room reason to laugh. But everyone seemed to respect one another. A lot of their questions disturbed me because they seemed to be expressing a lack of understanding about the basics of HIV and its transmission. I guess meanings get lost in translation though. When I talked to one of the Ministry presenters she said that it is actually denial--they are trying to get around using condoms. It's a good thing I wasn't leading the training in any sort of capacity. I don't think I could have identified their needs as the community leaders could.

I will share one more surreal experience here before I wrap up this entry. There was a big political event last week as the Russian president (prime minister?) made a state visit. This state visit was concerning none other than a favorite worldwide topic--OIL! With this state visit came lots of security. And not security measures like you see in the United States where secret service men and women would be covertly dressed in suits. It was a bit like a military state around here that day. There were helicopters flying all over the city with 8-10 armed men sitting in the doorways. Men in military gear with huge guns stood on many of the corners of the city centre directing people which way to go. Despite the fact that this may have been a signifcant state visit I found it quite alarming to see their security measures. It was almost as if they were prepared for civilians breaking out into riots. It seemed as though the men would not have thought twice about shooting anyone. I have heard that police and military members here don't care about the results of their shooting relative to the severity of the crime. A few months ago two men were caught stealing a woman's purse and were shot. One died immediately and the other was in critical condition. I am glad I don't live somewhere where armed men stand on the corners with huge guns. Speaking of politics and presidents, check out Obama's newest and youngest fan!