Kranshoek

Our work in the townships began this week. Zach and I were assigned to Kranshoek (pronounced Krantuk) to shadow one of the home-based care givers, Beulah. Kranshoek is the furthest of all the townships our group is working in, fifteen minutes' drive. Other pairs say how the gated communities of affluent Plettenberg Bay turn into informal shack communities is frightening -- some people can walk to their township in a kilometer or two. Kranshoek's houses, most of which are identical, one-room concrete homes from a government program, extend about as far as the eye can see. It's no slum; there's an elementary school, a number of kindergartens, small food shops, a soup kitchen, and a clinic. The clinic seems to be a combination of governmental services and an NGO funded in part by the US that focuses on HIV and tuberculosis. 105 people in the community have tested postive for HIV, though there are doubtless others who don't know it.

Beulah is a small, serious-looking woman who is extremely dedicated to her patients, some of whom she's been working with since she began the job a year ago. She makes her rounds daily, Monday through Friday, calling on twenty PlettAid's patients once a week to once a day, depending on the severity of their illness. The services she provides are no so much medical as they are supportive; she checks blood pressure and blood sugar levels, but more I think her dependable presence encourages patients to take their medicine and keep their appointments at the clinic. Her patients' diseases include hypertension, diabetes, paralysis, HIV, tuberculosis (including MDR- multi-drug resistant) and stroke victims.

Most of the patients don't speak English; about 90% of the town uses Afrikaans. I still can't comprehend how there are eleven national languages; most people speak many, but how do you know what to use when you approach a stranger? Conveniently for us, all of the major signs are in English. We don't communicate directly with many of the patients we see, but Beulah does a great job of explaining a patient's medical and personal history as we go.

We've already seen some patients many times. Cornelia is eighty-nine years old, and in very good health, save for an enormous boil on her head. It's been there for three years, and doctors can't fix it, so she needs treatment to prevent infection. We see her quite often, and she's always full of quiet smiles. This morning we washed her hair with special shampoo and clipped hair away from the area.

Sharon is so far the most gripping patient. She's an HIV and MDR TB patient, and she had been in the hospital in a city for four months recieving care. Since she's returned to Kranshoek, however, she's simply refused to take her medication. It's been two weeks, and she's missed her appointments at the clinic and avoided Beulah's visits. When we first met her, I didn't realize how sick she was; she was wearing a down jacket and a fleece blanket covered most of her body. Then I saw her legs -- the quintessential image of severe illness, no thicker than my wrist. I might have guessed she was fifteen; she's twenty-nine. Beulah berated her when she discovered the packets of unopened tablets. It's so frustrating because the medication is free for Sharon - she literally had someone coming to her door to remind her. She stopped taking it because the symptoms of TB had disappeared, but since it's MDR, it's residual and highly-contagious and dangerous; the HIV medicine made her vomit. Now she sits nearly immobile, weak and tired, and her lungs hurt to breathe. When she sneezes, thick blood comes out. Still she neglects her tablets, she sullenly deflects Beulah's questions, not meeting her eyes. She lives with her mother, who was cooperative with Beulah but didn't seem to understand the severity of the situation, laughingly calling Sharon stubborn.

We shadow Beulah all morning, for three weeks. Afternoons alternate between TBB seminars discussing public health and volunteering. In Kranshoek, we're working at the local school to sand and re-varnish old one-room classroom buildings. I'm enjoying getting to know the patients and we'll see how the next two weeks go.

Plettenberg Bay, South Africa

The end of our time in Thailand also marked the end of nearly four months in south-east Asia; I think the group was ready for a change. Our trip continued to our final country abroad, South Africa, via a grueling fifty-nine hour, six-flight, epic journey. Of all the countries we've visited, I think South Africa was the one I pictured least in my head. I really had no idea what to expect, and there will be a lot to learn here.

We're staying in Plettenberg Bay, a coastal town on the southern shore of the Indian Ocean (!) It was chosen because of it's safety relative to larger cities, and it's this bizarre mixture of different racial and socio-economic groups. Initially, it comes across as a hugely tourist town, attracting affluent visitors during it's summer months (December and January) and Main Street is full of expensive beachy boutiques. But there's also a predominantly black section of town with wholesale discount stores.

We're staying in a hostel - taking it over, really. The boys and the girls each have their own dorm room, and it's already quite crowded for nine girls to share a single toilet and shower. But there's really nice communal space, with couches, a pool table, and a beautiful balcony that overlooks the ocean, where we eat our meals. It will be a welcome change to trade our savory rice breakfasts for yogurt and muesli and fruit! Best of all, we have access to the small kitchen, and the supermarket in town is well-stocked, so we can cook just about anything we've been craving.

Our curriculum focus here in South Africa will be public health. We'll be working with an NGO called PlettAid, a home-based care service for 250 impoverished patients in the townships surrounding Plettenberg Bay. 40% of the patients (as opposed to 27% in the region) are HIV-positive; many have tuberculosis, disabilities, terminal illnesses. In groups of two, we'll be shadowing a care worker on her daily routine for three weeks. PlettAid has asked us to help by giving an evaluation of their organization's services to the patients we meet. Work will start on Monday; I'm partners with Zach.

So far we've spent our days meeting with PlettAid and visiting various townships. They're not at all what I expected, somehow rather than the quintessential images of poverty I pictured, they seem more spread out, and in between different towns lie beautiful green pastures. Also, it finally occured me why the town scene is particularly striking: not a single building exceeds one story, and telephone wires tower high above. It gives the appearance of being vastly flat and expansive.

It's nice to be so close to the beach -- a ten or fifteen minute walk. It's undoubtedly a gorgeous spot, but there's a lot more to be seen. I suspect our perception of Plett will change a lot as we begin to work with the carers.

Ban Huay Hee

It's been a while since the last blog update because we've been doing homestays in a rural community, sans electricity, let alone WiFi.  We've been living in Ban Huay Hee, a village in northern Thailand of the ethnic minority Karen people.  The whole community consists of 26 households, about 160 people, and they hosted us for three weeks.  

Each of us lived with a family; mine lived on the outskirts of the village, on a peninsula of land that jutted out into a beautiful expansive valley.  It's a little hard to describe the setting; half the time I felt as though I could have been in New England during autumn, half the time it seemed like Arizona's dry red dust landscape.  But out house was in the middle of it all, overlooking endless mountainside, and it was spectacular at sunset, not to mention the stars at night.  

My host-mother, Jipo, was the teacher at the local school, which goes only as far as elementary level. Beyond that, children have to travel into town, Mae Hong Son, which is about two hours by motorcycle.  There were fifteen kids at school, in two classes, and she taught the younger group, about 3-5 years old.  Most mornings I would follow my host-mother and her 4-year old daughter, Meji, into school, where I learned the Thai script from bossy but well-intentioned five-year-olds, and perfected my crayon abilities.  

my host sister, Meji

As a TBB group, we met in the afternoon for Thai language classes.  I have to admit that after a couple of days this seemed unnecessary, given that the locals in Ban Huay Hee spoke their own, unrelated language: Pakanyoh, the language that had followed the Karen people from Burma.  The first word to learn is the multi-purpose da-bluu, which is appropriate for hello, thank you, and good-bye -- pretty much the fundamentals in a home-stay situation!

Our curriculum focus was sustainable agriculture.  Ban Huay Hee was certainly an agrarian community; nearly all the food consumed there is produced on their own land (picture overgrowth on a mountainside, agroforestry, rather than the quintessential southeast Asian rice paddy fields I was imagining).  However, January is the dry season, and there's not much labor to be done.  The seasonal farming was in the burning stage, when trees are hacked down and left to dry before being burned to restore nutrients to the ground.  

Admirably, the community didn't adopt the industrial farming techniques that were popularized in the Green Revolution, but later proved to be environmentally damaging.  They use the same methods they've been practicing for hundreds of years, and by any measure, they're self-sustaining.  Seeing what it takes to be sustainable on this level, however, raises questions about how feasible it is to apply sustainable agriculture on a large, world-wide scale.  This community devotes so much of its daily life to cultivation and food preparation, not to mention the land needed -- it's hard to imagine being able to feed 6 million people this way.  

Food in Ban Huay Hee was, if anything, predictable.  It was pretty much a sure bet that any meal, breakfast, lunch, or dinner, would be based on a large bowl of rice.  In addition, there would be two or three side dishes that everyone shared, generally vegetables or egg, sometimes with small bits of meat.  I was lucky that my host-family ate with me, rather than feed me alone, as other families did.  The four of us ate together on the floor, and as I learned early on, you don't help yourself to more than a bite of the communal dishes at a time.  

Other highlights of living in Ban Huay Hee -- a day hike to Doi Pui, the highest mountain in the area, where, at the summit, we encountered thirty or forty soldiers of the Thai army, who were in town as security for the queen's tour of duty through Mae Hong Son.  They were by far the friendliest bunch of militia I've ever seen; they cheerfully insisted that we all take a group photo.  The irony was that with one arm cradling their giant guns, they flashed peace signs at the camera with their other hand.  

In the middle of our stay, we had a weekend trip to Mae Hong Son for independent student travel.  Zach and I went camping on a nearby river bank, complete with a campfire and a chorus of tree frogs, all night long.

Back in the village, we continued to study agriculture, and went on short trips to the fields to see the various stages in the cycle of burning fields, leaving them fallow, and re-cultivating them.  We had a go at chopping trees, the head of the village showed us how to blacksmith machettes, and we worked on media projects.

The farewell celebration was a nice night of singing, thank-you's, and presentations of our media.

with Jipo & Meji