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.