Duncan Village Day Hospital

We are up early this morning to go to the Duncan Village Day Hospital, situated in Duncan Village which is a local township. There is a group of peer educators whose program has just lost its funding. With the idea that their expertise might mesh well with his program, Craig is off – with me in tow – to watch a session in action. He is hoping to be able to offer them employment.

Craig drove me through Duncan Village last week so I have some idea of what the place is like. I have seen pictures of the townships in the past and this one is just 15 minutes from the Kennaway. There is no room here. Every inch is occupied by shacks made of salvaged scrap wood and corrugated tin. People are everywhere. It’s dirty and desperate. I feel like I’m in the Cheerio boat again, and this is an exhibit on poverty. I can’t quite engage with it. That we are in a shiny white BMW makes me intensely uncomfortable. It feels cruel. I don’t take photographs; the thought disgusts me.

The Duncan Village Day Hospital is inadequate but I suppose most hospitals are.  This one labours under extreme demand and scarce resources. It’s 8am and the place is packed. Every bench in every room and corridor is filled with people waiting for care. There is signage everywhere with information on  medications and hand washing procedures. I go to the toilet; it is filthy.

Craig and I are welcomed warmly. Hospital staff, some in uniform and some not, mix and converse openly. That’s what strikes me: like Mirelle’s teacher’s quarters in Joburg, this enclave is social and warm. This is no place for sly professional stiffness – people speak their minds directly and the level of interaction is both alarming (is this dangerous from a health perspective?) and comforting (it feels very different from a western hospital where the contact between patients and staff is so meticulously monitored). Then again, if I were here as a patient, perhaps I would feel that familiar sense of helplessness and loneliness. I don’t want to judge; I don’t want to romanticize. I am a bit exhausted with all the second guessing.

A hospital administrator invites us into her office. She has a prickly, off-putting demeanor. She is telling us a story that she has read in the morning paper. Someone from the village has been fishing in the sewer, washing the fish off, and selling it for food. She tsks and remarks that it is unbelievable what “these people” are capable of. Craig asserts that people do what they must to survive, and she says, “I have worked here for 30 years. You do and do and do and do… and nothing changes. These people are lazy.” I feel sick.

The session is about MTCT (mother to child transmission) of HIV. There is no room so the two educators set up in a hallway; they stand on one side facing a bench where Craig and I and 6 pregnant women are seated. They run the session in isiXhosa and English. I follow along using the pamphlet they’ve provided.

This is not my area of expertise, but I can tell from the noises coming from Craig’s throat that the information is inaccurate. He’s furiously taking notes on his pamphlet. The educator, Nomalizo, is charismatic and direct. She smiles easily and while everything else goes to pieces around us – people walk down the hall between us and the facilitators; the hateful words of the administrator ring in my ears; I look at the faces of the women beside me and realize they are girls – she is a rock. I hope that whatever obstacles present themselves, Craig will be successful in finding a way to work with her.

An amaXhosa girl asks a question. It is translated: “If I am HIV positive, can my baby be HIV negative?”

After the session, Craig speaks with Nomalizo. The pamphlet suggests that women need to start HAART (highly active antiretroviral therapy) if their CD4 count is below 200. The standard is 350, says Craig, and he asks about the discrepancy. There is a shortage of medication, confirms Nomalizo. As we speed away in the BMW Craig is angry and frustrated. “The information is wrong. Starting HAART at 200 is like saying ‘Good luck’, and besides, they’re using AZT. Of course they are dying. ” He is twitchy, obsessively ashing his cigarette out the window.

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4 Comments

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4 responses to “Duncan Village Day Hospital

  1. Kelly

    Ok, that’s worse than the sharks.

  2. Vivienne

    Very interesting post. The circumstances around HIV transmission and treatment in South Africa are heartbreaking to say the least. I am sure that along the way you will encounter as many people defying the odds as you will creating those odds. For excellent insight into working in a rural South African hospital do read the blog Just Up the Dose. Good luck!

  3. Craig

    Standard-of-care delivery in resource limited settings is a tough situation no matter how you approach it. When negative attitudes towards the “other” enter into the picture, it’s a recipe for disaster. The impact of these factors (and others) is apparent, making for a sad reality in many of the places she has visited in recent weeks.
    To learn more about the differences between internationally-adopted standards of care for HIV+ people and those sanctioned by the South African government, visit this site:
    http://www.i-base.info/htb/v9/htb9-3-4/PMTCT.html

  4. Pingback: Great news from the Eastern Cape: “Let Us Protect Our Future!” a go! « Personal S.A.

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