The TRUTH about South Africa

I admittedly have failed as a foreign correspondent to the masses awaiting my reports of living abroad in this wonderful and backwards place. Ok. Admittedly, the proceeding sentence was a gross exaggeration from start to finish. "Foreign correspondent" = blogger. "Masses"= friends and family. "wonderful and backwards"= ... well, let me get to that.

The one word that actually might be true is Failed. Failed I have. It has been extremely difficult for me to write. I have started a few essays and, in despair, gave up usually less than halfway through unsure of why everything just sounds wrong, why my fingers just freeze up at the keyboard as I stare blankly at the screen. It seems I can’t focus on summoning the force necessary to pull the thoughts out of my mind and, simultaneously, navigate the through the words on the page. It is exhausting. (Picture me as Sesame Street’s Don Music ending his masterpiece composition by banging his head on his piano keyboard in frustration, “I’ll NEVER get it right!”)



And there is already a lot of banging your head in frustration South Africa! And even more exhaustion. So I think I’ve chosen to avoid the frustration and exhaustion that would come from writing about the day-to-day frustration and exhaustion. Having said that, my New Year’s resolution was to write- to post blogs for the people who are interested, and to journal as a reference for my future book (which my mentor/preceptor has already entitled “Trials and Tribulations in South Africa: a series of short and not-so-short stories from Andrea Dean.” This was right before she officially crowned me the most unlucky Yale-associated student ever to grace University of Pretoria. A position I feel honored- amongst other emotions- to hold considering one of the last students had her car stolen.) So it is now January 28th and I am attempting to write, my surgery providing a legitimate excuse for the late start. I suppose it isn’t so bad. At least it is the opposite of the gym-goers who start Jan 1st and are only now gradually letting you annoyed regulars have your treadmills and free-weights back. I can still follow through.

Before I started writing, I needed to think about why I couldn’t write. I love to write. I thrive on it. It keeps me sharp and sane. But here, why couldn’t I do it?

My answer began to reveal itself as I began reading Rian Malan’s more recent book “Resident Alien.”

(Note: Some of you know Malan’s “My Traitor’s Heart” which I read as a junior undergraduate student and again during my time in Namibia when my class was able to meet him briefly only to be, quite frankly, unimpressed by his blasé and seemingly sour character. Nevertheless, as a white (half Afrikaans and half English) male who lived through the height and fall of apartheid, Malan presented a view of South Africa that was unlike all others. It wasn’t hateful, but was not an outpouring of blind compassion either. It wasn’t unrevealing of the errors of the country, but it wasn’t full of desperation either. It wasn’t graceful. It wasn’t angsty. It wasn’t cold. What was it?. I often cursed Malan for his negativity, yet somehow he resonated with me. I admired him in spite of myself. All this unconsciously, in a paradox I'm not sure I could appreciate at the time. A paradox I now understand as, well, “South Africa.”)

As I opened Malan’s introduction, he started by quoting an American journalist friend who said “No one can write fast enough to tell a true story.” I paused to roll my eyes. It brought to mind college hill in Providence, where colored plastic body parts are wrapped around tree trunks in the name of art and hipsters in tight jeans are scattered along the sidewalk, where I’ve been known to mutter “Fucking RISD students” as I drive past. But Malan was a step ahead of me.

His next paragraph starts, “In America, this is an artsy verdict on the limitations of the form. In South Africa, it’s like a law of nature: there is no such thing as a true story here. The facts might be correct, but the truth they embody is always a lie to someone else… Atop all this, we live in a country where mutually annihilating truths coexist entirely amicably. We are a light unto nations. We are an abject failure. We are progressing even as we hurtle backward. The blessing of living here is that every day presents you with material whose richness beggars the imagination of those who live in saner places. The curse is that you can never, ever get it quite right, and if you get it close, the results are unpublishable.”

At this point I pictured Malan banging his head on his typewriter (I still picture all journalists with typewriters) and crying “I’ll never get it right!” and I thought of Don Music at his piano and I thought of me at my laptop… and I knew Malan was onto something.



I won’t try to rephrase Malan because he nailed it- this confusing and impossible experience that is South Africa. I want to write about everything, but nothing I write will actually be worthwhile.

I can’t bring you the usually sentiments from the third-world, the ones about the injustice of dire poverty, the ones that I used to spit out like rapid fire when I went abroad, the ones that make you feel connected to something you’ll never actually know. (Though I have some of those.)

And I can’t bring you tales of the rainbow-nation, the ones about progress that is thick in the air, the ones that make us believe in humanity, the ones that leave us feeling hopeful for the future. (Though I have some of those.)

I can’t bring you the stories of being in what appears to be persistent apartheid South Africa, the ones where people are full of hate and fear, the ones where we curse the powerful, rich, white men, the ones that make us assess our own privilege. (Though I have some of those.)

… and the list of “some of those” could go on…

The problem is, I can’t write one without writing the others. I can’t even tell one story separate from the others. In this country, they are intertwined, co-experienced, fluid, yet persistent, all are alive in every moment, moving, but not changing. Where in most places, to tell the partial story is merely inadequate, here i in South Africa, the partial story fares much worse. It is a lie.

Perhaps even at a deeper level than suggested by Malan, I don’t even feel comfortable relaying the facts. It seems straightforward enough to transcribe the series of events which happened when I was mugged, or I travelled to Kruger National Park, or I started work in Kalafong Hospital, or any other adventure. But even these facts are confusing and impossible on their own. On their own, these facts are untrue. Without including the subjective (the fear, the guilt, the intrigue, the anger) the objective does not exists.

Art is about expressing the subjective, which naturally fluctuates with experience and time (as it is to be human.) This task is not entirely difficult under normal circumstances. But South Africa, things are different because not only is the subjective fluid, but the objective moves quickly and erratically. The subjective chases it around, flapping its wings breathlessly and rarely lands long enough to see and appreciate it, much less capture it or describe it in words.

I realize this blog says nothing. That is ok with me. I am using today to premise what will come, since request have been made. I’ll try for at least some small stories, antidotes if you will, probably seemingly without substance. But I assure you, it is in these short stories (ones that take less than 15 minutes to write) that truth lies and only in them that I can accurately record at least a hint of my experience. I’ll do my best…

“We yaw between terror and ecstasy. Sometimes we complete the round trip in just fifteen minutes.” –Rian Malan.

Back in America, the hate lives on.

Apparently, my other life needs me too.

http://www.nytimes.com/2009/05/19/health/19well.html

Lions with a touch of cynicism.

I, admittedly, do not blog. I know this disappoints some people. I am lazy. And busy. And I find myself tiresome when I do write. However, this week I am going for a photo story. Let us consider it a compromise.

In order to help remember that South Africa is not a just a place to go to have your research plan fall apart, lose touch with friends from home and get your passport stolen, I got out this weekend. We went to the Lion and Rhino Nature Reserve just outside Johannesburg. It was phenomenal.

1. "Dumb Human." This photo is blurry, but included here because this is the cheetah I raced. I actually won. This is because the cheetah was smart and stubborn as cats tend to be and simply chose not to chase the blue teddy bear which was being pulled on a string in 32 degree weather. I, on the other hand, apparently could wear a collar and be trained to sit. My defense: it WAS a really cute teddy bear.

2. "Don't f' with me. I have a snake." Evidence that having huge snake around your neck will always make you look badass and like you could kill someone. Even if you are making out with said snake. Seeing this photo makes me reconsider my lack of a skull tattoo on that right bicep.

3. "Gurltalk." This white lion is my new best friend. As you can see, she and I had a heart to heart and discussed a range of topics including the US joining SA in the ranks of leaders who've won the Peace Prize, Impala versus Kudoo meat, and men of all nations who aren't good enough for us anyway.

4."A good spoon." Is there anything more to say?

5. "Ouch. I have nerves there." This tiger was playful. And had huge claws. They felt un-good in my skin. But I couldn't resist.

6. "Adopting This One." In the end, I opted not to bring her home. She was 2 months old. Its only a matter of months before she would be able to give Socrates a run for his money. And I can't do that to Soc's ego.

I should add that I almost got eaten by a lion. Seriously. Ok. At least bitten. Other highlights included: Petting a rhino; Watching the cheetahs in the reserve get fed- man do they jump high; Falling down a hill; Teaching my Brazilians English words such as "Mane," "calling shotgun," and "charge"- as in "Keep driving. That rhino looks like he might 'charge' the car;" The hippo walk; Hearing wild dogs 'laugh'; Having a full grown male lion feet from my car; And drinking almost a liter of orange Fanta. The day was actually quite amazing. I needed it badly.

Getting mugged and attacked by a lion... in the span of one week... now THAT is South Africa.

The place I call Home

A JACARANDA TREE OUTSIDE MY WINDOW.

Donate your old cell phone: Help Mothers Save Babies

My research in South Africa involves running a support group for HIV-infected mothers via SMS (text messaging.) I need cell phones and hope you can help. Here is where, why and how it will help:

Antenatal care in South Africa, especially the Prevention of Mother-to-Child of HIVTransmission (PMTCT) program, is a perfect illustration of the complexity of HIV as a disease and, more so, the critical need for creativity in strategies to approach this epidemic. Amongst women seeking antenatal care in the country, between 30% to 40% are infected with HIV, most of these women seek care in the public (read “resource-poor, understaffed, overcrowded”) sector. Without proper PMTCT treatment, 30% of these women will have HIV-infected infant; this number rises exponentially in the first year of the child’s life if feeding guidelines are not followed. To put this in perspective, in United States, transmission is less that 1%, evidence that this number is obtainable with appropriate provision of antiretrovirals (ARV), c-sections and bottle feeding.

However, South Africa is our reminder that “medicine” entails more than throwing algorithms and a stocked pharmacy into a clinic. Currently in Southwest Tshwane, where all pregnant women theoretically have access to PMTCT, the transmission rate is greater than 15% (still lower than the national average.) To put this in perspective, in Pretoria alone, 200 babies are born every month with HIV. 200. Babies. One city. HIV.

So the question is, why are these programs failing? Why mothers leaving orphaned children when we have the ARVs to give them? Why are we routinely forcing children born into a life of chronic disease and ARV treatment? Or worse, needlessly watching them die before they reach their second birthdays?

The answer is scattered between society at large, the health care system, the strained clinics and health care workers, and, of course, the affect these things have on the behavior of individuals.

First of all, let us remember that PMTCT, like ARV therapy and highly active ARV therapy (HAART) in nonpregnant persons, is a demanding medical regimen to maintain over a period of time. Not only do the medications often produce harsh side effects and need to be taken multiple times a day, but it also requires constant follow up visits at the clinic during pregnancy and afterward. All of the components of PMTCT, which should be completed on a specific time line, face all the challenges of health care delivery in resource poor settings: lack of transport to visits, impossible waiting times, exhausted staff, problems with continuity and records of care, lack of a system to track patients, communication and education issues, space shortages, etc. These are all system issues being addressed in the Serithi Project (the larger research project I work on) but this is not enough.

Even in a perfect health care setting in South Africa, PMTCT could not function optimally. HIV is still highly stigmatized. Women who disclose their status are often kicked out of their homes or rejected by their families. Individuals do not want to be tested and, even if treatment is available, do not take it for reasons of denial or secrecy. Like other chronic (and fatal) diseases psychosocial factors faced by HIV-positive individuals run deeply, lead to social isolation and make adherence to PMTCT (including going to follow up visits or having their child tested) logistically, as well as emotionally, challenging. Indeed, the work of my preceptors and others have sought to describe phenomena such as stigmatization, disclosure status, social support, depression, self efficacy and coping styles and their possible effects on adherence to HIV treatment regimens in Southern Africa. Not surprisingly, these studies on what are known as “possible mediating factors of adherence” indicate that without addressing psychosocial factors, PMTCT fails.


In the Serithi Project workshops for health care workers which I sat in all last week, the participants were asked to brainstorm barriers to delivery of and adherence to PMTCT and then to come up with possible solutions (This is called participatory action research and seeks to give the health care workers ownership over their intervention.) Over and over in these workshops, I heard these wonderfully committed and passionate staff speak with sadness in their voice about the impact of stigmatization and the need to encourage women to disclose their status. Each workshop group wished they had more time and personnel to provide women with more counseling and one-on-one support as well as create support groups to help women struggling with PMTCT.

However, traditional “onsite” support groups just are not feasible in resource-poor settings. As stated above by the workers themselves, there just is not enough time, space or staff to implement them. In regards to patients themselves, pregnant women and new mothers have issues with transport, scheduling conflicts, lack of child care, and discomfort in the third trimester and/or the birth of the child, often forcing her to leave the group. But most notably, onsite groups fail to reach the most socially isolated women. Women with undisclosed status or great fear of stigmatization are likely concerned about breeches of confidentiality by peers in the group and are the least ready to partake in discussion. Therefore, these women often decline participation in .the groups and we miss an opportunity to support a woman who needs it most.

Here is where I come in!

My research project aims to evaluate the feasibility and acceptability of a pilot intervention using text messaging (SMS) as a means for social networking among HIV positive pregnant women in South Africa. Basically, I am running a support group for which functions solely through SMS. The technical stuff is sort of involved, but here are the basics: I am using UK-based software (ZygoHUBS) that allows a group of individuals to be simultaneously connected through SMS. Each participant will be given a phone enabled to send unlimited SMSs to a single number. When an SMS is sent to this number it is directed it to the Zygos database (specific to that number) which will then turn it around and deliver it to all the members of the given preset group. Responses will likewise be sent by SMS to the entire group. Think of it like a walkie talkie radio system except with short written messages instead of spoken and the frequency is the phone number assigned to the group’s database. So in this way, the conversation will function much like one would during a traditional on-site support group.

The idea of the intervention, like other support groups, is to bring together peers with a particular shared experience to empower, educate and support each other through dialogue. Each group will be of 8 women newly diagnosed with HIV and undergoing PMTCT, one “experienced mentor”- a woman who already went through PMTCT, and a “clinician”-who will likely be a resident or a psychology grad student with backup from a medical practitioner. The group will ideally provide an outlet to discuss psychosocial issues such as fear and stigma, converse freely about health and pregnancy, ask questions and be reminded about various components of PMTCT, hear others’ stories and learn from their choices and experiences. A similar project, Project Zumbido in Mexico, is our model and was an amazing success.

The idea is that these SMS-based peer-support groups allow for constant social support and daily peer contact while avoiding issues of transportation, childcare, scheduling or lack of clinic space or staff. Most importantly, using the aforementioned software, all discussion will take place under “code names” (on phones registered to the project,) so women will remain anonymous to each other throughout the intervention. Therefore, it is less confrontational that a regular support group and participation is completely confidentiality.

Ultimately, the goal of my intervention is to improve adherence to PMTCT and therefore decrease the HIV transmission to infants. Right now, I am working solely to provide evidence that the intervention is feasible in Tshwane, South Africa and using qualitative methods to evaluate what effect it had on women's experience with HIV and PMTCT. Ideally I will provide early evidence of the potential efficacy of the intervention by comparing measurements of before and after psychosocial factors (the “possible mediating factors of adherence”) and using records to assess PMTCT adherence. Basically though, this part of the study is to get the intervention up and running so that I can go to put it in the face of foundations and phone companies face and ask for money and involvement! Fun!

The point of all this is to show you how your old mobile phone could save a baby. (At least that is how they would say it if this was an infomercial for adopting kids from Thailand or something.) But really, I need 20 mobile phones by November. Your single phone will be a HUGE help to the me and to the project. The phones do need to be GSM phones (they need to have a removeable SIM card,) so no Sprint or Verizon. (We'll be able to unlock it to use local SIM cards here.) Compatible chargers are also appreciated, but we can buy them if you don't have one. If you have a mobile phone to donate, please send it or give it to my mom (or if you are in Providence, give it to Jason) who will collect them. My preceptor will bring them to S. Africa when he comes in November.

Susan Lach
15834 50th Ave N
Plymouth, MN
55446

You can email me or comment here if you have any questions! I appreciate all your help!

A weekend of Bliss

American Accent

Today I was inspired to post my first real blog ever to update any interested souls on my progress here in South Africa. “Why so moved?” you ask. Well it all started as I was phoning various mobile service providers in the area for my project. I had a sharpie in my hand, ready to check off “speak with Vodacom re: bulk SMS and phones” from my list of things to do. My grip on that sharpie got tighter and tighter as my extremely expensive airtime dwindled down while I was transferred from useless employee to useless employee because, through each person pretended to understand me and know to whom I should speak, what each one actually wanted was to pass my incomprehensible accent into the next poor bloke to deal with. However, just as I was about to stab the thus-far unused sharpie in my eye socket and hope it reached some vital part of my brain, I was put on hold one more time. I listened for a moment and set the sharpie down gently on top of my untouched to-do list with a smile.

The background music: “Africa” by Toto.

I couldn't help but laugh and it was by far the most pleasant 4 minutes spent on hold all day. It also gave me the courage to finally stop cycle of the ritual polite exchange, which would inevitably lead to the brief explanation of my project, then to the confused pause, and then to the transfer. When the next woman picked up, I finally just said “I need to be in touch whoever would be in charge of potential partnerships or the possibility of innovative technology.” Apparently, said in an American accent, “innovative technology” has a certain authority, or maybe charm, to it and I was immediately transferred to a fellow who is going to get the company to help me with my project.

Life is good. I thank Toto.

It has been a full three weeks and I think I can now consider myself “settled.” I am already in the habit of the “How is it?” greeting before any real exchange of information, I drive a manual on the left side of the road in traffic worse than New York, and I found the supermarket with parmesan cheese. (I have since made noodles with butter, parmesan and salt several times, telling people that it is a “traditional American meal.” After everyone tasted it, they thanked me, informed me that they felt thoroughly cultured and were, furthermore, impressed that I could cook. Is it immoral to feel satisfied from this exchange?)

I’ll admit, moving to a new country is frustrating. Nothing can be done smoothly since I have no knowledge of how the most basic stuff works. For the first week or so, there was one road block in front of another. Whether it is “I don’t think that is right,” (like needing South African health insurance to be a University of Pretoria student,) or “how was I supposed to know that?” (like only needing to put in 7 of 8 digits of my regular log-in student number in order to print,) or “that’s just plain confusing,” (like road signs which don’t indicate a cardinal direction, only the township to which they eventually lead... you don’t know the names/locations of townships, you are outta luck. Period.) it all makes everything take a bit longer. But the only time I really gritted my teeth were a few very important things, like getting an I.D. card so I had access to my dorm. For the first week I had to stand in the parking lot, look up at an open window and yell, “Hey. Hey! Can someone swipe me in?” This is where having a "cute" American accent pays off. Luckily, I now have my own I.D. card to swipe in and no longer have to whore out my foreignness just to get into my home.

So I’ve admitted that it is frustrating. However, it is also hilarious. Mostly, it is hilarious.

For example, one of my first quests was to get internet for my computer. The first exchange happened as I walked into a cell phone store where they sell phones, prepaid airtime cards, everything. These stores are quite common and are all very similar. It was a good place to start. After saying hello, I state simply, “I am looking for a modem which plugs into my computer and uses a SIM card to get internet.” They looked at me like I had two heads. I let a good few minutes to go by to allow them to get over the shock of my foreign accent and anything else that may have thrown them into a stupor- like the fact that I have an extra head. Then, one guy leaned onto the counter showing he was now intently focused on my words. I slowed down, “I have a laptop computer.” Head nods. “I need to use the internet on it.” Head nods. “From what I understand, there is some sort of device or modem which will plug into my laptop and allow me to go onto the internet.” More two-headed-girl stares. More silence. Suddenly, one guy’s face lights up. “OH!” he exclaims with eyebrows raised and a smile. He reaches to a shelf behind him and grabs a package. As he is handing it to me, I feel a sudden rush of joy and relief that I’ve connected with a human being and that, furthermore, I might get to have the internet. I grab the plastic and look down. It is a standard computer mouse. Not even the laser kind, the kind with the ball.

This is made even more hilarious by how simple this transaction should have been. I left that shop and walked into similar one a few doors down. They immediately pointed me in the direction of a computer shop who sold then me the modem. It did, however, take me an entire weekend to realize that, No, I did not have to storm back into the store and demand my money back for the bum modem they’d sold me, but that instead, I could just put the SIM card in right-side-up to get it to work.

The humor in these small things blows me away. Literally. My power adapter turned my miniature travel blow dryer into a hand held rocket jet,...complete with fire and the power of combustion. Though I nearly lost my face in the incident, I still laugh as I pick it up, aim it at my open window and dare, in a clicking-like language, the next human to try to get in. ... Ah yes. I’ve also seen “District 9” during my stay here. It is about aliens in Johannesburg. You see, the prawns – the aliens- have these super weapons which are only activated by their DNA. This means, logically, that my blow dryer is probably a prawn weapon and I was unknowingly infected with prawn fuel, slowly turning me into a prawn and, thus, giving me the capacity to turn the tiny hair styling device into a tool of destruction… Whatever. Just see the movie.

http://www.district9movie.com/

So contrary to what it may seem, I have not lost my mind. I am having a good time. I am indeed a little homesick sometimes- intensely when I try to explain that I became an “Auntie” a few days ago and then, at times, have to try the word “Nephew” with a few different intonations and even then sometimes get that look that tells me either (1) that I sound like a prawn or (2) that regardless of how I am speaking, I have grown another head in the midst of conversation. Even in these times of frustration or self-deprecating humor, I am so wildly happy to be here.... and so to South Africa I say, “Its gonna take a lot to take me away from you. Its nothing that a hundred men or more could ever do.”