I worked in primary care for 9 months. This involved visiting the 10 clinics(each clinic is visited approximately twice weekly). One visit would be a general health clinic which consisted of mainly diabetes and a rather nasty strain of hypertension. It is the type of hard core blood pressure that does not respond to adjustment of lifestyle, anti-hypertensive treatment or education. It usually boils down to adherence or perhaps a cultural clash of treatment. These patients are often tiny, very well seeming, old and smily gogos(grannies) with big bottoms...
The other health visit would be a very busy HIV/ ARV(anti retroviral) clinic where we start patients on ARV treament, review the treatment by looking at side effects, address adherence and general well being. These clinics were often very stressful due to the sheer amount of patients attending(waiting on the stoep from the crack of dawn). They have a first come first serve type service and the majority of patients are really thin, hungry and ill. There is always a clash with infections in these patients where the HIV seems to dominate TB in one patient and the TB seems to dominate in the other, or just sometimes not at all clear which infection is causing the problems and which one is top dog.
HIV in South Africa:
South Africa has the highest caseload of HIV with an estimated 5.7 million affected individuals. Most of the infected patients are aged between 24 and 34 years. There are on average 600 - 1000 deaths per day due to HIV. One in three pregnant women is HIV positive.
3% of households are headed by children. Life expectancy for men is now 39 and for women 37 years.
TB and MDR(multi drug resistent) TB and now XDR(Extremely drug resistent) TB is a real threat and common amongst HIV sufferers.
Photographs: They include 2 nurses who manage a clinic daily and who refer patients to doctors . They work independently and have alot of responsibility, especially at night(they treat anyone that comes through the door). The 2 nurse practitioners are from Zama Zama(Zama2) clinic and there is a photo of the old oven or placenta burner(not in use anymore.) I regularly bought peanuts(straight from the field) from the counsellor at Zama2 clinic. They were organic and delicious. they make it into a paste and eat it as a sauce for pap(maize). I also fried them in beer, which is nice.
This little girl came to clinic with her mother wearing a rather amazing fairy dress. She was very shy but managed a smile when I showed her the picture on the camera.
The next picture is Mboza store which is next to the clinic(approximately 1 hour from hospital). I bought 2 chickens from the counsellor at Mboza clinic for 30 rands each. Chickens and goats do very well in this area and I think all the money to be made in this area would be with the goats and chicks. it is very difficult to run over a chicken or goat. Cows on the other hand are not streetwise. Donkeys are popular, but more expensive.
The next photo is a weighing scale for little children at Phelendaba clinic. They literally hang the child in a bag from the scale!
The next photograph is a cupboard of ARV's. It is amazing how much budget and time is spent on HIV and ARV's. It is almost as if other illnesses have disappeared in the face of the HIV epidemic.
At one of the clinics there is a large pink penis for condom demonstration.Very effective! Condom usage is very poor. I think they are not big enough...as simple as that(tried and tested). A good reason why they are not used perhaps.
Condoms are freely available at all clinics. They are discussed at each ARV visit but there is a culture here where the man wears the pants(and what is inside) and the women have little say. Most women are simply infected because their husbands don't agree with condoms... and the men are not at home. They work in distant areas because there is hardly any employment locally. They get infected and then bring the infection home. What is more, most men still follow the culture of many wives...this clearly is a ticking time bomb.
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