February 28, 2009

A visit long in the making

More than two months ago, I wrote about how Petros, a young man I know in Itipini, was in jail on murder charges. I wrote about my struggle to decide whether or not to go see him. Then I promptly forgot him.

Actually, that’s not quite true. He was at the back of my mind but there were so many other things at the front of my mind I let him slip back. I was conscious he was slipping to the back of my thoughts but the idea of visiting him was too intimidating for me and I was glad to have him off the front-burner.

About two weeks ago, I learned from his sister that he had had a court appearance (postponed until next month). When she saw him there, she said he was not well and had been in the hospital. That put Petros front-and-center again and after doing some reconnaissance work, figuring out when visiting hours were and what was required, and thinking about how I would approach the visit, I drove onto the prison grounds Thursday morning.

There were several false starts. It turns out there are (at least) two prisons on the grounds. I went to the maximum security one, called the “Mthatha Maximum Centre of Excellence.” (From what I saw, it was not a centre of maximum excellence, I can assure you.) But he wasn’t there and they had no record of him. I was going to check the medium security prison but I had to get back to Itipini so I decided to find his sister and figure out where he was. Relying on her from the beginning, rather than going solo, might have been a good idea.

(I hadn’t told the family or anyone in Itipini about my plan, in part because I didn’t know how they would react. You’ll recall that my good friend Noxolo was fed up and ready to forget all about him the last time I raised the subject. She’s not related to Petros but she’s a good barometer of the mood in the community.)

It turns out Petros is in the medium security prison so I returned in the afternoon with his sister, Sesi, and her friend, Phatiswa. But the guards would only let two of us in. I immediately volunteered to wait outside but Sesi insisted that Phatiswa and I go see Petros while she waited. We navigated our way through the gates and were shown to the visitor room. Phatiswa and I were an odd couple. She is quiet and withdrawn (around me) and I was nervous and looking for her to show me the way. We both kept deferring to each other.

I had no expectations for the visit but the room was generally consistent with everything I’ve seen in movies. There was a long glass wall with benches on both sides and collections of small air holes in the glass so we could speak to each other. There was Petros, waiting on the other side.

He was obviously happy to see us and although I was nervous I couldn’t help but smile to see him as well. He looked healthy and said he had never been in the hospital. It was really difficult speaking through the glass what with the Xhosa and the swirl of all the other conversations around us but I learned lots of interesting things.

He said he was eating enough and there was enough room to sleep at night. (News accounts of this particular prison have made it sound horribly overcrowded.) They aren’t let out during the day so he mostly watches television.

He has a lawyer, whose name he forgot, working with a public defender-type agency. I never asked anything about the charges or the alleged crime. I didn’t know how to and I didn’t see it as the point of the visit.

I think he was a little disappointed we hadn’t brought him anything. He asked for things like toothpaste and cookies, which other visitors had brought their prisoners that day. As I wrote in my previous post about this, I don’t want this relationship to be about gifts or what I can buy him. I just told Phatiswa to tell Sesi when we got out and let the family handle it.

Mostly, I was just impressed that he was laughing and smiling. I let him and Phatiswa talk to each other while I marveled that something I had made out to be so difficult and overwhelming in my head was actually turning out to be just fine. In fact, I was already making plans for a return visit.

On the way out, I asked Sesi if she knew of any other people from Itipini in jail. She would make a great chair of some sort of family support group because she started reeling off names before saying, “There are 13 people from Itipini in jail.” I didn’t recognize any of the names - I know very few young men in Itipini - except for Petros’s accomplice, whom I barely know. Still, the number was a bit stunning. It made me even more resolute not to purchase Petros any treats. If word gets around that I’m doing that, I’ll be opening myself up to appeals from the families of the other dozen.

But I did start thinking about next steps on the drive away. Petros can read English pretty well and I began to think about where I could find the right kind of books to give him and just what the right kind would be. I thought about going for his court date, although I’m not sure how effective that will be. Cases here are delayed and postponed again and again and again and people spend months or years in prison awaiting trial. It is likely that at his next hearing he will just be told to come back in another month.

I did find myself questioning the value of the visit. We weren’t there for longer than 15 minutes and it was so difficult to communicate. What could possibly be gained by going back? I don’t underestimate the importance of showing Petros that he has not been forgotten. But I also don’t see what we’re going to “do” at the next visit. Haven’t we already exchanged all the news we have to exchange?

My last post on this topic generated a considerable amount of e-mail. I welcome your feedback on this post as well, especially suggestions for what I could do for Petros that wouldn’t make the relationship just about me buying him toothpaste.

February 26, 2009

Hard at work


The school year started a month ago but we haven’t quite finished the job of getting everyone sorted out. (Why this is our “job” is an issue that comes up below.) Specifically, there are still some students who don’t have school uniform shoes yet, or, if they have them, are either too small, too worn out, and generally unusable.

I should say first of all that I don’t actually think not having a pair of shoes is the end of the world. Children run around Itipini all day barefoot even if they do own shoes, especially in the summer heat. Why not just go barefoot to school as well? The trouble is that rules are rules and the rules say each child needs to have a uniform or else they can’t go to school. Yes, I agree. It’s a dumb rule.

I wanted to illustrate this post and so began taking pictures of students’ feet. They thought it was kind of weird but they just love having their picture taken so they obliged. All of these are “good shoes.”
Lots of families are good about outfitting their children with hand-me-down uniforms bits or spending some of the grant most of them get for each child on the uniform. But shoes are a particular obstacle because they are quite expensive. A good pair of shoes can cost half a month’s grant and that grant is used to cover a lot of expenses beyond shoes. The expense of the shoes is the main reason we haven’t purchased any yet. I simply did not have enough cash when we went uniform shopping.

I’m not quite sure how this happened but last week a hoard of mothers (about 30, I’d say) all showed up on the same day and at the same time demanding shoes. Not requesting but demanding. That put me in a bad mood to begin with and after several false starts, Mkuseli and I began to see them one-by-one. We basically had two requests - show us the old pair of shoes and tell us if you get a grant. If the old pair of shoes was in decent shape or could be repaired rather than replaced we sent them off to do it for themselves. Replacing a sole only costs about two dollars here. If they got a grant we also told them to buy the shoes themselves. You can get a cheaper pair of shoes for about six dollars or a quarter of one child’s monthly grant.

Our principles seemed great until they met reality. The trouble is that the two of us and the mothers disagreed about what constituted a decent shoe and whether they could legitimately afford to buy them themselves. Plus, it was the middle of the month and the grants come at the end so all of the cash from last month is gone but this month’s hasn’t been distributed yet. As a result, each conversation became a knock-down, drag-em-out affair (in Xhosa!) with the mother explaining her financial history to us and how she could not possibly afford them and us explaining how shoes are expensive, we can’t afford all of them, and this is what grants are for. That brought the reply that the grants aren’t big enough to cover everything they are stretched to cover - notably food - and this was a bridge too far. I was tough and unyielding (for me) and found myself saying repeatedly, “zithengele” or “buy them yourself.”

There was also something else at work. Not all the mothers were being completely truthful with us. One mother swore she didn’t get a grant when I knew that she did because she had told me so when we interviewed her for the micro-credit program. (Why she needed us to buy shoes when she was ostensibly making money for herself is a topic for an upcoming post.) I told her as much and she blinked briefly and then began to concoct a story about how she actually didn’t get a grant for this child. In another case, as we finished with one mother, she handed off her old pair of shoes to a second mother so the second mother could display them again as evidence of how much her child needed new shoes. This might have worked but they did it literally right in front of me with no pretense of secrecy. Another mother came in and showed off two pairs of shoes in absolutely horrendous shape and I was about to agree we could help her with shoes until Mkuseli pulled me aside and whispered angrily in my ear that those weren’t the shoes the children were wearing to school and were just the oldest and rattiest pair the mother had been able to find.

That is when I decided I had had enough. The heat, the language barrier, and especially the dishonesty made me end that day’s proceedings. I went outside and announced to everyone still waiting that if they got a grant, they were on their own and if they still needed help they should come back the next day after school with their child in uniform so we could see the shoes on the child’s feet.

Almost no one came back the next day, which confirmed for me a view I’ve been developing that many people will try to ask us for money on the chance it might work and if it doesn’t then they’ll find another way to manage. I have seen this to be true in many, many situations. I am always surprised at how much more money than I expected is floating around in Itipini. This is not to say that life in Itipini is just fine but that people can often find a way to cope without my help.

It also made me wonder how much I’ve been lied to in the past. The same day as the shoe situation, a woman had come into the clinic with one child and asked for files for two children. One of our rules is that a child has to be in the clinic to get medicine or formula because we want to see the child ourselves rather than rely on the mother’s report. (Not that the mother’s report is incorrect but that unless we do this one mother will come get formula for her baby and her four neighbours’.) I asked this mother where the second child was and she indicated a child sitting on the floor next to her. This ploy might have worked except a) I knew the child to be the son of another woman sitting on the bench and b) I had just found that child’s file. I shook my head and asked again where the child was and the mother again indicated the same child sitting on the floor. I was pretty frustrated by that point and just walked away and let the mother wait a long while before I helped her again. I can catch these situations now but I wasn’t always able to. And what am I not understanding now?

Back to the shoes, I am of several minds about the issue. I want children to have as few distractions as possible at school and if having shoes will focus the mind then they need them. But I also don’t want to create the expectation in Itipini that we’ll just buy shoes for everyone even if people can buy them themselves. That is, in part, what the grants are for. I want people to understand that when they buy something for themselves it is better for all concerned because it gives us more money to spend someplace else. (Try explaining that in Xhosa!) If a mother doesn’t get a grant, she should be working with the social worker to get one, not appealing to us for help. (It would help, of course, if our social worker actually came to visit us or was even in his office at the right hours.) I also don’t think every child needs a brand-new pair of shoes. Poverty sucks but I’m not going to opt for the Cadillac option (expensive new shoes) when there’s a lesser version (repairing the shoes) that will do.

It all becomes a very complicated lesson in situational ethics. I know I wasn’t consistent throughout the many conversations and several mothers called me on it. But I tried, I really did.

The continuing saga of my mail

I’ve written before about how I get my mail at the hospital and how sometimes the folks at the hospital have a hard time getting to the post office to pick up the mail. When I went to check on the mail the other week, there was none - no surprise - and I asked if I could give someone a ride to the post office to get the mail.

“No,” my friend there replied. “The problem is the hospital has not paid the bill at the post office. The post office won’t let us take the mail.”

I decided to let the matter lie that day but came back a few days later to ask again. They still didn’t have any mail as the hospital still had not paid the bill. I decided to put a little pressure on and began asking a series of friendly questions.

It turns out the provincial government in Bisho has put some sort of freeze on purchases so everything needs to be approved by there. This purchase had not been approved and so the post office cut off service. My friends in the mail room assured me they personally thought it was very important that the hospital get mail but had been unable to similarly convict any of their managers or supervisors.

“When is something going to happen?” I asked vainly.

“Just wait until Jacob Zuma is president and then all your problems will be solved,” said one of the employees, putting a wee bit too much faith in the results of April’s elections. More seriously, he added, “We are planning a strike on this matter next Wednesday in front of the manager’s offices.” I think he meant demonstration and I think he was trying to impress me.

I’ll be impressed when I get all those back issues of The Economist.

(P.S. It is a public hospital and a public postal agency. When the money gets paid really what happens is it gets transferred from one line on a government’s budget to another. It seems so minor and insignificant but it’s major enough to cause me grief.)

It takes a real man to use a pink umbrella on a sunny day

February 25, 2009

Bethany Bible School

On Saturday, I had a great trip out to a rural village about 120-kilometers from Mthatha. I went with my friend Joe, a Mennonite missionary, who with his wife Anna runs a Bible school in the region that works with members of small, independent African Initiated Churches. (Anna stayed at home with their children for the day.)

I loved the experience. That day’s teaching session was in a small mud church that was a part of the pastor’s compound. There were about a dozen students and Joe taught for a few hours, partly him teaching inside and partly the students studying the Bible in groups outside. Joe clearly loves teaching about the Bible and he is very good at it. That day’s lesson was about the law (his texts were Leviticus 14:1-9 and Mark 1:40-45 and he used them in a really neat way) and pitched at a very high level. I learned several new things myself. There was good give-and-take and the students were attentive and had some great insights. Joe works (very smoothly) with a translator but he also has an impressive knowledge of the Xhosa Bible.
Joe teaching about the structure of the Old Testament - teaching Hebrew words to a Xhosa audience!

Attentive students

Bible study groups enjoying a respite from the near-constant rains we’ve been having lately. The church is in the background of the third picture.

Joe reviewing the Leviticus passage in Xhosa and preparing for the second session.

Joe and Tat’Adonis, one of the members of the committee that runs the school

Bethany Bible School runs on selected weekends during the year and offers 24 individual sessions on a rotation over six years. If each one is as good as what I saw on Saturday - and I’m sure it is - there will be a lot of literate and educated Christians in the rural Transkei and that surely is a good thing.

You can read more about Joe and Anna’s work on their family blog - http://joeannasawatzky.blogspot.com - and on Joe’s personal blog - http://josephsawatzky.blogspot.com. Check ‘em out.

February 24, 2009

Moving Day

I wrote in my last monthly e-mail about Nolizwi, a high-school student in my after-school English class, who was robbed of all her school supplies on her way home a few weeks back. She had to take a dangerous route home because she had been booted out of her aunt’s home, her mother is sick and lives in the villages, and the only person she had to turn to was a distant relation who lived five (dangerous) miles from school.

Last week, it was moving day. I drove out to the home of the distant relation with Nolizwi so we could get her things and move her into the new home we had arranged for her in town and closer to school. Here she is, with all her worldly possessions.
(Incidentally, the day before we moved, as Nolizwi walked across the dangerous bridge again, she met the same guy who robbed her the week before. He asked her to be his girlfriend. When she declined, he demanded her cellphone. “You took it last week!” she yelled and walked away.)

The distant relation is wheelchair-bound and very friendly. I didn’t recognize her but she evidentially knew me because she called out to me from the kitchen. I wandered over to the window. “Jesse,” she said. “I need a new wheelchair. How do I get one?” I have been known to procure new wheelchairs from time to time (in stories I have not told on this blog for fear of opening myself to prosecution) so I told her how she would have to go to the hospital and request one. She nodded and said she’d go do that, which was a relief because I have pushed my luck with wheelchairs too far to try again for someone I don’t know.

When I had poked my head in the window, directly under my nose was a bed and in that bed was an obviously sick man, with all the classic symptoms of advanced AIDS. He was practically comatose and could barely respond to my greeting.

I was pretty torn about the whole situation. My job on this particular trip was to get Nolizwi and her belongings from point A to point B. It was late afternoon at the end of a long day, the sun was setting, and I hadn’t had lunch yet. I did not need another sick person to occupy my time, especially one who had an at best tangential connection to Itipini and whom I had never seen before. But he was really sick and he was right under my nose and the Gospel reading for the week was about Jesus healing the paralytic who was dropped in from the roof by his friends. Healing that person probably wasn’t on Jesus’ list of things to do either.

I asked the woman in the wheelchair what was wrong: “Oh, that one. He is sick.”

“Thank you for that statement of the obvious,” I thought.

I asked to see his medical records and see what - if anything - they had been doing for him. It turns out they had been taking him to the clinic and were waiting for results of a blood test, whether the initial test or a CD4 count I couldn’t tell, but they were on the right path. I didn’t have much hope that a person this sick would be able to last all the way through the anti-retroviral preparatory process but the patient was “in the system” and that was all I would have been able to do for him anyway.

As we said our goodbyes, the woman in the wheelchair was effusive in her praise of me and said something like, “You have been blessed by Jesus with powers like his.” Ha! If only she knew how helpless I feel.

Nolizwi got a warm welcome at her new home, which give me a smidgen more of hope for her future.

February 22, 2009

One-Talent People

A few months back, we read the parable of the five talents (Matt. 25:14-30) in my weekly Bible study group and I’ve been thinking about it ever since. Jesus tells the story of a master who goes away for a while and entrusts three servants with various amounts of money, one with five talents, another with two, and the last with just one. The first two invest theirs and make a profit so the master rewards them upon his return. The third servant puts his in a hole in the ground and thus can return only what he was given to the master, for which he is punished.

Let me first say that when I was younger, I read all the picture-book Bible stories our church had several times each and this one always stood out to me the most. What does Jesus care about our wealth and why should you get punished for keeping something safe? I’ve since come to appreciate a lesson from this parable, namely, we shouldn’t be hoarding our gifts and talents but using them to build up others.

But what I’ve been thinking a lot about lately is Mr. One Talent, who is often dumped on the dust-heap of bad parable characters, along with the Levite, the unforgiving slave, the unprepared bridesmaids, and so many others. “Don’t be like them,” we are taught to think. I’d prefer to put Mr. One Talent in the group of unfairly-maligned parable characters, along with the prodigal’s older brother and a few others. I’ve realized the position of the one-talent servant probably most closely approximates that of the people I encounter in Itipini.

It’s all about relative position. I don’t like to get in the heads of Bible characters too much but consider Mr. One Talent. He sees his fellow servants getting a significant amount of money and him getting the least of all. Not exactly a ringing endorsement of his trustworthiness or ability, is it? He sees his fellow servants starting businesses and raking in the cash. (In the picture book I read in church, the five-talent servant starts what looks like an import-export business and I remember him ending up with lots of camels.) Perhaps he thinks to himself, “There’s no way I can do what they are doing so I’d better do nothing at all.” We naturally compare ourselves to our peers, I think, and when he did that he would have seen that he was the worst off of the bunch.

Obviously, Mr. One Talent is missing the point. His job was not to replicate what Mr. Five Talent had done but to take what he had been given and do what he could with it. That, surely, is all the master expected of him. But we can understand why he did what he did. He was just too busy thinking of his relative position that he failed to see the possibilities inherent in his absolute position. Even one talent, after all, was still a considerable amount of money.

Are the people in Itipini like Mr. One Talent? The comparison may not stand up to intense scrutiny but there are some similarities. I think many of them have spent a lifetime watching people who seem to be more talented than them be a lot more successful. They see these people in town, on the news, and in the dominant cultural messages. I’ve written before about how I think there’s a disconnect between the cultural idea of “do it for yourself” and the ability to actually do that and I won’t rehash it here but suffice it to say that people in Itipini are aware of their relative position. Perhaps they’ve tried to work their way out of it and failed or perhaps the idea of actually getting out of poverty seems so ludicrous they don’t even want to try. Whatever the reason, on some level I think there is a psychological barrier at work. I see this all the time in scores and scores of ways I won’t list here because each story would take so long to explain.

Just like Mr. One Talent, however, they are overlooking that even their apparently limited talent is actually quite large. At the very core, every person is a unique child of God blessed with certain gifts. That’s not insignificant! The challenge is getting people to look away from what surrounds them and look instead to the magnitude of the gift that lies within. That is not easy, especially when those same people may have already given up hope, allowing their talents to lay fallow deep, deep within them.

I haven’t managed to flesh out this idea as fully as I would like in this post and there’s still a lot I can’t figure out how to say. But at least one implication of this view is that much “development” work, especially when it is meant to be sustainable and community-centric, must necessarily and primarily be psychological. The first challenge is not helping people build a new well or getting them the right medicines. The first challenge is helping them realize the capacity and wonder that lies within them and how that can change their lives. I’m obviously biased here but I don’t see how that sort of work can be done without reference to a Creator God, which means that religious (Christian?) education is a necessary part of even ostensibly secular development.

I once quoted Desmond Tutu saying, “For true reconciliation is a deeply personal mater. It can happen only between persons who assert their own personhood and who acknowledge and respect that of others.” It is relatively easy for me to assert my own personhood because I’ve been raised to think that way. (Asserting it graciously is another matter, mind you). But what if the people we encounter are incapable of expressing their true personhood as God created them? We’ll have to overcome that hurdle before we begin to see reconciliation.

Dramatis Personae

After a while in Itipini, I’ve come to know so many people and parts of so many stories, I can’t possibly begin to tell even a fraction of them on this blog. They just come fast and furiously, overwhelmingly at times, and each requiring a tremendous amount of energy. Here’s a snapshot of a few ongoing stories I regularly encounter.

Thobeka needs anti-retrovirals. She’s had a low CD4 count for a while and made slow and sporadic progress through the ARV prep process. But she just can’t seal the deal and go for the necessary appointment to get the drugs. There are definitely some psychological problems at work in this situation but at the root the problem is that she just doesn’t take the ARVs seriously enough. We’ve had to hand-hold her to get her this far but she needs to take the final steps herself.

Phelokazi gave birth last June at age 15 or 16. This week she tested positive for HIV. Since she’s been breast-feeding her baby all this time, that raises health complications for him (though the transmission rate is lower than you’d think in the early months). She also doesn’t seem to have much if any family around to support her, the child’s father is now in jail, and she’s not in school.

Mvuso has a series of unknown health problems - all exacerbated by his alcoholism - that have left him unable to walk or care for himself. He is skin and bones now and has been to a never-ending series of appointments with doctors over the last several months but to no avail. He might need surgery but he’s not a candidate for it because he’s so weak. But his weakness is brought about by his illness. It’s a catch-22 and impossible to figure out how to break it.

Tunyesa is a 17-year old HIV-positive mother who randomly walked out on her child last week, leaving her with the neighbours. The neighbours didn’t want the child and came to us to protest. We were about to call the social worker when Tunyesa nonchalantly returned to Itipini. She’s also not regular about CD4 counts and might be pregnant again.

Ali was high after sniffing glue in November (hence the burn marks under his nose) and so spilled boiling water on himself, resulting in partial thickness burns over 20% of his body surface area. He was in the hospital for 97 days, preparing for and recovering from skin-graft surgery. Now he’s back in Itipini, hasn’t been in school in ages, lives, apparently, only with his 15-year old sister (who is also a mother), and needs to have his wounds frequently bandaged, which takes an immense amount of time. Fortunately, they are healing quite well.

Patricia has needed bilateral hip replacements for year. Since that is highly unlikely here - the hospital is too overwhelmed to be able to do elective surgeries - it would be great if she could get into an old-age home. But that requires all kinds of referrals and paperwork and hurdles that take concentrated effort to surmount.

Those are just the patients I have pictures of. There’s also the woman with elephantiasis in her feet and a grossly swollen hand that just will not get better; the young mother who needs to be checked out by the eye doctor but never seems to go; the child who had meningitis when he was a baby that has left him with mental damage but whose mother can’t seem to get her act together long enough to go to the doctor; and many more “frequent fliers” in the clinic. There’s also the non-medical cases, people (mostly children) who need a lot of help just to get into school or to get enough to eat at home.

Not all of these should be our “problems.” There are, in fact, organs of government that should step in. But they don’t or aren’t capable of providing effective and timely help. So people look to us for help and it is hard to turn down a suffering person. Beyond all the obvious reasons why these situations could be complicated, there’s the small matter of the language barrier. You’ve read these brief summations in just a few minutes but you are likely read English as a first language. To get to the point where I could summarize a history in a few sentences, we first had to battle through endless complexities in Xhosa.

It’s overwhelming.

A visitor's view

My friend Emily, now in New Zealand, after two weeks in Mthatha, wrote a post on her blog about her time her. Check it out.

Yes, I’m aware that pride is a sin…

…but I’m so pleased at how my tomatoes are turning out.
It may not look like much but it’s definitely the most I’ve ever produced in a garden.

I am currently accepting recipe suggestions, especially for the following - fried green tomatoes, salsa, and tomato sauce.

February 19, 2009

How does she do it?

Here’s a picture from a recent after-school English class.
On the left is Victoria, one of the “star” high-school students. (That’s “star” by our standards. She passed last year but as I’ve explained that doesn’t always mean a lot.) On the right is her son, Ayabulela, a bundle of joy who enjoys pre-school - especially lunch - more than any other child. In this class, we were practicing writing letters and Victoria brought Ayabulela along to keep an eye on him. I kept him quiet with an apple.

(I’ve written about these two before and their relationship with Victoria’s mother, who was once quite sick.)

I just can’t fathom how someone can be both a high-school student and a mother at the same time. The obstacles each role creates for the other must be so great as to be nearly insurmountable. But somehow she manages.

A Turning of the Tide?

I want to be very cautious about how I phrase this but in the last two months in the clinic we’ve noticed a definite uptick in the number of HIV tests we perform. If we keep up January’s pace, we’ll do far more this year than in any recent year.

As I’ve noted before, it can sometimes be like pulling teeth to get someone to agree to an HIV test. People are just too afraid and would rather not know than know. But knowing your status is the first step towards getting help and is a crucial part of getting the HIV epidemic under control.

I don’t have any good explanations for this sudden surge in tests but it is gratifying. A young woman I know very well came in for a test and was negative. It was really wonderful to see the joy on her face and hear her exclamation of delight - “I am HIV negative,” she shouted for all the clinic to hear. I’ve made a point of telling her and others like her that now they need to tell their friends and especially boyfriends to come do the same thing.

At the same time as we’ve had more self-referred patients for tests, there’s been a steady stream of people who show up too weak to walk, vomiting, with diarrhoea, in pain, gaunt, and emaciated. In many cases, they’ve had HIV tests in the past but have not regularly had their CD4 count checked to keep tabs on the progress of the disease. It is inexpressibly disheartening to see someone who is so sick and could have been helped long ago if only he or she had taken the time to visit the clinic.

One woman came in this morning who had tested positive several years ago and had never had a CD4 count done. The last time she visited our clinic was a little more than two years ago when she had been encouraged to come back the next day for a CD4 count. (We can’t do counts every day for a variety of reasons too complex to explain here.) She continued to live in Itipini but she had never returned to the clinic. Today she came in, supported by a friend, not looking too thin but weak and labouring hard. None of these was her chief complaint, however. What made her return to the clinic was her painful feet. Jenny took the blood for a CD4 count but we still have to wait a week for the results and then - if everything goes well - it’ll be another month of appointments before she can get ARVs. Will she still be alive then? I hope so. We’re dancing along the edge of the cliff with someone like her. I like high stakes as much as anyone but not when those stakes are someone’s life. Remember Nosisi? Her story is emblazoned in my memory and I want to avoid anymore like her.

Ironically, today’s patient lives with Nobathembu, a woman I’ve written much about before, who is now on ARVs but not before she nearly died of AIDS. Nobathembu spoke passionately at our World AIDS Day celebration last December on the importance of knowing your status and having a CD4 count done regularly. Evidentially, that message didn’t make it to her friend.

February 17, 2009

A bit of news

Here's a slice of the news from Mthatha:

A POVERTY-stricken mother who did not have money to give her daughter a dignified funeral was stopped by neighbours from burying her in her Mthatha yard .

The grieving mother, Nomahomba Matsambu-Gasa, 54, could not afford the cost of giving her 30-year-old daughter, Nomonde Matsambu, a proper funeral.

After her death, the family resolved to bury her themselves, wrapped in a worn blanket.

The neighbourhoods referenced are as poor as Itipini... and don't have a Community Project serving them. It makes Itipini seem quite well-off by comparison.

My visitors are gone. Posts with actual content returning soon!

February 15, 2009

What’s the difference?

“Is there an ontological difference between relief/development work and mission work?”

That’s a comment I scrawled in my notes at last year’s mission training (yes, I use words like ontological in my notes), notes I pulled out of a box in my parents’ basement in September and it’s a question that I’ve been gnawing on for a while.

Basically, the question I wanted answered then is if there is a core or essential difference between the kind of work done by, say, a Peace Corps volunteer and a YASC missionary. It’s an important question because in many ways I saw YASC and the Peace Corps as equivalent before I joined the former and my prime motivations for moving overseas were to do the type of work epitomized by Peace Corps folks.

The question has popped up again for me in the conversation I’ve been having with other missionaries about the church’s proposed change of the term missionary to “mission partner.” Some missionaries have written me to say that in their countries missionaries are held in higher regard than NGO workers, which I hadn’t expected. That conversation also led to the article I linked to in a previous post in which the atheist author argued for missionaries in Africa.

The answer I wrote to this question in my notes at mission training was “in mission work attempting to enrich souls with God’s grace; not just do good but be good.” I guess that’s true but it’s still hard to see the concrete ways in which the difference between my work and that of a PCV is apparent.

Any thoughts on the matter?

It’s all fun and games…

...until your rear wiper comes off.

The dirt road into Itipini turns into quite the mud pit after several days of rain, like we’ve had this week. That in turn makes the car muddy, which in turn means all the people I give rides to get their clothes muddy getting in and out, which means they complain to me all the time.

On Friday - for reasons that defy explanation - there wasn’t any school so there were lots of children hanging around all day. To give them something to do, I told them to wash my car. A big crowd of them took to the task with an eager enthusiasm and spent at least two hours working away at it. (It’s a small car.)
Then a handful of them came into the clinic holding the rear window wiper. Sigh...

February 12, 2009

Check it out

I'm fascinated by this op-ed and I don't quite know what to think of it all:

Now a confirmed atheist, I've become convinced of the enormous contribution that Christian evangelism makes in Africa: sharply distinct from the work of secular NGOs, government projects and international aid efforts. These alone will not do. Education and training alone will not do. In Africa Christianity changes people's hearts. It brings a spiritual transformation. The rebirth is real. The change is good.

I used to avoid this truth by applauding - as you can - the practical work of mission churches in Africa. It's a pity, I would say, that salvation is part of the package, but Christians black and white, working in Africa, do heal the sick, do teach people to read and write; and only the severest kind of secularist could see a mission hospital or school and say the world would be better without it. I would allow that if faith was needed to motivate missionaries to help, then, fine: but what counted was the help, not the faith.

More on these sorts of topics later.

February 9, 2009

Tables and Chairs

I continue to be happily inundated with visitors, leaving me with almost no time to stay up-to-date on this blog. Fortunately, I’ve got a story that can be told mostly with pictures.

Last week, we took a donation of tables and chairs up the primary school Itipini students attend. They were donated after a visitor saw the deplorable state of the classrooms and how the students in some classes didn’t have tables or unbroken chairs.

There are two classrooms with no tables or chairs at all, the first and second grade. We only had enough for the first grade class (45 students).

Pictures are definitely more valuable than words in this situation so let me show them off.

The first grade classroom before the donation.
Bringing in the new tables.
The new tables and chairs being used.
Mkuseli showing off some of the old chairs. Note the absence of legs.
The second grade class remains without tables. They just put their books on their laps.
The third grade class has a few desks but not nearly enough for all the students. It doesn’t stop them from mugging for the camera, however.
In the upper grades (this is grade eight, I think), they’re all kind of crammed in the room.
The lunch ladies have food to cook but they have no money to buy firewood to cook it. We bought a bit for last week but it is not even close to a long-term solution.
But the first grade students have tables and chairs now and that is a step forward.

Waiting at the end of the day.

February 4, 2009

A visitor

I just wrapped up a 10-day visit with my aunt Judi from Chicago. It is always great to have visitors all the way out here (still time for you!) but it doesn’t leave much time for writing, blog posts or anything else. In lieu of that, then, I’m just going to post some of the pictures she was able to take of me “in action.”

We had the first English class of the new year (more on that in another post). Note how enraptured I have them!

The car gets its weekly wash. It’s a dirty, muddy road into Itipini.
Deep in conversation with Jenny about something, no doubt, of death-defying importance.
The clinic staff - Jenny, Dorothy, Lwazikazi, me.
One night, I invited some people from Itipini over for dinner. Another night, I invited my Mennonite missionary friends, Joe and Anna, over. The watermelon was particularly popular.
We took a trip to a pretty remote nature reserve on the Coast and enjoyed more waterfalls that go directly into the ocean, among much else.
It was pretty clear that Judi was on vacation.