June 23, 2009

Lots of goodbyes

I’m writing this post from the Jo-burg airport, killing a long layover on my way out of South Africa for the last time. (For now.) It’s over.

I had to say goodbye to lots of people these last few days and weeks. That’s not an easy thing to do, especially when so many of them don’t quite understand just how far away it is I am going.

In lieu of any sustained reflection on the experience or the departure, I’m just going to post some pictures with a few captions to show you some of the people that have been in my life these past few years.

There was my Bible study group, which had a good-bye potluck for me.
Joe, Zama, and I were the only guys there that night.
There was Yoliswa, my fabulous Xhosa tutor these past two years. I’m still looking for conversation partners to keep my Xhosa up in the U.S.
There was my friend Adam, the only white medical student in Mthatha.
My missionary friend Matt came up for one last weekend in Mthatha. As luck would have it, when he left I had to push his car in my pajamas to pop the clutch.
There were professionals around Mthatha I’ve come to now in the course of my daily work. One is Sister Nellie, who is the driving force at Ngangalizwe Health Centre. After a relationship that was occasionally contentious, she was surprisingly magnanimous the last time I saw her.
There was also the deputy principal of Nozuko High School, who has been on me as long as I’ve known him to help him raise money to build a hall at the school so they can host events and generate income for the school. He works so hard with so little reward. I happened to show up during a parents’ meeting to vote on new members of the parents’ advisory board. He wanted me to run for the board and didn’t seem to understand that I was telling him I was leaving. He at least insisted I vote. I have never cast a less-informed ballot.
In Itipini, I had time to lead more round of morning prayers with the pre-school children.
Then I set out to visit all the many people in Itipini who have shaped my life, like the Nophondo clan that was busy washing their clothes when I went to see them…
...and the crowd in one of the shebeens
...and a former TB patient…
...and the daughter of a staff member who died while I’ve been in Itipini…
...and a woman whose name I love to say, Nomadamazana Malangeni, who is happily lost in a mental fog most days...
...and a current TB patient, who tried to hide his alcohol behind his foot and his cigarette in his hand when he saw me. (You can see the smoke coming from his hand.)…
...and Johnson, one of our watchmen…
...and Zanemvula, one of the few older men in Itipini I genuinely like and respect. I was so touched when his daughter died suddenly last year. As he is one of the taller people in Itipini, I gave him all the clothes I had decided to leave behind. I was a bit embarrassed I had three boxes worth of pants, shirts, sweaters, shoes, and much more to give away and my luggage was still way over weight. He liked it though…
...and then finally the staff, who gathered for a goodbye on my last afternoon.
I’m using the time in the airport to polish off a few more posts I’ve been meaning to write for a while so keep scrolling down to read more about these last few days in Itipini.

“She turned me into a newt.”

The story I told recently about the young man who burned down the shack of one of our staff members because he thought she was a witch and had cast a spell on his girlfriend got me thinking about witches and witchcraft. We dismiss that sort of thing in the rich world but, as this incident shows, it is a very real and salient consideration in places like Itipini. I started asking around among my cultural interpreters and here’s some of what I learned.

One cultural interpreter sighed when I asked her about the situation and explained that young men are always blaming old women for their problems and doing so with the language of witchcraft. One other young man in Itipini who suffers from severe alcohol- and drug-induced dementia even blames his mother for his troubles but has said he won’t harm her because he loves her.

In my limited knowledge of witchcraft, which, as the title of this post indicates, stems mainly from one scene in a Monty Python movie, it seems that it is always the old women who get the blame so this news didn’t strike me as unusual. What was interesting is that it is the young men in Itipini making the accusations. I wonder if this has anything to do with how relatively powerless the young men are. They can’t find steady jobs, they can’t get married, and they aren’t educated so they can’t get positions of (legal) power in society. In contrast, the women, especially the older women, are doing all the work that keeps society functioning - raising the grandchildren and great-grandchildren produced by these young men, working long hours at informal jobs to keep the young men fed so they can spend their money on alcohol, and so much else that keeps everything ticking along. It struck me as one more indicator that a major need in South Africa is a re-conceptualization of masculinity and what it means to be a man. (As I’ve noted before, that’s not my job.)

One cultural interpreter explained that she believed that a person could acquire HIV in their sleep, independent of sex or bodily-fluid transmission, if someone else cast a spell on them. This woman is otherwise well-spoken, intelligent, and well-educated on HIV, which she has. She is also devoutly Christian and saw no apparent contradiction in her beliefs. When I mentioned this conversation to another friend in Mthatha, he noted that it is another reminder that HIV is not just a medical condition but also a spiritual one. I hadn’t thought about it in those terms before.

What was most stunning to me, however, was what I learned about how beliefs in witchcraft affect our work in Itipini. Two of our staff are responsible for what is loosely called “home-based care.” When people live alone and are too sick to take care of themselves, these two older women bring them food to help them back to health. This seems like a perfectly harmless and uncontroversial thing. Two jobs are created and sick people get the nutritional assistance they need. That is about the amount of intellectual energy I’ve put into thinking about this program.

So it came as something of a shock to me when, in conversation about witches, one of my cultural interpreters said, “You know, people don’t like it when Elsie and Mrs. Nani [our two staff] bring them food. They think it is doctored and they don’t want to eat it because they think it is making them sick.” She stressed that not everyone thought this way but even if some people think like that, it is a major obstacle to the success of home-based care. Sick people need the food so the medicine for say, HIV or TB, can be effective. Whatever the reason, if they won’t eat it then that’s a problem.

But how do you solve it? Is it the fault of our two staff members that they are looked upon with suspicion? Should we take a job away from two responsible and hard-working staff because of the effect they have on the success of the program? How do we convince sick people to eat the food they need, regardless of where it comes from?

I often talk about the obstacles posed by cultural differences but I realize I don’t always specify what I mean by the phrase. This is one of many examples of the obstacles that are a constant in cross-cultural work.

More obstacles

I found myself thinking a lot in these last few weeks about the many obstacles to education that students in Itipini face. It’s June so that means it is time for mid-term exams, which stretch over three weeks and give students some time off during the course of the school day. That, in turn, meant I saw them more frequently than normal during the day.

One student, Siziwe, lives with her family in a shack just above the clinic. On a few occasions, I had to head that way for other reasons and poked my head in to say hello.

One time I found her warming her hands over the dying ember's of the morning's fire.
Another time, I found her lying in her sister’s bed, bundled up in a blanket in the middle of the morning.
A third time, I found her sitting in the sun with her sister, her sister’s child, and a neighbour’s baby.
Each time I saw her, I asked when her next exam was. But I didn’t quite know how to ask the question that was most pressing: how come you’re lying in bed when you should be studying?

On one trip, I asked Siziwe to show me her bed and she pointed to this tiny thing, which she shares with her younger brother.
She can’t sleep very well there. I wondered if that had something to do with the answer to my question. If she can’t sleep well at night, perhaps she needs to spend time during the day catching up on that sleep. And if she’s always cold because there’s no insulation in the shack and there’s not enough blankets, then maybe she needs to spend time during the day warming up. (No one ever believes me when I tell them this but it gets quite cold here during the winter, especially at night.)

I remember how much I studied for exams in high school and college. But I never realized that what allowed me to spend so much time on studying were things I took for granted, like a comfortable bed, thick walls, and a working furnace, among much else.

June 20, 2009

Trying to pull back

There’s these two brothers in Itipini I’ve mentioned in a previous monthly e-mail.
On the left is Zanethemba; on the right is his older brother Lizwi. They aren’t always so dour (well, Lizwi is). Here’s Zanethemba in a lighter moment.
Zanethemba came across my radar first back in March when he tested positive for tuberculosis and also had a low CD4 count. He was pretty sick. A few months later, Lizwi came in with the same set of symptoms more or less. He tested positive for TB as well, which is not surprising given that they both share this shack, which is about seven feet on a side.
That was where the story ended until a little while ago. It is nothing unusual in Itipini - people have HIV, people get TB. In this case, they just happen to be brothers and live together.

It turns out, however, that Lizwi has a few children, at least three, in fact, none older than 10. One of them is Siphisihle, the young girl who had TB when I first arrived and whom I invested a lot of energy in then. They had been living with their mother but she dumped them on Lizwi a few weeks back because she figured Lizwi was about to die and she was going to move on to a man who could earn some money. In addition, Lizwi’s wife’s oldest daughter dumped her young baby with Lizwi and took off. That daughter happens to be Tunyeswa, whom just a few weeks ago shocked me with the sharp deterioration in her condition.

Here are all four children.
At one point, the youngest of the three siblings had a very bad lip infection and couldn’t eat or even really open her mouth until the antibiotics went to work. But the children look after each other and care for one another. Here’s Siphisihle and her younger brother Siphamandla.
So now there are four children and two adult men living in a tiny little shack with only two beds just a few feet apart. Neither man apparently knows how to be a father and Zanethemba can’t always remember all the names of his nieces and nephews, mainly because I don’t think he’s taken the time to learn them. Lizwi would like nothing more than for us to figure out a way to get them into a home someplace that could look after them.

There’s all kinds of reasons to be concerned but one I think about often is the potential spread of TB in that shack, especially as Siphisihle has already had it. The TB guidelines call for us to test the people a patient lives with but children need a Mantoux test and in order to get that we have to get them all to a certain clinic on one day of the week. Given how hard it was to get the one child with the lip infection to take his pills, it is easy to get exhausted simply thinking about the logistics of organizing those tests.

We’ve repeatedly called the social worker for help and guidance. Nothing. (Remember how I said the government has an informal relationship with Itipini?) Siphisihle and her older sister go to school. The younger children hang around the shack all day. It is cold this time of year and they don’t always have a lot, or even any, clothes. Lizwi and Zanethemba get food because they have TB and it is easy to include the children in that and check on them every day. The greatest source of hope in this situation is that the children actually do a reasonably good job caring for each other and are in good spirits.

But there are no easy solutions and I want to scream at the complexity of the situation. Tunyeswa has disappeared since she last came in looking so sick. I’m concerned about her health but also about her siblings and child. If I ask her about her children when I see her, will that make her less willing to listen to my advice about her health? I want Zanethemba and Lizwi to get better (and they are, especially Zanethemba, who has improved in leaps and bounds) but I don’t want to absolve them of all responsibility because they’re sick.

And in all of this, I know I need to hold back and not get too involved because I’ll be gone before the situation begins to improve, if, in fact, it ever does.

This is what incarnational ministry gets you. You learn all about the contours of a situation, which is a blessing of sorts, to begin to realize the true complexity of life. But you don’t necessarily get any closer to a solution. You just have to hope that knowledge of the situation is good enough. It feels particularly unsatisfactory.

Hard to find time to do much writing lately but I am taking plenty of pictures

June 16, 2009

Much like the Beatles, my last concert was on a rooftop


Some of you might remember the story of Pakama, a woman who about this time last year was very sick and on death’s door. She has since got the right combination of pills and is thriving.

When Pakama was sick, a dominant characteristic of her personality was her strong desire to live. She was always directing me and telling me what to do, how to push her wheelchair, when she had another appointment, which pills she had to take when, and on and on and on. I’m convinced that it was that will to live that helped her survive when I’ve seen many other people in her position die.

Now that she is better, I see a lot less of her and her bossiness is a lot less endearing, for instance, when she comes in the clinic and cuts everyone in line. I often thought she was only pushy with me but then I watched the other day as the HIV support group in Itipini set to work planting their part of the garden.

Pakama is at the top of the photo in the dark shirt, taking a sort of supervisory and managerial role while everyone else works.
She closely supervises this woman.
Missed a spot!
And another!
And only at one point does she deign to bend over and help out, though being careful not to get her shoes dirty.
I find this series of photos hilarious and stood on the rooftop and watched her work for sometime but that may only be because I know her so well.

June 15, 2009

No winners in this situation

Itipini is what is known as an “informal settlement.” The organs of government in the municipality have an informal relationship with the community. Most of the time, I think they’d prefer to think it doesn’t exist. That had tragic results this week.

On Wednesday, there was a young resident of Itipini wandering around with a giant bush knife, threatening to kill one of the employees of the Community Project, whom we call Mrs. Nani.
The young man claimed that Mrs. Nani was a witch and had put a spell on his girlfriend. (Snippets of Monty Python immediately flashed through my head when I heard this and I wanted to go searching for a duck. Then I realized how serious things were.)

I know this young man reasonably well and I also know his girlfriend. She is hands-down the most well put together young woman in Itipini. I can’t see how anyone could think she has been bewitched.

On Wednesday, the young man was mentally unwell and drunk. (In addition to the bush knife, he was walking around with a paint can full of home brew.) Understandably, he was making a lot of people nervous. So we called the police. No answer. (Really!) I took one of the pre-school teachers, Nthantisi, and went to drive to the station. On the way, Nthantisi was very critical of the station we were going to and said they wouldn’t help us. Instead, she called the local emergency number. They answered the phone and promised to come right down. Unfortunately, they didn’t know where Itipini is. (These are the police! They know everything!) So we waited to show them the way. After five or ten minutes, I suggested we call again to see what was going on. The folks at the local emergency number said police officers from our local station were on their way. That was the same local station Nthantisi had just been criticizing. So we returned to Itipini to wait for them. They never showed up. Itipini is less than five minutes from their station.

Mrs. Nani didn’t go back to her home on Wednesday afternoon and slept at a friend’s place. I wondered as I went to bed that night if she would be alive on Thursday.

I was wrong, thankfully. She lived. But late on Wednesday, her shack went up in flames. Absolutely nothing was saved.

The fire department had shown up long after the place was beyond saving. When I arrived this morning, it was still smoldering.

On Thursday morning, the young man was still around. Evidently, the community had performed a little vigilante justice, as he had a bandage across his head and looked like he’d been beaten up. (Why do they always wait until after the fact instead of intervening beforehand?) But he was also quite docile so Jenny took him and Mrs. Nani to the local police station. The young man was arrested and Mrs. Nani made her complaint. But later he was released and is now back in Itipini. Why? Because there's no food at the police station to feed the prisoners.

I’m only tangentially involved in this situation but I get only marginal satisfaction from the outcome. Mrs. Nani lost her home. And the young man isn’t getting what he needs either. Clearly, he needs medical care, mainly psychiatric and substance-related. Jenny commented that he looked pretty pathetic as he was led away.

What kind of police station makes you come to them to get service? Where were the police officers who might have been able to prevent this? And given how much of a problem substance abuse is in Itipini, where are the people and programs to help address those issues?

People in Itipini don’t treat each other right all the time, it’s true. But it seems like the government never treats them the way they deserve.

Skipping School

A well-known obstacle to education in the developing world is attendance. Sometimes kids just don’t go to school and there’s no truant officer to make them. And oftentimes, they have legitimate reasons for not going.

Luleka, one of the students we support in high-school, missed a day of school because she had to take her younger sibling to the clinic. Their mother was busy taking their brother, who had just had a seizure, to the hospital. Luleka got the role because she’s the oldest daughter.

I don’t know the name of this student but her mother had to work in town one day, which meant the older child had to bring her younger sibling to the clinic and miss school in the process.

Xolelwa, the oldest child in this picture, is one of eight or nine daughters (I keep losing track) in a family. She’s also already an aunt several times over. The three children in this picture with her are a few of her nieces and nephews. I haven’t seen Xolelwa miss school because of these nieces and nephews but she spends a lot of time caring for them in the afternoon. I wonder what it’ll do to her back, having to carry them around from such a young age?

I used to get frustrated when I saw children we support not in school. Now, I just give a resigned sigh. I don’t know how money alone can solve a problem like this.