They did tell us at training it was important to take a break every now and again...

Long Lines and Young Mothers

Tuesday is the day we immunize children and hand out baby food and formula at the clinic. It is easily the busiest day of the week and rather hectic, with children crawling, drooling, toddling, screaming, crying, and laughing all over the place and mothers talking to each other (in Xhosa, of course.) The line is long when we show up and never appears to slacken. On an average day, we see about 30 patients at the clinic. Today, we saw 58.

Here’s some pictures I took today of the mothers waiting outside:

And also waiting inside:

This baby probably knew it had a shot coming:


Jenny was teaching me today how to give immunizations. The actual skill of loading a syringe and performing an IM injection is one I’m familiar with but I don’t quite think I’m as cold-blooded as she is. She just jabs that needle right into the baby’s thigh. Meanwhile, I was watching the baby’s face go from giggling to shock to pain to screaming. Tomorrow, though, we go to a children’s home to perform immunizations and I think I’ll have to overcome my squeamishness then.

"The Little Differences"

In the movie Pulp Fiction, John Travolta and Samuel L. Jackson begin the movie by discussing Travolta’s recent trip to Amsterdam. Before they get to the famous “Royale with cheese” moment, the conversation includes this snippet:

JT: “But you know the funniest thing about Europe is?”
SLJ: “What?”
JT: “It’s the little differences. I mean, they got the same stuff over there they got here but just there it’s a little different.”

I’ve been thinking about this conversation as I adjust to life in Mthatha and figure out how to describe what life is like. So, in the spirit of Pulp Fiction, here’s a list of the “little differences” I’ve found in adjusting to life in Mthatha, South Africa from life in Nome, Alaska.

-Light switches are opposite from the U.S. Push down to turn on, push up to turn off.

-Neither Italian nor Mexican cuisines appear to have penetrated the market much. Pasta is relegated to a tiny corner of the store and pasta sauce is often impossible to find. Salsa is similarly hidden (though not hot sauces) and I haven’t been able to find black beans – a staple of my diet – anywhere

-Speaking of food, Mthatha has to have the highest grocery store per person ratio of any town I have ever lived in. They are everywhere! I’d be happy to trade a couple grocery stores for a good bookstore, as Mthatha doesn’t have one of those.

-For all my 25 years, I’ve used Crest toothpaste, only to move to South Africa and find Crest has overlooked this market. So I’ve been forced to switch to Colgate, much to my dismay.

-Cars here (and I am sure this is true all over the world) are much smaller than the behemoths Americans drive. Several people refer to the truck we drive to Itipini as a “tank” because it is so big to them, when, in fact, it is smaller than what in the U.S. is classified as a “light truck.” Consequently, I am learning a lot of new car models that major manufacturers make but clearly do not even bother marketing in the U.S. as they are so small. Also, I haven’t seen a car yet with power windows.

-There’s always an attendant for everything. If I go to the gas station, there’s someone to pump the gas for me. If I park someplace, someone will offer to “watch the car” for me and then help me out of the space when I come back. At the grocery store, there are people to help carry the groceries to the car. Of course, everyone wants to be paid for this.

-People in Mthatha seem to like clean cars, as there are a number of car washing places around town. (Not the automatic type, but people who will wash your car by hand.) This compares to Nome, where people seem to measure their manhood by how dirty their truck is.

-In my house, the toilet, bathtub, and shower each have a separate room. And the room with the toilet is not the room with the sink.

-I can't find plain ol' orange juice anywhere. It's all some sort of orange-fruit mixture. Another staple of the diet down the drain.

There are many, many more but that’s a preliminary list.

Positive / Negative

Thursday is the day that the clinic offers free HIV tests to anyone who wants one. There are often aren’t too many takers and it seems a number of people don’t want a test because they don’t want to know the results. But we’re usually able to badger enough people who’ve been chronically ill or have STDs to come get a test.

I asked to learn how to do the tests as I imagined it was a matter of drawing blood, sending it off to a lab, and getting the results in a few days. The real reason I wanted to learn was that I wanted more experience drawing blood. The actual testing of the blood, I assumed, would be someone else’s job. But when I sat down to learn, I realized the reality was quite different.

Apparently, there are kits these days that can test blood for HIV within 15 minutes. All it takes is a few drops of blood dropped in a plastic tray, a reagent chemical, and an egg timer. So my job was to prick the patient’s finger, draw blood, drop it onto the test, and wait. It reminded me a lot of taking a patient’s blood sugar.

The patients receive pre-test counseling from our Xhosa nurse, Dorothy, so when they sit down in front of me they are totally clear on what the stakes are for them. It is literally a matter of life or death. As you might expect, there is a tremendous amount of emotion flowing through them and it is impossible to draw blood from them and not share in those emotions. After I draw the blood, we sit and wait and watch for the lines to appear on the test. One line means negative, two means positive. Each test feels so emotionally draining and it is not even my blood and life on the line. I don’t actually tell them the result – they go back to Dorothy for that – but I am the first to know and I am sure they can read my body language.

(Of course, I shouldn’t be quite so dramatic. We have a number of HIV-positive patients in Itipini who have been living with the virus for a number of years. Even in South Africa, where the virus is endemic and the government has been controversially slow to respond, HIV is not an automatic death sentence. There is reason for hope.)

I did three tests my first Thursday. They were, thankfully, all negative.

Working Hard or Hardly Working?

When I was a reporter in Nome, I worked at least 40 hours a week and frequently more, covering whatever happened to be newsworthy. So it has been quite a shock to work in Itipini, where we show up around 9:30 and are done by 3.

On the one hand, it is nice to have the time in the afternoon to read and relax while it is still daylight (though the commute eats up significant time on both ends). But on the other hand, part of me wants to scream, “These people are living in horrible conditions. How come we aren’t working round the clock to make them better!” There are a number of talented people working in Itipini. Surely if we all worked longer and harder we’d do more good than we’re doing now.

In fact, I’ve taken this thought further at times and thought about how unjust it is that at the end of a day of work I can return to my electrified home with running water, cook a hot dinner with food that’s been in a refrigerator all day, and generally be warm and safe all night long. If I’m truly to serve the people of Itipini, should I not only work long and hard hours but also actually become one of them as well?

I’ve been reading Thomas Merton’s excellent memoir The Seven Storey Mountain lately and this passage, in which he speaks with a Hindu monk, caught my eye and helped me wrestle with some of these thoughts:

One of the chief reasons he [the monk] gave for the failure of any Christian missionaries to really strike deep into the tremendous populations of Asia was the fact that they maintained themselves on a social level that was too far above the natives. The Church of England, indeed, though they would convert the Indians by maintaining a strict separation – white men in one church, natives in a different church: both of them listening to sermons on brotherly love and unity. [Merton is always looking for opportunities to slam the Anglicans it seems.]

I don’t know anything about missionaries: but I am sure that, by our own standards of living, their life is an arduous and difficult one, and certainly not one that could be regarded as comfortable. And by comparison with life in Europe and America it represents a tremendous sacrifice. Yet I suppose it would literally endanger their lives if they tried to subsist on the standard of living with which the vast majority of Asiatics have to be content.

Perhaps I am too busy quantifying the good we are doing to realize it really can’t be quantified. What matters is that somehow the interactions between the people of Itipini and us build a small part of God’s kingdom in this corner of South Africa. No human or group of humans will ever be able to snap their fingers and make all things well. To use economic terms, I’m not sure what the marginal gain of each additional hour of work would be, though the marginal cost to us would increase the more we worked. So what matters, then, is not how much gets done but that it gets done at all and done well.

Still, part of me can’t shake the thought that it’s all a complicated rationalization for a short work day.

(Of course, there's a ton of behind-the-scenes work that makes Itipini function so smoothly that I am not yet really aware of. I'm sure if I had to do all that, I'd be complaining about working too much.)

Man, this missionary business is tough!

First “Ambulance” Call in Mthatha

It was a busy day Monday at the clinic and I was trying to keep the patients in some semblance of order, which is challenging enough in English and even more so in Xhosa. In the middle of it all, two young men walked in, picked up our stretcher, and walked out. They returned in a few minutes with a young man on the stretcher and wordlessly put him down in the middle of the floor. With the help of our after-school program director, who is Xhosa, I was able to figure out that he had just been shot, several times, in a fight.

I had never seen a gun shot wound during my time in the Nome Ambulance Department but quickly swung into EMT mode. He was fairly lucky as the bullet appeared to pass through his abdomen with minimal damage. He did have a broken elbow, however, which was spurting blood. (Ironically, of all the body parts the children have been teaching me in Xhosa, the only one that has stuck so far is the word for elbow – “nqneba.”) We got him bandaged up and put him in the back of our truck to take him to the hospital. My fellow volunteer Robert drove and I rode in the back. “Great,” I thought. “I’m finally doing something and it’s just like Nome!”

Of course, it was nothing like Nome. First, the canopy on the truck bed has about four feet of clearance so I was crouching. Second, I realized how used I was to the machines we had on the ambulances in Nome. I could just hook a patient up to one and get a set of vital signs. On Monday, I had to physically take them, which is not usually hard but becomes much harder on rutted and pothole-strewn roads. I could hardly keep my fingers on a vein long enough to get anything. Third, we had to negotiate downtown Mthatha without lights or sirens. Downtown Mthatha brings new meaning to the word chaotic – pedestrians crossing freely, cars ignoring lane marking, stop lights that barely function, and so and so forth – and I doubt lights or sirens would have helped. Fourth, I had no tools. It was just me, my knowledge, and the patient. No fluids, no needles, no stethoscope, nothing. Fortunately, he was fairly stable without any interventions.

We got the hospital (the shiny new Nelson Mandela showpiece hospital) and handed him over. I took off my gloves and went to wash my hands. And though I searched high and low and found several sinks and soap dispensers, I found no soap at all. And it wasn’t like all the soap dispensers were just temporarily empty. It looked like they had never even seen soap. So I rode back to Itipini with my hands at arms length. We’ve got plenty of soap at the clinic.

What Does Itipini Look Like?

Pictures are worth a thousand words, after all.

And this is the clinic.

Driving

After a week of riding shotgun, I have begun driving myself around Mthatha this week and dealing with all the challenges that brings. So far, I think, so good.

South Africans drive on the “wrong” side of the road and while I still occasionally head to the left side of the car to drive, I am more or less adjusting to this difference. Of course, it helps immensely to have a passenger who will start screaming in terror when I forget where I am and revert to the right side of the road.

I also re-learning how to drive a stick shift car. On a theoretical level, I know how to drive stick but on a practical level, I am quite a bit rusty. Fortunately, the car has a forgiving clutch and I haven’t stalled in the middle of any intersections yet.

The biggest challenge is what might be called the driving ethos is Mthatha, which can basically be summarized by saying “anything goes.” I have to drive right through downtown to get to Itipini and it is quite exciting and terrifying, particular as I try to remember to stay on the left, not stall, not hit any pedestrians, and get through intersections with frequently broken traffic lights.

Doing and Being

When I look back on my first week in Itipini, I can’t say I’ve actually done anything. Sure, I’ve bandaged a few wounds, helped a few children learn their alphabet a bit better, bought food that’s been distributed to people who need it, and a variety of other small tasks. But when you tally it all up, I’ve hardly accomplished anything.

I was thinking about this mid-way through the week and feeling pretty discouraged. After all, at my old job in Nome, I measured the success of a work day by how many news stories I was able to write, how many minutes of tape I could edit, how many interviews I could get, how many events I could cover. Outside of work, it was the same: how many ambulance runs I could take, how many mountains I could climb, how much activity I could cram into the 24 hours I had each day. As a student, it was also the same: how many papers I could write, how many books I could read, and so on and so forth. I am in the habit of measuring myself by what I am able to do so to be confronted at the end of the week with a wholly inadequate list of accomplishments is somewhat frustrating.

But when I reflect on my week in another light I can be a bit more positive. I was an adult who spent time with children who crave attention and I did so in a mostly loving way that hopefully shone a little joy into their world. I was a welcoming presence at the clinic and smiled at the patients who visited and even when I mangled their language and names, I did it in a way that made us both laugh. I think I treated TB and HIV patients the same way I would treat anyone else, which can’t be said for everyone here. I was willing to spend time in a place I did not have to (and that most other people stay away from if they can) and I did so ungrudgingly. Who I was last week was more important than what I did.

On the one hand, this is great. I thought several times last week as several children turned me into a jungle gym, “I’m getting paid for this. This is fantastic!” On the other hand, if I get to the end of a year and all I can say is, “I was a kind and loving presence to people who don’t see a lot of that,” I doubt I’ll be satisfied. Who we are may, in fact, be more important than what we do but that’s a lot easier to say than it is to internalize and act upon.

Of course, I’ve only been a here a week. Once I figure out how things are done at Itipini, I’m sure I’ll go right back to measuring myself by what I’ve done. But I’ll try to be thankful for this brief period when I primarily cared about who I was.

Becoming a Xhosa Woman

My fellow volunteers and I spent the weekend at a lodge on the Wild Coast known as Bulungulu. The Wild Coast is an undeveloped (and under-visited) part of the South African coastline, famed for its beaches, rolling hills, and much more. Bulungulu is an interesting approach to tourism – part business and part community development. The lodge is 40-percent owned by the local subsistence community and local residents own and operate all the touristy type attractions the lodge offers. On Saturday, we signed up for the “women power” tour, in which we were to spend part of the day living as a Xhosa woman.

Now I have long believed that in many cultures it is women who are the glue of a society (honestly!). The role of men in many societies, it seems, is to take it easy, show up when all the work is done, and claim credit. But it is one thing to objectively “know” this and quite another to actually “do” it.

First, let me say, this tour was the ultimate in Tom Sawyer-ism. Basically, we paid money to help a (very intelligent) young woman with chores she would have had to do anyway: getting water, collecting wood, cooking, washing dishes. I was happy to pay the money, not only because it went directly to her but because it was such an eye-opening experience.

Collecting water is not so hard; it’s the carrying it back on your head that kills you. In this picture, our tour guide is only holding her bucket, I am sure, so I don’t look quite as bad. Girls start learning this at age four and she could easily walk without a helping hand on the bucket.
Collecting wood is harder; you have to go searching through tangled thickets looking for whatever deadwood hasn’t already been picked up by another family. Carrying it back is even harder than the water. You get poked every which way and it’s heavy. When carrying both the water and the wood, I was glad to take a picture because it was a valid excuse to put down the load.
When you’ve got something on your head, you can only look side-to-side and then only gingerly. You can’t look up-or-down to see what you might be about to step on or trip over. And have I mentioned the Wild Coast is renowned for its hilliness?

Cooking and cleaning is not so hard. But is just a steady stream of work, one thing after another. Every time, we sat down to take a break, it seemed, we were told what there was to do next. I managed to get out of a little work by collecting some rocks and entertaining the children with a little juggling.

This morning “tour” nearly did me in so I spent the rest of the day on the beach. It was legendary.

Same All Over

Kids... gotta love 'em