Tuesday, 30 July 2013

5 Good Life Decisions…in South Africa

1. “Climb” Table Mountain & Watch the Sunset
Crazy beautiful view
All 14 of us on the trip decided to hike Table Mountain on a free day we had off from our community placements and class. I was super excited, but failed to dress appropriately as I was wearing heavy hiking boots and black fleece pants on one of the hottest days we had in Cape Town (if not THE hottest- yikes). I was essentially melting, but kept going because I knew it would be worth it afterwards to see Cape Town from the top! To my dismay, after about 2-3 hours of walking through random trails that people directed us towards, we found ourselves at the bottom of where the cable car takes you up the mountain. I could not believe that the whole time, instead of walking up the mountain, we were walking across the mountain from our residence at UCT. Since I was already roasted in my poor clothing choices, I decided to take the cable car up with a few others who were tired as well. 
Ah, look at that sunset!
That ended up being one of the best decisions I’ve made (if not the best) on this trip) as I got to truly breathe in the beautifully majestic views from the top of the mountain without feeling too exhausted. After eating a scrumptious oven pizza and taking various silly pictures with some of my friends, we decided to stay until the last cable car ran so that we could watch the sunset (those are my favorite)! Alongside good company, I felt so relaxed and was simply on cloud 9 just sitting there, breathing in the crisp air while my eyes got lost in the hues of the skies.

Who could resist taking silly pics on top of Table Mountain?

2. Seeing Penguins- Up Close & Personal
Penguins have actually been my favorite animals since the fourth grade, and the thing I least expected prior to my trip here was to see penguins in Africa… but I did! Thanks to our tour guide, Conroy, we were able to go to Foxy Beach to see African penguins (including the babies!) basking in the sun, and playing around in the water. It was the closest I have ever been to penguins, especially because the glass at the zoo truly ruins the experience of seeing penguins in real life. So this experience was basically a dream come true for me, and while you may or may not be a huge penguin fanatic prior to going to South Africa, trust me- you’re going to fall in love with them after you see them there!
3. Seeing (& Eating) Ostriches: “Be one with the Ostrich”
 Ever since I bought an ostrich figurine at a local market in Soweto, I have been semi-obsessed with them. After we left Soweto and settled into Simon’s Town, our group went out for a nice dinner during one of our nights there. Guess what was on the menu? That’s right, Ostrich! It is a common delicacy in South Africa, and I really wanted to try different foods while I am abroad here so I ordered the ostrich curry. The verdict? Deliciousness! It was almost a mix between beef and lamb in my opinion- yum and yum. (sorry vegetarians!) 

After we left Simon’s Town, our tour guide Conroy took us on a bus tour to some popular sightseeing points before we settled into Cape Town (including Foxy Beach as mentioned in #2). On our way back from one, we were able to see an ostrich right next to our bus! I have never seen one up close like that either, and I was so excited to see that lil (well, not so little) guy. I later felt bad that I had eaten ‘his kind’ only a few days prior, but it was conflicting since it was tasty.  When I tried to explain my contrasting thoughts to a friend on the trip, they just told me to say I wanted to be “one with the ostrich”, and I guess by eating it, I was? It was hilarious to me to think about this way, and nonetheless, seeing an ostrich up close was pretty cool.

4. Feasting at Old Biscuit Mill
Delicious pizza anyone?!
After hearing about this place from other volunteers at St. Joseph’s Home and reading about it online, I was excited to see this amazing, so called “hipster” craft and food market place. And alas- it was amazing! Not only did friends and I pick up some beautiful rings, scarves, and other gifts in the crafts area, but we ate really well at the gourmet food market! Anita and I decided to split everything in half so we could try double what we usually would, and I am so glad I did! They had everything from smoothies to macaroons to bruschettas to pizza to crepes to paella and everything in between! We ended up eating one of the most amazing four-course meals. With every flavor beautifully outdone itself in the market, I was in bliss as a foodie.

5. Paragliding Over the City & Water
Paragliding in action!
A few of us on the trip had really wanted to go paragliding in Cape Town since the beginning of our time in South Africa. Who else wouldn’t want to fly like a bird over this beautiful city? But, going paragliding proved to be a lot more difficult than expected. Every time we called, the conditions weren’t right for the weekend. It was either too much wind, not enough wind, rainy weather amongst other reasons that made it unsafe. We had basically given up hope until we got a call on the morning of our last full day in South Africa- the conditions were good enough for us to go that morning! It was crazy. Before I knew it, I was strapped to a pro, and was literally sailing off a cliff, over the city and towards the beautiful blue water. I couldn’t believe that it was actually happening. It felt like I was in an IMAX theater or something along those lines since I wasn’t attached to anything on the ground. I was actually floating over this whole scenery with just a guy strapped behind me controlling the winds with a giant parachute! It was one of the BEST decisions of the trip and man- just look at that view!
 P.S One bad life decision? Not backing up your files, having your laptop die during your last, important work week in South Africa, and having to upload a blog post once you’re home after you wait to get your laptop fixed and have your pictures uploaded! Yikes- let this be a lesson to everyone: Use a USB or Google Docs for important files!!! You won’t regret it :)

-Jessica Lee

Sunday, 21 July 2013

Challenges in HIV Treatment

                  Although South Africa reluctantly rolled out its government-funded ARV program in 2004, there are still many challenges the government faces in regards to HIV treatment. Two of the key challenges go hand in hand: ARV adherence and program retention. Surprising to some is the fact that South Africa actually has an adherence rate of 90%, one of the highest in the world (Achmat, 2007). This is primarily thanks to the work of NGOs, who often place an emphasis on treatment literacy, community awareness, and primary care clinics. However the same year that Achmat’s paper was published, another study showed that South Africa was suffering in terms of patient retention. The Cornell study found that after one year in treatment there was only a 60-80% patient retention rate, which steadily declined over time (Cornell, 2007). When looking at these papers side by side, one is faced with a surprising juxtaposition: while in treatment patients are very adherent to their medications, yet less patients are adherent to the treatment itself. In the next few years South Africa will have to focus on increasing patient retention rate by exploring the factors that may lead to loss to follow up (LTFU).
Zackie Achmat, HIV activist, with Nelson Mandela

              There are several factors that can lead to increased numbers of LTFU patients. In my opinion the two most important are computational errors and the over-burdening of primary care clinics. Both the Cornell paper and the WHO Global Update on HIV Treatment acknowledge that the estimates of LFTU patients are not completely accurate. It is estimated that anywhere from 33-48% of LFTU patients are actually deceased, and another 12-54% are “self-transfers” who access care at different places (WHO, 2013). Yet this inconsistency is telling, as it reflects the current lack of organization in the government ARV system. A successful program needs to be able to keep track of its patients, whether or not they have died or they are truly LFTU. However while the true number of LTFU patients may be lower than estimated, there are still too many people not retained in the government system. Much of this can be attributed to an over-burdened program that was unprepared for the dramatic increase in patients in recent years. Many clinics just do not have the staff or resources to continuously keep track of their increasing number of patients, and with an estimated 6.3 million HIV-positive South Africans it is not difficult to understand their plight (Class lecture, 6/25/13).
Thabo Mbeki...how many deaths is he responsible for?
                  Luckily there are ways to improve retention rate and decrease the number of LTFU patients. According to the WHO, “several studies…have shown that decentralizing ART services improves retention in care” (WHO, 2013). The studies that they are referring to have found that a district hospital’s retention rate is on average 80%, compared to a regional hospital’s retention rate of 69%. We saw the benefits of decentralized primary care first hand last week during our visit to Gugulethu. At the ARV Club we visited there were less than 30 patients enrolled, which means that it is easier for them to get their medications, and their absence is noted if they do not show up. Another prospect for increasing retention rates is the gradual introduction of FDCs in the public sector. While availability may be currently limited to some prioritized group, taking one pill once a day will certainly lead to more adherences, versus having to take three pills two times a day (Class lecture, 6/25/13).
                  LTFU patients are a big challenge facing the future of ART in South Africa. The main problem isn’t getting people in treatment to adhere to their medications, but it’s getting people to adhere to their treatment after testing HIV-positive. Many factors play into retention rates: statistical errors, poor record keeping, burden of resources on primary care, revival of traditional medicine, social stigma, and AIDS-related deaths. However by focusing on record organization and continuing efforts to decentralize ART care the picture of HIV retention may not look so bleak.


Achmat, Zackie, and Julian Simcock. "Combining Prevention, Treatment and Care: Lessons from South Africa." AIDS. 21.4 (2007): S11-S20. Web. 2 Jul. 2013.

Cornell, Morna et al. "Temporal Changes in Programme Outcomes Among Adult Patients Initiating Antiretroviral Therapy Across South Africa, 2002-2007." AIDS. 24.14 (2010): 2263-2270. Web. 2 Jul. 2013.

Grimsrud, Anna. Class lecture: Antiretroviral Therapy in South Africa. June 2013.

World Health Organization. Global Update on HIV Treatment 2013: Results, Impacts and Opportunities. Geneva, Switzerland: WHO Press, 2013. Web.

By Leah Rosenbaum

Saturday, 20 July 2013

Yabonga: The First Week of the Workshop

It was the first week of the workshop that Brett, Lindsay, Shelby and I had invested our time and creativity into making and it was successfully accomplished! Everything was executed as we had planned, and if anything we had enough time to not only do what we had scheduled but more fun activities for bonding with the students. Looking back on all the planning that we had done, it was good that we had certain time frames to get an idea of how much time we would potentially need when actually doing the activities the day of.    
On the first day, everybody just started to warm up to one another. It was not just us, the students from America, that did not know the tenth year students, but even the gap year students had never met them and the students were not all familiar with one another. The ice breakers were definitely essential in making these students more likely to open up and participate in class. For each activity that we had, we had different people leading them and I think this way of doing it was really effective. By having one leader per activity, the kids could sense the organization of the program that we had created and were more prone to listening to the person listening. The rest of us that were not leading the activity sat with the group of students and participated with them. I think this was very important in this program because it made us capable of connecting with the students. While it was important to have order in the classroom, the atmosphere was a lot more fun because we were not trying to be intimidating older figures but rather individuals that wanted to help them and give them some information about careers while having fun with them as well.   

Yutong and Amanda joined us at Yabonga this week. Yutong came by on Wednesday and Amanda came by on Friday. I was really shocked, and pleasantly shocked at that, that these students were so happy to see new faces. They were extremely welcoming from the moment that these two stepped into the classroom. On Friday, when Yutong did not come out, some of the students that had been in class on Wednesday asked us, “Where is Yutong?” It was nice to see that these kids remembered her name and were missing her presence as well. On Friday, there was a comment that Amanda had made which really got my thinking. At the end of the day, Amanda and I were chatting and random things after the day had ended and we were waiting for the van. She asked me “Wait, Sierra, wasn’t that kid wearing the scarf that that kid is wearing now? And that kid was wearing the hat that that kid is wearing now?” Glancing in the direction of the people that she was speaking of, I nodded my head. She then went on to ask if these kids had known each other before, to which I replied no. What came as a surprise to her, made me realize this reality as well – this was that these kids are so open and sharing with so many different aspects of themselves and their culture that even if they had only known one another for a week, they seemed as though they had known each other for years. If somebody were to walk into that classroom at the moment these kids were jumping around and smiling and laughing together, they would think that these students had grown up around each other for a very long period of time. In the states, there is this sense of ownership that us as Americans have. We achieved this or we achieved that. This is mine or that is hers or his. While there is nothing wrong with this, because yes, if something does belong to you and you earned it, you have every right to say that it is yours, it was just an interesting experience seeing kids share all of the things that they had with one another after knowing each other for a week or less.

Life, The Game Reserve, and Everything

During one of our last weeks here in South Africa we visited a game reserve. The day began relatively early with a rushed breakfast followed by all of us shuffling into a small bus smelling heavily of cigarettes. Enveloped in this comforting morning aroma most of the group took this as an opportunity to catch up on much needed sleep. We drove for some time over an hour to reach our destination, during which several of us snapped pictures of the sun rising over the mountain-scape.
            Upon arrival we were met with another breakfast followed by face painting that I did not partake in. From here the real meat of the experience begins. We walked outside to be greeted by large touring trucks featuring completely exposed engines and rows of bench seating. Once they started going it took a bit to get used to the constant jostling our off-roading adventure was providing. While the game reserve in no way compares to the massive game parks that I think we’ve all seen on TV it did offer a more intimate experience. While there weren’t immense herds of animals, for the animals they did have we drove our lumbering truck right up to them and took pictures while our guide talked about the finer points of their behaviour.
            The variety of animals on display can probably be imagined based on what most people have seen or heard about Africa. We began with Cape Buffalo, followed by eland, zebras, antelope, elephants, wildebeests, rhinos, lions, and ending with a lone ostrich. To go into descriptions of all of these animals would probably be tedious for many and to also include pictures would make this post overlong but worth mentioning separately out of all of those were the rhinos.
            The rhinos are worth mentioning because they got me thinking. This small little reserve filled me with awe but upon seeing these rhinos I also realized there was sadness there too. The two rhinos the park had in their possession lacked horns, and not because that is some sort of rare and unspectacular rhino variant but because several years ago they had been poached. Poachers had snuck onto the premises, tranquilized the rhinos, and used saws to remove their horns. They cut deep, damaging the bone growth plate of one of the rhinos and we were told that it would never re-grow because of this. To me this represented human greed and ignorance on the small scale, but it also made me begin to think that there was something fundamentally wrong with the park as a whole.
Not that it was a bad experience or that I wasn’t enjoying myself but just that I realized at that point that none of this was natural or at least what we’d like to think of natural as being. In reality it’s more unnatural that those animals are there than if they were absent at this point. Looking at the reserve, at Cape Town, South Africa, America, and the world it becomes increasingly clear how much has been squandered. Now I don’t want to get all moralistic and say that the human consumption and the pursuit of small green pieces of paper is evil because what species on the planet doesn’t multiply until it becomes impossible to do so. Eventually populations hit their carrying capacity after which things take a dive, and the realization that this probably isn’t the greatest idea to consume with no end may be what really separates humans from other animals. Does this assert that people who don’t have this epiphany are animals? Maybe, and perhaps it’s my duty as the lone GECS major of the trip to document this.  
But to end on a lighter, less philosophical note; overall the show of life on display was incredible. How all this came about from some primordial soup to give rise to what we saw that day is amazing and awe-inspiring both in its improbability and in its beauty.

-Andre Phillips 

P.S. Thank you Maggie for allowing me to use your wonderful pictures for these posts.

Politics and the HIV Epidemic in South Africa

There are a whole host of South African political events and movements that have had unique effects on the development of the HIV epidemic, from apartheid to the Treatment Action Campaign but instead of addressing a specific event or movement I would like to spend some time talking about social embeddedness in South Africa. Social embeddedness is the degree to which the government is listening and acting on the demands of the people and the lack of it in South Africa today is a crucial issue that has affected not only the development of HIV but many other issues as well.
            Following the fall of the apartheid regime, South Africans received enormous political and legal gains through the newly created Bill of Rights and Constitution, however despite these gains the socioeconomic landscape remained and still remains very similar to the days before 1994. Just like in the US, after the abolishment of slavery, there has been a failure to redistribute wealth leading to poverty that mostly carries a black face. Except here, in South Africa, that face is the majority of the population. The plan to redistribute following apartheid was largely built upon macroeconomic policy dependent on foreign investment with the hopes that international wealth would somehow trickle down. The issue with this is that many initiatives to benefit the people were ignored for the sake of creating a welcoming environment for investors. One of the most important of these for the HIV epidemic was the rollout of ART’s. Along with Mbeki’s denialism the cost and fear of scaring off investors played a secondary role in denying treatment.
            The focus on investor oriented economic policy and the failure to redistribute have stunted the progress of public health and more specifically HIV treatment through the massive disparity that exists among the people. This has shown itself in the disparity amongst public and private health care but in more subtle ways has also affected the development of social movements. The disparity in resources has meant that most movements are organized and managed by the middle class and this further distances the poor from politics. This has meant that many social determinants of health, such as sanitation and education, have been largely ignored. A problem has to become big enough or visible enough to garner the attention of those with skills to maneuver the political system and these people are rarely found amongst the poor. Here, an analogy of a boiling kettle seems widely applicable to many movements where those closest to the bottom, the poor, are affected most. This is where the boiling begins. The bubbles rise and begin to affect the water above it until it finally reaches the top where pressure builds and eventually either forces the government to action or the lid is blown off and the result is a revolution.
            This is a shame because the modern government of South Africa from it’s genesis has been good at creating policy, but it has failed in the implementation and enforcement. What makes this worse is that the ANC has controlled the government almost effortlessly and without the threat of the power of the vote there is no reason for them to not just simply follow the money. A government for the people, by the people, and of the people is an American myth that applies to democracies the world over. It is the power of the vote that primarily ties people to the government and if that vote becomes guaranteed the government falls into complacency. Goodwill can only take an initiative so far and ultimately self interest must be wrangled into the equation for meaningful results to be attained. The complacency that the government now carries has played a major role in slowing the rollout of ARV treatment and in transitioning to a clinic focused health model. For each issue it has taken a highly focused and organized group of people to force the government into action and that allowed the HIV epidemic to become as large as it has.

-Andre Phillips

Community-based learning at CMT

We’ve already heard plenty of stories about people living with HIV in South Africa, the majority of whom reside in under-resourced black townships, suffer from poverty and unemployment, experience fragmented family life, and lack the basic access to quality care and information. These populations have also been extensively analyzed, in a rather detached manner, as either figures demonstrated in papers or participants of randomized controlled trials. However, through community-based learning opportunities such as working with local non-profit organizations and the homestay weekend in Langa township, we finally came to understand them as real people - people who have their own aspirations and struggles just as we do. The weekly journal and reflection session further enabled us to bring together both the observations out in the field and the classroom learning.

Entrance to the CMT office 

       Community Media Trust, the local non-profit organization Amanda and I have been working with for the past six weeks, is dedicated to producing all forms of media for the purpose of promoting health literacy in South Africa, primarily under the brand of its popular TV show Siyayinqoba Beat It!. Apparently, one of the major causes of the high prevalence of HIV especially in those remote townships in South Africa is the lack of easy access to quality health information. As a result, an incredible number of residents in those underserved communities would test positive for HIV due to inconsistent condom use, while only a few would actually know their HIV status and even less would get and stay on ARV treatment. In addition to providing them with affordable and accessible health care, I believe it’s equally important to educate the patients with adequate information to keep themselves safe and healthy, thus empowering them with regards to their entitlement to health services. “If you test positive, think positive too!” Once the patients know that they can lead a normal life, including working, having a family and giving birth to healthy children, just as well as their healthy counterparts, it would be much easier to take a positive outlook on life and learn to live in harmony with the virus. 

Amanda (my partner, left), Debbie (our supervisor, middle)
and I (right) at the Siyayinqoba Beat it! Wrap-up Party 

      Our major contributions involve writing up press release for the website, editing a video clip about an event, and doing literature review for a research project. Our experience is also highlighted by a couple CMT events that we luckily got to be part of, notably the teenage pregnancy workshop, the HIV/TV training session for community health workers (CHWs), and the Siyayinqoba Beat it! Wrap-up Party.

CMT Outreach staff

     Through these experiences, I learnt to view a lot of things from a very differently perspective. The fates of black people have been so miserable, and their dignity been so unreasonably undermined, that they are too eager to protect their own people from any further insults from the western world, even in the extreme way. I regret having thought of those who rejected ARV treatment or HIV in general as stupid or wrong. I hope that we are here not just because of empathy, in some sort of mindset like “These black people are so poor. They have so many problems and I have to be there to fix them!” I wish we could really treat them as our equals in the mind, before we talk about social “equality” in the broader sense. I hope we truly learn to understand the lives and aspirations of individuals, respect the culture they take pride in, value everyone’s contribution to the community, and most importantly care for their wellbeing. I’d like to share my favorite quote from the Great Gatsby here“In my younger and more vulnerable years my father gave me some advice that I've been turning over in my mind ever since. "Whenever you feel like criticizing any one," he told me, "just remember that all the people in this world haven't had the advantages that you've had.”

      I also got a better understanding of the essence of community based learning. What the organization can offer greatly varies across each placement site, yet it's important to be open-minded and positive. As many seemingly trivial tasks reveal their value to me over time, I have realized that what we feel and learn ultimately depends on how we approach our work and manage to get the most of it. 

By Yutong Zhou