Monday, July 21, 2014

67 minutes

Last Friday would have been Nelson Mandela's 94th birthday.  'Mandela Day' is always a big thing in South Africa, but this year, as it was the first Mandela Day since his death last December, was extra special.  South Africans don't celebrate Mandela Day with a public holiday like we tend to do for our leaders in the US.  No, instead of sitting around catching up on movies or sleep or something, South Africans encourage one another to spent 67 minutes doing something to make the world a better place.  I LOVE this country!  (Side note:  Why 67 minutes?  Because Mandela gave 67 years of his life to public service, so the public is asked to give 67 minutes of their time to honor his legacy.)

I got back to Cape Town from Lesotho just in time to join HOPE Africa in our 67 minutes.  There are lots of options for what 'service' can look like, and all are worthy causes.  Some of the other Anglican Church employees visited an NGO that makes sleeping bags for homeless people out of recycled plastic bags.  One of my friends in Hermanus picked up trash along the cliff path.  The presenters on my favorite Cape Town radio station spent the day at a community food garden.  We at HOPE believe that, while giving 67 minutes of your time is great, real lasting change happens when you have an ongoing partnership with the communities in which you work.  As such, we chose to visit one of the schools in Khayelitsha that we're already involved with.  Friday was also the last day of the winter school holidays, and the holiday program for the kids was coming to a close.  We partnered with another local NGO, Abagail House, and a few generous families to serve lunch for the kids and hand out a few supplies and toiltries that would be useful at the start of their new term.  We also got to stick around and see what the different students had prepared for their Mandela Day assembly.  It was such a great day, and I'm so glad I came back to South Africa in time to participate!  I think Tata Mandiba would have been proud of all his children.

The HOPE girls show off the packages we made for the kids.  They contained a wash cloth, soap, toothbrush, and toothpaste to help the kids look good and stay healthy for their new school term.

Abagail House, an NGO in Khayelitsha where these local ladies are employed sewing garmets.  Currently they are sewing new track suit uniforms for the school we visited.

Thandeka enjoys a cup of tea with the Abagail House ladies.

Two of the boys enjoy their lunch.  The kids really liked having their picture taken, and some of them were hamming it up!

These guys did some magic tricks and made baloon animals for the kids!

All of the classes assembled for their Mandela Day festivities

Each class had prepared a song and OH MY GOSH could some of these kids sing!

And check out this eight year old drumming!  She was AWESOME!

Jenny from HOPE (on the left, gray sweatshirt) joined right in with the oldest class!

Class photo.  I'm actually in this picture!  Don't see me?  That's because I'm crouched behind the umbrella holding it down as the Cape of Storms was busy earning its name with gale-force winds.

Saturday, July 12, 2014

Can these bones yet live?

"The hand of the Lord came upon me, and he brought me out by the spirit of the Lord and set me down in the middle of a valley; it was full of bones. He led me all around them; there were very many lying in the valley, and they were very dry. He said to me, “Mortal, can these bones live?” I answered, “O Lord God, you know.” Then he said to me, “Prophesy to these bones, and say to them: O dry bones, hear the word of the Lord. Thus says the Lord God to these bones: I will cause breath to enter you, and you shall live. I will lay sinews on you, and will cause flesh to come upon you, and cover you with skin, and put breath in you, and you shall live; and you shall know that I am the Lord.” So I prophesied as I had been commanded; and as I prophesied, suddenly there was a noise, a rattling, and the bones came together, bone to its bone. I looked, and there were sinews on them, and flesh had come upon them, and skin had covered them; but there was no breath in them. Then he said to me, “Prophesy to the breath, prophesy, mortal, and say to the breath: Thus says the Lord God: Come from the four winds, O breath, and breathe upon these slain, that they may live.” I prophesied as he commanded me, and the breath came into them, and they lived, and stood on their feet, a vast multitude. Then he said to me, “Mortal, these bones are the whole house of Israel. They say, ‘Our bones are dried up, and our hope is lost; we are cut off completely.’ Therefore prophesy, and say to them, Thus says the Lord God: I am going to open your graves, and bring you up from your graves, O my people; and I will bring you back to the land of Israel. And you shall know that I am the Lord, when I open your graves, and bring you up from your graves, O my people.  I will put my spirit within you, and you shall live, and I will place you on your own soil; then you shall know that I, the Lord, have spoken and will act,” says the Lord. - Ezekiel 37:1-14

One of my favorite passages in the entire Bible is the valley of the dry bones in Ezekiel.  I don't know why I love it so much, but I think it's something about the flow of the words; it's very lyrical.  The point of it is so beautiful too - even things that are dried up and decayed can be made new again by the power of the Almighty.  In fact, it's not just possible, it's His promise.

The past six weeks that I've been living in Lesotho have been really challenging for me.  The reality is that daily life in Mantsonyane is hard.  The third world problems like no running water, no heat, iffy electricity, and lack of modern conveniences like a shower or a washing machine or even a flushing toilet take their toll on you.  Fresh healthy food is scarce.  Most people can't afford to buy meat or chicken or fish regularly.  Fresh vegetables don't grow here during the winter (Well, nothing except cabbage.  There is lots of cabbage).  The staple food in Lesotho is pap, cornmeal porridge that is sort of like grits.  That's what most people eat every day, their main (or only) source of nutrition.  Many people walk two or three hours to go to their nearest health care facility, and when they get there they often find one overworked nurse and not enough medications to go around.  It's a reality for many families that one parent lives and works somewhere besides the village where the family resides, often all the way in South Africa, so far too many families are split up for months at a time.  Nearly one in four adults is HIV positive.  One in four.  That statistic alone would cause a major crisis, even in a country with way more resources than Lesotho.  Here it's not just a health care problem, it's absolutely devastating to every aspect of life.  Since the beginning of the HIV epidemic, Lesotho has, according to some sources, suffered an 18% population decline solely due to AIDS.  18% of the population just gone.  18%!  Can you even wrap your mind around loss like that?  

When you're looking at all these problems put together, how can you not start to feel that the situation is hopeless?  Lesotho can at times seem too far gone, beyond help.  I'm not proud of what I'm about to say, but I will be honest.  After just six weeks in rural Lesotho, I'm exhausted.  There were many moments during my time at St. James that I felt totally bewildered, not even sure where to begin.  The stream of patients is never ending, new people are being infected with HIV every day, more and more kids show up sick and malnourished, and nothing seems to improve.  What could I possibly offer that would make even the tiniest bit of difference to these people?  What on earth am I even doing here?  I really wish I could say that I came to Lesotho and dove right into work and made a huge impact and wasn't bothered by the conditions at all.  But that would be a lie, and it would be incredibly unfair to the people here who do work so hard and so cheerfully and with such little reward.

Yet, Lesotho isn't a hopeless place at all.  St. James Mission Hospital has been providing care for more than fifty years.  I wonder how many children have been born here, how many people have been started on ART, how many cases of TB have been cured?  I have so much respect for everyone I met at St. James.  They all cope way better than I do.  They give their time and talents selflessly, often living away from their spouses and children, all to better the lives of their patients.  I admire the attitude of the residents of Mantsonyane, too.  No one complains about the difficulties they face every day with lack of water or bitterly cold temperatures or no electricity.  Well, no one except me anyway.  When I go running in the afternoons, local kids see me and come racing up to follow me, sometimes for 15 or 20 minutes, chattering away in Sesotho and so excited just to see me and run around and get out their energy like kids everywhere do.  No, Lesotho isn't a hopeless place, and I don't believe that it is too far gone.  I don't think Ezekiel would believe that either.

The grace of God is sufficient for any situation.  That's a promise, and that's a fact.  

'"Mortal, can these bones live?” I answered, “O Lord God, you know.” Then he said to me, “Prophesy to these bones, and say to them: O dry bones, hear the word of the Lord. Thus says the Lord God to these bones: I will cause breath to enter you, and you shall live. I will lay sinews on you, and will cause flesh to come upon you, and cover you with skin, and put breath in you, and you shall live; and you shall know that I am the Lord.”'  

And that happened.  Ezekiel commanded the winds to come give breath to the dry bones, and they did.  To put it another way (and yes, I'm going to quote Marilynne Robinson AGAIN):

"It has seemed to me sometimes as though the Lord breathes on this poor gray ember of Creation and it turns to radiance - for a moment or a year or the span of a life. And then it sinks back into itself again, and to look at it no one would know it had anything to do with fire, or light. But the Lord is more constant and far more generous than it seems to imply.  Wherever you turn your eyes the world can shine like transfiguration. You don't have to bring a thing to it except a little willingness to see. Only, who could have the courage to see it?"  

The work that is being done by the many faithful people in Mantsonyane is this breath of creation, turning an ember to fire and restoring life to something dry.  The entire staff of St. James has the courage to see.  About this I have no doubt.  And it is my great privilege to bear witness to these things, to share this story with you, even as I am humbled by my own shortcomings which have become glaringly obvious as I watched those around me give their all while I barely found the strength get out of bed in the morning.  My time at St. James has not been easy or fun, but I believe it was one of the most powerful learning experiences I've ever had, and I will look back on these few weeks many times in the coming years of my life and know how blessed I was to have had the opportunity to see.

Saturday, July 5, 2014

Workin' it

This week I’m going to tell you a little more about the work that Hananja and I have been doing for St. James.

Let’s talk about Hananja first.  Hananja got here last Tuesday, so she was able to give St. James 8 full days of her time.  She is very generous to spend almost two weeks here on a completely volunteer basis – she even covered her own travel expenses out of her pocket.  So three cheers for Hananja and her awesomeness! 

Hananja spent her first day or so here at the hospital assessing their food-related needs.  As a registered dietician, she is qualified to do all sorts of things like teach about breastfeeding, develop specialized diets based on specific needs for particular diseases, calculate energy requirements for individuals and advise them on how to achieve their goal weight, advise about community food security, and loads of other things.  St. James doesn’t have a dietician on staff, so there were a lot of work areas for Hananja to choose from.  Due to her limited time here, I suggested that she pick one or two areas that she felt would be most beneficial to the hospital, and she chose to work closely with the domestic supervisor and kitchen staff to update the patient menu.  The menu is currently based on what is available in Mantsonyane year-round, what the kitchen staff knows how to cook, and what will be most cost effective.  Hananja created an updated menu that allows for a wider variety of healthy foods while still taking these factors into account.  She has spent the past few days working with the kitchen staff to help them learn how to cook the foods she has suggested in a way that will retain their nutrients, and she has taught the staff how to measure foods better as they cook to make sure that patients get enough to eat without there being lots of leftovers that waste precious resources.  All of this is really exciting stuff!  Hananja has also been helping me with one of my projects related to patient education.

So, what have I been working on for the past five weeks?  I’ve had four main projects here at St. James.  The first is just spending time in the various areas of the hospital and clinics to learn about health care in Lesotho, especially the areas where I have a lot of nursing knowledge like the labor ward and the OR.  It’s been very educational – you wouldn’t believe some of the things that nurses are forced to do here, just because resources are so limited and medical technology is basically nonexistent, so the staff has to make up for this by being on top of their game all the time and going way beyond what I would feel comfortable doing for a patient in the US.  There is just no choice here; if you want to save a baby, that means doing an emergency c section without an electrocautery or an ECG monitor.  I’ve also spent some time travelling to the satellite clinics and in the outpatient department (OPD) at the hospital.  I have an interest in HIV and AIDS care, so I still want to take one day to shadow in the HIV office here at St. James.

The two main administrative projects (with a clinical component) that I’ve been working on here are statistics and patient education.  Currently, the hospital turns in monthly statistics to the government about the number and types of patients they see in the outpatient department, but they don’t capture any statistics for their own use.  So, after spending some time in the OPD to get a feel for how to best capture useful data, I’ve developed a monthly stat report, and I’ve filled it in with data from as far back as 2012 so the hospital can start to look at trends in illness over time. 

Anywhere in the world, patient education is always an important part of the nursing process.  St. James’s OPD is doing most of their patient education in the morning while the patients wait for the doctor to finish his rounds of the inpatient wards.  The problem with this system is that whatever nurse or trained nursing assistant happens to have time in the morning is the one who does the education for the day.  What I’ve been trying to do is standardize the education topics so that different nurses will make sure they hit all the important points about a given topic.  In other words, I’m creating a patient education file filled with pre-printed sheets about a variety of topics, everything from HIV to burns to diarrhoea and vomiting to oral health.  Hananja was really helpful in reviewing this file for me to make sure I thought of all the most important points for each topic, and she contributed pages on nutrition and breastfeeding.  Also a big shout out to my very favourite American dentist for writing a page on oral health.  Thanks, Jen!  As part of the patient education work, I’ve also made handouts to give to patients who are diagnosed with certain conditions that are very common here.  With Hananja’s help, I was able to make information sheets for TB, diabetes, and hypertension that are simple and direct and have lots of pictures.  Now all we need is for someone to translate these sheets into Sesotho.

Finally, the other big project I’m working on here is Hands on Health.  I think I explained a bit about the HoH program before, but it’s a community engagement initiative that is seeking to empower community members to take charge of their own health (meaning holistic health – physical, mental, and spiritual).  I have sat in on HoH meetings and created a draft of a guideline for how to participate in the HoH program.  This was an exciting week for HoH – the coordination team has started visiting the local facilitation teams outside of Mantsonyane, so I’ve been accompanying them on these visits.  Basically we’ve been holding meetings with the local teams and other stakeholders like the village chiefs to talk about the HoH program and gather support for the initiative.  The meetings have been going really well, and we have more site visits coming up next week.

All work and no play makes Keri a grumpy girl, so Hananja and I are in Maseru this weekend before her flight back to Cape Town on Sunday.  Then I’ll return to St. James for one last week to finish up all these projects.  For my last two weeks in Lesotho, I’ll be doing something a little different.  I’ll be in Maseru for one of the weeks working with the Diocese of Lesotho, and the final week I’ll spend with Thabiso from HOPE Africa as he makes site visits for another project that HOPE is involved with here. 

I hope everyone had a good 4th of July!  I am celebrated by searching for American food in Maseru.  The closest I could get was a chicken burger, but it was very tasty and accompanied by fabulous South African wine.

Hananja training the kitchen staff on how to measure food.  She really got to know the staff pretty well, considering she was only here for about two weeks. 

At the HoH visit to Ha-Popa, Mapaseka had everyone trace out the acronym SALT with their feet so they would remember what it stands for.

Hananja’s mom donated a bunch of polar fleece fabric, which we cut it into 84 scarves, so lots of people in Mantsonyane will have warm necks thanks to her!

Yeah, we rode a minibus taxi to Maseru.  It was actually a lot less scary than I thought it would be, and, lucky for everyone else in this taxi, I consumed a heavy dose of motion sickness meds before climbing aboard.

Minibus taxis are rather cramped, though.

Sunday, June 29, 2014

Lesotho photos

I have some exciting news to share.  Remember Hananja, my friend from Hermanus?  Of course you do, because I blog about her all the time.  Well, she is in Lesotho!  Way back in September when I was first getting to know Hananja, she told me that she was interested in missions and in sharing her professional dietitian skills in a place where they're needed.  So I said, "Well, there's this hospital in Lesotho..." and thus began a discussion about her maybe coming to St. James for part of the time that I am here.  I'll tell you a bit more about the work she's doing in my next post.  But for now, not only do I have the pleasure of her company, I also have the use of her laptop!  So please enjoy some of the promised photos from Lesotho.
These first few photos are from the Hands on Health meetings we had during my first week here.  This is one of the small groups during one of our brainstorming sessions. 
I am sharing  my group's plans for a guideline tool about HoH

Thabiso is VERY excited about HoH!

I had only been here a couple of days when we got a dusting of snow!  See?  I told you it was cold!  But the snow was really pretty and I enjoyed seeing it.

The hospital's garden

Just a guy.  Riding on a donkey.

The hospital complex as seen from the road above.  The brick house with the red roof that's right in the middle of the photo is my house!

Patients wait for the outpatient clinic to open in the morning.  The big white building is the main part of the hospital.

Dr. Mack, one of our three physicians, posing outside of the clinic in Ha-Mafa.

A full moon over a very Lesotho landscape

The 'road' to Ha-Popa.  Again, the photo doesn't really capture how bad the road actually is, but I guess you can sort of get the idea.

When I was in South Africa, I sometimes invited friends to my house for Mexican food, which I would make using taco seasoning packets that Jacob brought me from the US.  We called these nights 'Mexican Monday' or 'Taco Tuesday'.  Well, Hananja and I continued this trend and had a 'Taco Thursday' in Lesotho!  And yes, I know I look a bit like a gangster.  Remember, the style is 'missionary chic'.

Filling my bucket at the garden tap.  The hospital's water issues are really becoming a problem.  None of the buildings, including the main hospital where the patients are, have had running water for about two weeks now.  This tap in the garden is the most reliable of the outdoor taps.  Sometimes it's on all day, but often it only comes on after 5 PM, which means there is no running water available anywhere on the hospital grounds for most of the day.  This is bad enough for me, who is used to having running water in my house all the time, but it really is difficult for the hospital.  Imagine trying to clean surgical instruments without running water. Yeah, it's a problem.

These guys saw me taking photos on a walk yesterday and asked me to take one of them.  The guy on the right in the front is wearing one of the traditional Basotho blankets that I've mentioned.  You can also see the round stone huts with their thatched roofs, which is what most Basotho homes look like.

Lots of times when I run, kids will just kinda follow along behind me.  These kids were following us for quite a ways, and Hananja (being Hananja and therefore adorable) obviously had to get them to skip down the road with her.

... and some cows in the river.
So there you have it.  A few photos to give you a bit of a picture of Lesotho.

Saturday, June 21, 2014

Stuff that's different

First, let me give a giant shout out to Martin!  Martin, in addition to being my very favorite nursing colleague ever, was the only person who commented on my last blog post and asked me a question.  And since I promised to answer any questions in my next post, here you go:

Martin asked me how severe is the burden of HIV disease in Lesotho?  

There are actually several different statistics you could use to measure the prevalence of HIV and how it affects delivery of health services.  For my purposes here, I am going to use data I got from the CIA World Factbook, which ranks every country in order of the estimated percentage of people age 15-49 who are HIV positive (known as the adult infection rate).  The most recent estimated adult infection rate from 2012 was 23.1%, ranking Lesotho second highest in the world behind only Swaziland.  This is a sobering statistic, but I have heard estimates that are even higher, up to 26% (again, it depends on exactly who and how you're counting).  The two main goals of the government's anti HIV campaign are to provide free ART to infected individuals and to prevent mother to child transmission.  A few years ago, the CD4 cutoff for ART initiation was raised from 200 to 350, and all health centers follow strict guidelines for HIV testing and prevention of transmission during pregnancy, labor, and breastfeeding, including lifelong ART initiation for all pregnant and breastfeeding women (Option B+).  So, yes, there is a huge burden placed on the system by the prevalence of HIV, and dealing with this pandemic takes quite a lot of time, money, and manpower.

Thanks for the question, Martin!

I mentioned in a previous post that life in Lesotho is very different from anywhere else I've ever lived.  So I will now describe a few day-to-day 'normal' things that are quite different in Lesotho.

The steps involved in making your bed:  My bed at home is made with a fitted sheet, a flat sheet, and a pretty bedspread on top.  My bed in Lesotho, on the other hand, has an electric heating pad underneath the fitted sheet, a flat sheet, a wool blanket, the thickest fleece blanket I've ever seen, and a comforter.  Also, I sleep in long pants, two pairs of thick wool socks, a long sleeved shirt, and a hooded sweatshirt, and even with all that, I STILL wake up shivering in the middle of the night.  

What you wear to work:  In Lesotho, everyone wears a coat ALL. THE. TIME.  Got a pretty shirt you want to show off?  Forget it!  It is very cold here, even inside the buildings, so most people never take off their coats in winter.  It basically looks like we're all wearing the same thing every day because we never take off our outer layer.  It's a good thing that people are too busy trying to cope with the hardships placed on them by lack of infrastructure that no one really cares what you look like.  I long ago gave up on trying to dress pretty and rather just dress in whatever will keep me warmest, usually about 4 layers of sweaters, so I look a bit like a marshmallow.  I have dubbed this personal style 'missionary chic'.  

Where people congregate at 5 pm after work:  After work, we all go to the Mantsonyane version of a bar, namely, the water tap in the garden.  Really the atmosphere is kinda similar to a bar in that there can be some jostling of position as people fight to get their beverage before it runs out, but that's where the similarity ends.  We're not here for a cocktail, we're here to fetch enough water to do things like wash the dishes and flush the toilet.  Oh, and if you're not me, then yeah, you'll be drinking the water you fetch.  Some people call me paranoid for buying bottled water, but I had a discussion just last week with one of the nurses in the outpatient department about how you can tell when the water quality goes down because you see a spike in patients complaining of nausea, vomiting, and diarrhea.  So yeah, I am happy to wash my dishes with the water from the garden tap, but I'll be sticking with my bottled water from Maseru as much as possible, paranoia or not.

The process of doing laundry:  Oh, laundry.  Never my favorite task.  In the division of household chores at home, Jacob usually does our laundry because he says I fold his socks wrong (OCD much honey?), but here in Lesotho, doing the laundry is particularly unpleasant and time consuming.  Forget a washing machine and dryer (Ha! A dryer... what's a dryer? I haven't seen one of those in nearly a year!), here I do my laundry in a bucket.  Even worse, I actually had to go through the embarrassing situation of asking someone how to do laundry in a bucket, because I genuinely did not know.  Do you soak it first?  For how long?  How do you know when it's clean enough?  Hot water?  Cold water?  Warm water?  Thabiso was gracious about explaining the process of laundry in a bucket to me.  He didn't even make any snarky comments about me being a spoiled American girl, and I would have deserved it if he had.

The oven:  I have a nice gas oven in my kitchen here.  Unfortunately, the way you turn it on is to open the gas valve, turn the dial all the way up, strike a match, and stick your entire arm inside the oven to light the flame which is of course at the very back.  Y'all, this is not a good idea for me.  I don't have the best track record with flames.  I once set a YMCA bus on fire.  (If you've never heard me tell that story, then next time you need a good laugh, ask me about it.)  But really, I am quite accident prone, and I say a little prayer every time I want to bake something.

Transportation:  There are two main modes of transportation in Lesotho.  They are called right foot and left foot.  If you're wealthy and you want the latest in transportation elegance, you don't get a BMW or a Mercedes.  No, you get a shiny new donkey.

The meaning of the word 'road':  Now, I don't want to be unfair or overly judgmental.  There is a beautifully maintained tar road that leads from Maseru to Mantsonyane.  Yes, it is very, VERY windy, and yes, I do suffer from horrible, debilitating motion sickness, so my opinion of this road is that it is an evil, tormenting beast, but it is a quality road that that is well-graded and pothole-free.  But turn off the main road and head up past the hospital in the direction of our surrounding clinics, and 'road' becomes a term for that pile of rocks you walk on to get from one place to another.  Last Wednesday, I again accompanied the medical team on a visit to another of our satellite clinics in Ha-Popa.  I had been warned that the 'road' to Popa was 'bad', and indeed it was.  It took us over two hours to travel 25 kilometers in a 4 wheel drive vehicle.  I tried to take a picture of the road, which I will post whenever I get access to a laptop, but really the photos don't do it justice.  You'd have to see this 'road' to believe it.

The perils associated with being a runner:  Anywhere in the world, there are always some potential hazards to running on the road.  In Lesotho, the likelihood of getting hit by a car is pretty slim, and the possibility of getting mugged for my iPod or something is basically nonexistent.  But tripping over one of the sheep that's blocking the road?  Very possible.  In fact, it might have already happened.

On a more serious note:  I know that there are a lot of terrible things happening in the world right now, and in times like this we are asked to spread our compassion so far that it can be stretched thin.  There are many truly horrifying situations going on, but I feel I must ask you to please add the kingdom of Lesotho to your prayer list.  I am sure this isn't even making the news in the US because 99% of Americans don't even know that Lesotho exists, but the three party coalition formed following the 2012 elections is collapsing, and parliament has been suspended.  So far there hasn't been any violence, but as the situation continues to develop, or rather, deteriorate, I ask you to hold Lesotho in your prayers.  After just three weeks here, I have developed a deep and abiding respect for the Basotho nation, and I am in awe of what has been accomplished here.  In a part of the world with a long history of foreigners taking over and decimating the local culture, the Basotho have managed the impossible and maintained not only their independence, but also their identity.  I hate to see this nation struggle like it is now.  So please, pray for peace and unity in the Mountain Kingdom.

Saturday, June 7, 2014

A different world called Lesotho

I have a confession.  A year and a half ago, I had never heard of the country I'm living in.  Honestly, had you ever heard of Lesotho?  And would you know how to pronounce it if I didn't tell you (it's Lis-ou-too, by the way)?  Even after I learned that I might be placed here and started to do some research, I didn't really believe that a place like this existed.  I had read that Lesotho is still a very traditional society and parts of it, particularly the mountainous middle of the country where Mantsonyane is, are still very similar to the way they were 100 years ago, the way they've always been.  Yeah, I had read that (thanks Lonely Planet!) but I didn't quite believe it.  Well, I'm here to tell you it's true.  This is one of the most remote places I've ever been,  and it really isn't Westernized at all.  Herd boys really do wear their Basoto blankets and walk up and down the mountains after their sheep or cattle.  Men ride around on donkeys or Basotho ponies.  Women leave their round, thatched roof huts to go to the river to get water.  And there are villages on the sides of mountains that have no roads in or out.  I can see one on a hill across from the hospital.  Let me assure you, places like this DO still exist in 2014, and I get to live here for the next two months!  It's like going back in time, like arriving on an alien planet.  You really cannot imagine how utterly different life is here.  Yet people are still just people, and the Basotho people I've met so far are warm and friendly and wonderful in every possible way.

I have to admit that life in Mantsonyane is challenging.  Here are some reasons why:

There is no hot water.  Which means bucket baths are the only possible option. You heat some water in a kettle or urn and use that to wash, which is neither very glamorous or very fun.
Sometimes there is no running water inside the house at all.  This seems to happen daily, for anywhere from a couple of hours to most of the day, the water just stops coming out of the taps.  I don't know why.  Luckily, there is a tap on the hospital grounds that has water even when the water in all the buildings has stopped flowing.  So you just go fill your giant bucket at the outside tap.  Well, if you're me, you ask someone to help you because that bucket is heavy when it's full!
Obviously you can't drink the tap water, or the water you fetch in your bucket, unless you want to boil it first.
It is VERY cold here at night, well below freezing, and there is a dusting of snow on the ground.  I know, y'all were polar vortexing all winter while I was lying on the beach in South Africa, but it's not a fair comparison.  You had central heat.  I do not have heat.  Or hot water.

And that's life on the hospital grounds, which believe me, is much more modern than the surrounding villages.  For example, here are some things I have that the average person living in the next village over does not have:

The outdoor tap with running water.  Many people have to walk to the river to fetch water.
A large house.  The hospital really gave me a great place to live!  It's a little bigger and similarly furnished to my house in Hawston.  There are actually four bedrooms, enough space for 6 people, but I have it all to myself.
Internet access.
A gas oven and stove.
A gas heater, otherwise known as my new BFF.  It doesn't heat the whole house, or even the whole room, but it is a big help on these frigid nights.
Access to and money to buy bottled drinking water from Maseru.
A fridge.  Not that you really need one, you could just stick your food outside and it would stay quite cold.
A TV that works.  My TV in Hawston didn't work, so this is actually an improvement!

As you can see, I am very lucky.  

What sort of work will I be doing here at St. James?  One of my goals is to support for the Hands on Health program.  HoH is basically a public health initiative with the goal of getting local communities to be more involved in taking care of their holistic health.  Facilitation teams comprised of staff from the hospital, local clinics, the Anglican church, and other interested people conduct visits to community residents and talk about their concerns.  It's basically a grassroots way of identifying needs in the community.  HoH is still in its early days, so I will be working with the coordinators to develop some written guidelines for how to conduct visits and record information.  I will also be spending some time in the hospital learning from the nurses here, particularly in the labor ward, OR, and outpatient department.  The hospital has asked me to help evaluate the way they capture and organize their patient care related statistics.  Finally, I'm going to help the hospital look at the effectiveness of the health education they provide their patients.  I think it will be a busy two months!

So that is an overview of what is going on in Mantsonyane right now.  After I spend some more time in the hospital next week, I can tell you a little more about what it's like.  And I promise I am taking lots of photos, but I don't have access to a laptop right now to download them from my camera, so just wait a few weeks, then I'll show you some.

Until then, stay well!

Tuesday, May 27, 2014

Saying goodbye to Hawston

This is my last blog post from Hawston, and I'm afraid that what I've written seems inadequate.  I'm trying to convey something I'm feeling, and I fear that my language is failing me.  In the words of Marilynne Robinson, “It all means more than I can tell you. So you must not judge what I know by what I find words for.”  And please don't be turned off by my honesty.  I think it's important to for you, the people who donated to make my mission possible, the people who have prayed for me, and also for the people in South Africa who have come to mean the whole world to me, to know this.

If I have to sum up what my time in Hawston has been like, I would say I fell in love.  I never expected that to happen.  When I first got to Hawston last August, I have to admit I was a little freaked out.  I had just spent a week and a half in Cape Town, and who doesn't love Cape Town?  It's an awesome city, and I was lucky enough to fit right in to the HOPE Africa offices and Anhouse.  I had a surprisingly easy transition to South Africa; I kinda just dove in and never looked back.  But then I had to move.  I arrived in Hawston on a Friday afternoon and found myself very alone for what turned out to be a long, cold, rainy weekend.  I didn't know a single person in town, and I couldn't even get the hot water turned on in my house.  I'm sure you can imagine that I wanted more than anything to go back to Cape Town (or even, at my very lowest moment, back to Richmond).  Thankfully, that weekend ended, I started work at the care centre and began to meet people in Hawston and Hermanus, and by the end of the first work week, my outlook had changed from 'Oh God what am I DOING here?' to 'I can totally do this, and it's going to be great!'

Still, at the end of that first week, even at the end of the first month, when I would say I was pretty settled, pretty happy, I didn't expect THIS.  I didn't expect to love my job so much, to be accepted into a group of friends so completely, to feel rooted to this place so irreversibly.  I really feel at home here.  And that surprised me.  Yeah, the Western Cape is a beautiful place, and I think anyone who visits would love it here.  But it is so much more than that to me.  On my way home from my trip to Kruger with Jacob, on a foggy and drizzly day (just like the day I first came to Hawston in August), when I drove over the last mountain pass and the view of the coastline opened up in front of me, the sun chose just that moment to poke through the clouds, and, believe it or not, there was a rainbow right over Hawston.  I started crying.  Now, I'm not much of a crier.  The last time I cried was when I said goodbye to Goldielocks.  But that day I almost had to pull off the road because I was suddenly sobbing.  I don't mean like a pretty little tear on my cheek, I mean like red eyes, runny nose, hiccups and all sobbing because it was the last time I would truly come home to Hawston.  I have come to feel that this is MY Hawston, MY Hermanus.  But after this week, it won't be my Hawston anymore.  That is to say, I know that I will never come back to South Africa.  I don't mean I'll never visit, I certainly expect that I will at some point.  In fact, I have plans to come back to Hermanus for a few days after Lesotho and before I fly home for good.  What I mean is that, even if I visit, I will never really come back here, in any significant sense of the word.  There is a big difference between visiting somewhere, even if it's somewhere you know and love, and living there.  It's like going to a college reunion.  Awesome, but not the same as being a student in college.  If my life is a book, then the chapter about living in South Africa ends now, not in August.  

There are things I'm excited about.  I'm totally psyched about going to Lesotho.  This is a great opportunity, and I can't wait to get started.  I get to go to two countries this year, make an impact in two places.  How amazing is that? And I'm excited to go home in August.  I miss my family, my dog, my house, my city, my friends, my car, Mexican food, craft beer, trees, porches, sports I understand, TV shows, fast and reliable internet, and a host of other things.  I really miss my very patient and understanding husband.  Not only was he willing to allow his wife to leave him for a year, but he also listens to me complain about how I don't want to go home to him.  A lesser man would find that insulting, but not Jacob.  Jacob tries his best to understand what I'm feeling and support me any way he can, even if he doesn't like it.  I wish every woman in the world could find a guy as amazing as my husband.  

So it comes down to this:  I feel at home in two very different places, on two very different continents, with two different groups of people, with a different job, a different lifestyle.  And if I love Virginia and South Africa, then I am doomed to always miss one or the other because I cannot be in two places at once.  But I have decided that this is a great gift.  Not only did I have an awesome life in Richmond with a loving family and great friends and a good job, but now I have a second place where I feel like I belong.  Lots of people would kill to have one place like that.  And I get two.  Yeah, I fell in love with Hawston.  And yeah, it sucks to leave, and it sucks even more to leave early.  But it is actually a privilege to be so sad about leaving, because it means that I was so happy here.  In the end, even if I never come back, even if I'm leaving a part of myself behind, I get to have a second home, and that makes me one of the luckiest people I know.