10 things

I don't have a lot to share with you this week, so here is a blog post about 10 completely random things I love about South Africa, in no particular order:

1.  Mountains:  Rugged mountains that extend right up to the coast.  Everywhere I look in Cape Town or Hermanus, there are mountains, and I love them all.  I love hiking in them, I love sitting and looking at them, I love just knowing they're there when it's too dark at night to see them.  As much as I love the rolling green hills of Shenandoah, these craggy fynbos-covered mountains have a special place in my heart too.  I decided this yesterday when I was standing at the top of Lion's Head in Cape Town enjoying the panoramic view of the city bowl, Table Bay, and the Atlantic coast beaches.  Yeah, not a bad way to spend a Sunday afternoon.

2.  Fun to pronounce words:  Places around here have names like Rondebosch and Bloubergstrand and Hemel-en-Aarde that are just fun to say.  They sort of roll off your tongue, and I feel super sophisticated every time I get to say one of these names.  Also, South African English has incorporated some words from other languages that are really fun to use.  Example: deurmekaar, from Afrikaans, means confused or messed up or crazy.  Doesn't 'deurmekaar' sound much more confusing than 'confused'?

3.  People:  South Africans are a friendly bunch.  Everywhere I go, as soon as people hear me talk and identify me as American, they want to know what I'm doing here and what I think of their country.  South Africans mean it when they say 'welcome' and 'make yourself at home'.  They always walk you out to your car at the end of the night, and they take like half an hour to say goodbye, simply because they like each others' company.  This is true of every South African I've ever met, regardless of language or color or culture, and it's one of my favorite things about them.

4.  Woolworths:  Woolies is like South African Target, but even better.  It's the grocery store with the freshest produce AND the department store with the cutest (and very reasonably priced!) clothes.  Also, they sell really nice jeans for about $18 that happen to fit me great.  A trip to Woolies is very dangerous to my bank account, and believe me when I say that my credit card will breathe a sigh of relief when Woolies is no longer in my life.

5.  Fynbos:  Move over, peonies.  Proteas should be the flower of choice for stylish ladies of the Kate Spade toting/farmers market shopping/pencil skirt wearing variety.  The national flower of South Africa is huge, comes in a variety of colors, and grows wild all over the place.  Every fashionista should keep at least one giant vase of proteas in her house at all times.

6.  The Southern Cross:  My very favorite constellation, and you have to be in the Southern Hemisphere to see it.  

7.  Ginnea fowl:  Ginnea fowl are everywhere here, running down the street in little lines, on the side of the highway, sitting in the front yard.  Most of my South African friends think it's weird that I like ginnea fowl so much because they're basically a common pest, sort of like squirrels in the US.  But they really are the most beautiful birds - jet black with tiny bright white spots, bright blue necks and a striking red throat.  I think they're absolutely gorgeous and no one will convince me otherwise.

8.  Funny accents:  I've gotten so used to people saying 'ba-nawh-na' for banana and 'to-maahhh-to' for tomato that I've come to like it.  Everyone sounds so classy!

9.  Gas station attendants:  South Africa, like New Jersey, has gas station attendants who pump your gas for you so you don't have to get out of the car.  But unlike New Jersey, these attendants also check your oil and water level and tire pressure, and they clean your windshield.  What now, Jersey?

10.  Wine:  I will miss paying $5 for a really good bottle of red wine (seriously... good wine really does cost $5!).  I'll also miss drinking it out of Hananja's tin cups as we chop to-maahhhh-toes for a salad and chat about grown-up stuff.

OK now go buy a plane ticket and come see this place for yourself!

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.

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.

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 4^th 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.