A special guest post by Jason!

While Ashley was hiking Table Mountain, I went on a field lab with my Public Health class.  What’s a field lab, you ask?  Well, for each class on the ship there is one day that the professor and students set out in port on a field trip related to their class.  The field lab for the International Public Health class I am taking was on the first day in Cape Town.  We went to an NGO named TB/HIV Care Association followed by lunch and a tour in Langa, Cape Town’s oldest township.

Approximately 6.4 million of the roughly 50 million residents of South Africa are infected with HIV, making it the country with the largest population of HIV & AIDS, as well as one the countries with the highest percent of the population infected. TB is also widespread in South Africa and the odds of getting TB increase dramatically if one is HIV positive.  Also, TB is the most common cause of death among those with HIV.

Even though South Africa has some of the gravest problems in the world in terms of TB and HIV, they are starting to make strong strides in terms of turning the ship around.  The TB/HIV Care Association is one piece of the puzzle in making South Africa’s public health future brighter. They seek not only to screen and diagnosis, but to also link diagnosis to care and to increase the retention of care. TB and HIV are both treatable diseases. If monitored and treated effectively and completely, not only can those infected with HIV survive many decades with the diseases, but they can also drastically reduce their odds of passing the disease onto other people, in some cases reducing the odds by up to 96%.  Though HIV is incurable, TB is curable but the treatments often last longer than a year, so one of the most difficult aspects of treating TB is ensuring that patients continue their treatment even after they start feeling physically better.

The Association has 22 mobile testing centers deployed in certain parts of South Africa.  When a person walks into the mobile clinic, they can be tested for HIV via a blood test and given their result within 15 minutes. If they are HIV positive, another test followed by a 20 minute waiting period can determine if they are a candidate for antiretroviral therapy (ART), one of the primary means of treating HIV and AIDS today.

 

A mobile HIV and TB testing and screening clinic.  15 minutes after taking a blood sample, this clinic can know someone’s HIV status and then begin to provide further guidance and counseling.  It is on-the-ground efforts like this that will reduce the prevalence and devastation of these diseases in South Africa and beyond.

After visiting the TB/HIV Care Association, we had lunch in the Langa township at a place called Eziko Restaurant.  The mission of Eziko is to train unemployed people in the community in cooking and catering, thus empowering them to find employment.  Lunch was a win-win in that we got to support a great organization as well as have a very delicious lunch.

Immediately after lunch, we were given a tour of the Langa township via a member of the community. Until the early 1990’s the white minority population that ran the government of South Africa instituted a policy called Apartheid that kept different racial groups physically separated.  Three racial groups existed in South Africa’s system: white, colored, and black.  Despite the separation of races to different and often very remote areas of the country, the white government still wanted colored and black people nearby to serve as workers in the white areas such as downtown Cape Town.  Thus, informal settlements sprung up as housing for the non-white races that worked in Cape Town, but were not allowed to live there.  The areas where they lived became known as townships and still exist today despite the removal of official racial segregation.

There is so much I could say about the Langa township, but there are only two main topics I wish to touch upon here.  First of all, despite the horrible history of South Africa and the terrible impoverished conditions that still exist today, the people in the townships are not full of hate, out seeking revenge, nor do they feel sorry for themselves.  What matters for them is what is happening today and their future and that of their children.  Because of the high unemployment of the area, the community members tend to have an entrepreneurial bent, seeking out income to feed their families in any way possible.  From the little shacks set up on the sidewalk selling various items, to the ladies who would prepare a South African delicacy of sheep’s head (known as smiles because of the teeth and mouth visible on the head) by thawing out frozen sheep’s head shipped from other countries, burning off the wool while keeping the skin intact and then boiling for two hours.  Make no mistake, the members of the community are hard-working people who are trying their hardest to improve the poor situation they have been historically born into.

This is our guide, Siviwe, showing us a sheep’s head that women behind him had prepared.  Despite my usual outgoing attitude towards trying new foods, I did not try this one while in South Africa.

The second topic is the strong sense of community within the Langa township.  The examples are endless, but let me try to share a few.  First of all, there are young children running all over the township seemingly under no supervision.  In fact, we had kids crawling all over us wanting piggy-back rides or just their hands held.  Once on your back, these kids would be with you until an adult told them they need to split up from our group.  We had no clue who these kids’ parents where, but that did not matter in this community because everyone watches out for everyone else and everyone else’s kids.  If an adult in the community gave the kids instruction to return home, they would listen.

Another amazing example of the sense of community within Langa is the vacant houses near the highway.  The government of South Africa has made a goal to get all of the people out of shanties and into better homes.  However, in the Langa township new homes were constructed that were too expensive for the poorest members of the community, those living in shanties, over-crowded hostels, or half of a shipping container.  The members of the community that could afford the nice new homes by the highway have boycotted the homes, keeping them vacant until the government fulfills its promise to provide better and affordable housing for the poorest members of the community.

Alongside the strong sense of community are immense social pressures to follow certain customs and traditions.  The simplest being that it is considered very rude not to respond if someone greets you.  However, it gets much more complex.  Many members of the Langa township still practice traditional male circumcision at the age of 18 which involves spending 1 month in the wilderness and the circumcision being performed by a non-medically trained person.  Compared to medically-performed circumcision, the tradition subjects its followers to unnecessary health risks including death.  Despite being a very-well educated man and understanding the health risks, our guide claimed that his sons will follow the tradition as well.  The reason?  The tradition is considered necessary to pass from boyhood to manhood and those who do not follow the traditional route will not be respected in the community.  In an area where the opinion of your neighbors matters much more than your individual success, this is one the worst things a father could inflict upon his son.  This circumcision example is just one of many situations in Africa where the modern world has the technology and know-how to improve health, but making changes necessary to apply that knowledge is difficult because of communal traditions where the attitude of the entire community must be changed all at once.  Our guide did not provide many details about the 1 month in the wilderness because those who talk at length about the practice are no longer considered men and no longer respected in the community.  Also, he mentioned that there is a separate process for girls becoming women.  However, he knew nothing of the practice because women who discuss it, even with their husbands, are no longer respected in the community.

This picture captures a lot about life in the shanty towns.  A family lives in the little shack in the center of the picture.  A shanty like that can be constructed really cheaply in less than one day.  There are three other items of note in the picture. First, a faucet. There is not running water or plumbing in the shanties, many families will go this faucet to retrieve their water.  Second, electric lines.  There is electricity in this township and in these shanties, however the electricity is often distributed via many electrical cords making the area very unsafe when it rains and fires which often destroy many hundreds of shanties are a constant threat.  Finally, in the upper right hand corner is a satellite dish for tv.  Although this may seem out of place in such an impoverished area, sports are big in South Africa and those who have a dish and tv charge others in the community to view sporting events thereby serving as a source of income for the dish and tv owners.

This little girl came up to me and basically tried to climb onto my back from the ground, so I bent down and let her on for a piggy back ride.  I decided to jump once to give her a little excitement, but little did I know after that she would repeatedly count “1, 2, 3!” at which point she would expect me to jump, which I did.  Each jump was followed by about a 1 second break before she would start counting again.  My legs were starting to feel it after a while.

This other little girl came up to me and grabbed my hand.  Well, actually she grabbed onto my index and pinky fingers with one of her tiny hands around each.  She then decided it would be fun to pick up her feet, repeatedly, putting all of her weight on my two fingers.  Luckily, she was pretty light!