The beginning of our stay in Durban has been clipping along with something new almost everyday. On Monday we visited the University of KwaZulu-Natal, where we got registered as international students at the Nelson Mandela Medical School. Our driver gave us a brief orientation of Durban city center and beach front, before we spent most of the afternoon viewing the new football stadium. The rest of the week was back to work!
Tuesday and Wednesday we worked at the Marianhill Clinic, which is a private clinic run by the Islamic Medical Association and is located in a very rural township area. On any given day, the clinic has one or two Sisters (nurses) who conduct the patient visits and administer treatment, as well as a counselor for HIV testing. This is the only primary healthcare clinic in proximity to the rural community, so the volume of patients ranges between 140 and 160 people per day! Because of the huge patient load, the Sisters move through the patients very quickly, taking only a few minutes to assess, diagnose and prescribe treatment. Medications are dispensed and administered in the same visit, but this is delegated to a nursing assistant so that the Sister take the next patient. Patients who present with an STI or signs of a viral infection (ie. shingles) are directly referred to the HIV counselor for testing. Although the pace of this sort of healthcare would be unheard of in the States, it is extremely efficient in this setting. Because the clinic is private and in no way subsidized by the government, every patient that is seen must pay 40ZAR (about 6USD); this includes the visit and any medications that are given; however, HIV testing and counseling is free.
During our days at the clinic, the HIV counselor was kind enough to take us to see a sangoma, who is a traditional healer in the South African culture. An overwhelming 80% of people in South Africa have sought treatment from a sangoma at one time or another. The sangoma that we met was a 97 year old woman, who showed us her collection of herbs and mixtures for treating different ailments. People must pay the sangoma for her services and sometimes this can be several hundred Rand. Our sangoma was very patient with all of our questions and wide-eyed observations, and even did a good luck burning ritual while we were there.
Thursday and Friday we moved on to Chatsworth Hospice, where we became acquainted with the hospice system in South Africa and went on home visits with the Sisters. Chatsworth is a dominantly Indian community in Durban, in a suburban-like setting; during Apartheid it was where Indians were allowed to live, and have since stayed.
Hospice in South Africa is a non-governmental organization and is comprised of inpatient and home-based care. Chatsworth only has ten inpatient beds and so most patients received care at home (which is the majority preference anyway). The Sisters keep logs of patients who have terminal diagnosis as well as patients who are in remission. During the home visits they assess the patient’s needs and will either make a referral for them to be admitted to the inpatient facility or they will just provide education and social support to the families. Hospice Sisters and the few doctors that make rounds on the inpatients, work on a primarily volunteer basis which is truly impressive considering the workload. Each geographic region/district has a hospice that serves its respective community, but again, it receives no support from the government. Hospice in South Africa is more widely accepted and carries less of a stigma than in the US; it was a humbling way to end the week, working alongside the dedicated Sisters.
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