Mafikeng, South Africa, 2008 (March)

I’m back in Jo’burg after a week in Mafikeng. Strangely (and terribly!) the weather here has taken a complete nosedive, with steady rain all weekend and temps struggling to make it out of the 50s. I know that colder times are ahead, but not yet! It’s still technically summer!

My week in Mafikeng was spent with a group of my colleagues auditing the patient files at an antiretroviral therapy (ART) clinic that’s part of the national treatment program. There were about 30 or so of us there, plowing through over 8.000 files in four days, collecting data and reviewing the quality of care and reporting. This is what 8.000 files look like:

I like reviewing patient files because it’s rare exposure to the individual story of each patient, as opposed to the typical distance inherent in my more macro-view desk job. It can be quite emotional too, though. Patients who are on ART are sick with AIDS. They have to have reached a certain threshold of illness—in South Africa, that’s a CD4 count below 200—in order to qualify for the drug treatment. In normal healthy people, the CD4 count is 500-1500, but the number decreases the sicker you are with AIDS. For the first time, during this file review, I saw a couple of patients whose CD4 count was 2. Two. Jeez. It’s like I could almost visualize the last two little soldiers fighting on. Worse, still, I saw one patient whose count was listed as “<1”. As I look through the files, I can’t help but cheer on the ones who are taking their medications regularly (a must for ART) and see their CD4 increase and viral load become undetectable. I also groan with frustration and sadness over the ones who stop their pills or simply disappear from the clinic files. These aren’t just data; these are real people.

My colleagues typically played music while we worked, mostly South African stuff which I enjoyed checking out. I always find it interesting and amusing to see what American music gets embraced by a culture, though. I mean, American music is huge here, just like anywhere else, but in every culture, there are some songs that are really adopted. For example, Toto’s song “Africa” (you know the one: “blah blah the rains down in Aaaaaafricaaaa…”) is a perennial favorite in this country, and can frequently be heard anywhere from the muzak in grocery stores to choral performances, which just seems so amusingly ironic, and yet simultaneously unironic, to me. Anyway, the American song that kept making it into my coworker’s mix was “Another Day in Paradise.” Yeah, the one from the 80s that’s all depressing, like here we are in poverty-filled America, how about that? Anyway, so not one, but TWO cover versions (!) of this played many times during my stay. All I could do was laugh at the absurdity of it all, hold my head, and say, “ay yi yi!”

There were five feral kitties on the clinic grounds who ran away from people, except those holding chicken, and generally spent their time lounging in the sun and dumpster diving. Of course, I tried to make them love me, but they had no interest. Here’s their glamour shot:
There are two last little cultural tidbits that I first observed on this trip. One is that in South Africa, the date of, say, March 05, 2008, could be written 05/03/08 OR 08/03/05. And both are considered acceptable. Of course this leads to ridiculously unnecessary confusion, and potentially poor data quality. It’s just kinda classic. The other thing is that, if my coworkers are any indication, people seem to have no qualms about sharing drinking glasses. I noticed this when a sweaty dude marched right up, poured my water glass full, and proceeded to chug it. Assuming he was just unaware and wouldn’t want to drink after me, I said, “Oh, that’s my glass!” and he smiled big, nodded, and gave a thumbs up! THEN he poured a glass for the lady next to me in the same glass! Being a notorious non-sharer myself, my eyes about popped out of my head. And these are health workers! This one was news to me.

Here’s a photo of me and my coworkers (some had already left) on our last morning. Can you spot me?

And a bonus photo of my adorable, brilliant friend Alex, age 9, in Durban. She’s wearing my fun new sunglasses, but the other fabulous accessories are all her own.

Johannesburg, South Africa, March 2008

It’s late summer in Johannesburg. Every afternoon we are treated to monstrous thunderstorms where the span between lightening and thunder is negligible and the buildings thrust with each enormous boom. These brief episodes bring about the green lushness that the city enjoys during the dry hours. I swear this must be the season of the lovers—I see them in every verdant, open space, leaning together enjoying a late summer evening. There is warmth in every direction.

I’ve been here two weeks, but it seems more like a month or more already, given how jammed-packed my days have been with new experiences and sights. It’s a country where days start early—it’s expected that you’ll be at work around 8 am, and friends don’t hesitate to call you at that hour even on the weekends—so you have to be up and ready with the sun. Ibises, which (to me) resemble dodos, and are effectively the pigeons of South Africa, will arouse any late sleepers with their screaming “caaaaaawwww!”

One of the things that is new this time around is the intense local interest I've noticed in the U.S. election. Every time someone--from taxi drivers to waiters--hears my accent, I get, "Oh, you're American! Tell me about the election!" I swear, most average folks here are following the results closer than I am. I think the source of this is two-fold: sincere pleasure at the fact that George Bush is leaving office and definitely an incredible excitement about Obama. I see what bridges he could build internationally--just by being himself--if he makes it to the office. It's gratifying to know that, at least in this part of the world, we're nearly forgiven for the past eight years with no lingering hard feelings.

Back to the personal, my housing situation has been inadequate—I’ve been staying on the campus of the University of the Witwatersrand—and while this has been an interesting ethnographic observation of South African undergraduate life, I’m ready to settle into an apartment with my old self. On Sunday, I’ll finally get to unpack my bags at my new flat. My living space is so important to me—even when I travel—that I’m already fantasizing about hanging up my clothes and stacking books on the shelf.

But before then, I’m off to sweet old Durban this weekend, where it will be 90+ degrees, for a visit with two families that are very dear to me. And on Monday (no time in my new place!) I’m off to Mafikeng, North West Province, which is only about 15 miles from the Botswana border, to work up there for a week. Photos and more updates, including an explanation of what I’m doing here, will follow. For now, here are a few snapshots from around town:

Clouds before an afternoon storm:

This was news to me, but apparently there are Mormons here. The soccer I was already aware of (that's an understatement):

An evening view of Hillbrow, the seedy downtown district where I work, with the landmark Telkom tower:
The view out my office window, taken this very morning. A new parking lot is being built entirely out of brick: