March 3 2010
Drive around Soweto:
Vali, a PHRU driver, took me around with him on his visits to the patients of the clinic to deliver letters. This was my first full tour of Soweto. The only word to describe Soweto is diverse. The living conditions range from areas like Mulswatle with shacks, dirt floors, tin roofs and no roads to areas like Rocktown and White Town with two story homes with beautiful architecture located across the street from the friendly, well maintained Thokoza Park.
It is very disheartening to actually see the children living in the shacks playing on the roads and wearing dingy, holey clothing. No one should live in these conditions. The government is building RDP houses in between the shacks in certain communities such as Freedom Park. These houses have a living area and one bedroom plus a bathroom. Each family is allocated one house regardless of the size of the family. The shacks are not destroyed, so new families then move into the abandon shacks.
Another occurrence is that the family that has received an RDP house rents out the RDP house and continues to live in the shack. Building RDP houses is a right step toward eradicating the squatter camps but there needs to be some improvements to the system to actually manifest the change.
The poorest, must run down and dirty area of Soweto is Kliptown. The residents of Kliptown actually live with pigs and use the same river water to clean themselves and wash clothes as the pigs. In this area, there is not even room between the shacks for the government to build RDP houses, nor are the residents of Kliptown shacks being moved into the newly built RDP houses in other communities. The PHRU driver said he doesn’t believe the government is doing ANYthing in or for Kiptown (like its just a lost cause). This is so frustrating and disappointing that I get sick when I think about it. And what’s more is that just across the main road from Kliptown is Eldorado Park with nice, fenced in houses and street lights and sidewalks. The disparity is unimaginable until you actually see it with your own eyes.
On the other side of Soweto, is a first world development. It begins with the brand new rail station that has been built for the World Cup traffic. Across the railroad tracks you will find a very modern, enclosed, shopping mall, a beautiful park, and houses that would go for millions of dollars in certain areas of the US.
On a side note: There is a lot of drama between the new buses and rail system that the government is implementing and the older minibus taxi services which are losing business to the new buses. The minibus taxis have been going on strike in attempts to get the government put a stop to the new bus services, which in my opinion would be horrible because SA is in need of serious public transport improvement and this one of the first large movements by government toward that end.
During the drive, I got to see the Morris Iaasikson High School where the infamous student riots began on June 16, 1976. On that day, black students organized together in protest to the Afrikan’s infiltration of schools and burned down any building or structure that was Afrikans and also burned and stones many Afrikans people. This riot was the spark to the flame that ignited the rest of South Africans to demand equality or at least better treatment from the Apartheid.
The visit around Soweto was eye-opening to say the least. Previously, I was obviously aware of the disparity surrounding South Africa but it took seeing the conditions in person to really grasp how stark of a disparity actually exists.
Sunday, March 21, 2010
Wednesday, March 3, 2010
Some facts and experiences with the SA Healthcare system
Training for Midwife nurses:
I set in on the training session for the midwife nurses at Lenasia South Community Health Clinic today. The obstetric ward at Lenasia South CHC is a MOU (Midwifery Obstetric Unit), which means that all babies are delivered by a midwife. In the public (governmental ran) health care systems in South Africa, the majority of labor and delivery attendants are midwives. Women will be delivered by a doctor if she has complications or is high risk initially; very few women fall into this category. Even most HIV + pregnant women will have safe, normal deliveries and be attended to by a midwife.
For this reason, HIV + specific obstetrical training occurs at the MOUs and hospitals on a regular basis. This month’s training is crucial, however, due to the change in SA governmental guidelines for treatment of HIV in pregnant women and in HIV exposed babies.
The 4 major changes being implemented in April 2010 are:
1) All HIV + pregnant women will be initiated on AZT at 14 weeks gestation (as opposed to waiting until 28 weeks)
2) Women who have a CD4 count < 350 cells/ml will begin ART (triple-therapy) (as opposed to just AZT – mono-therapy)
3) Provision of a “tail” to prevent NVP resistance from single-dose NVP. The tail consists of two new ARV tablets.
4) NVP to ALL HIV exposed babies for 6 weeks (instead of AZT)
Another major change that is being discussed is the promotion of exclusive breastfeeding. Currently, the government supplies 6 months of formula to all HIV + mothers. The government is now discussing recommending exclusive breast feeding due to cost of tins of formula. Yes, breast milk carries HIV, but the pathway through the baby does not allow for the virus to enter the baby’s blood… as long as the stomach lining isn’t compromised. Mixed feeding will wear down the lining of the stomach, however, so women MUST practice EXCLUSIVE breast feeding to reduce risk of transmission. This is obviously a controversial issue.
Labor and Delivery in SA:
One common occurrence in SA is that the women who should be delivering at their local MOU (such as Lens. South) are traveling to the larger Baragwaneth hospital when they go into labor, which is causing an overflow of patients and stressing the system at Bara. I will be researching the reasons for this bypassing of local clinics during labor more in depth, but for now the general idea is that women believe that they will be attended to by a doctor at Bara versus a midwife at a local clinic. However, this is false. Yes, there are doctors at Bara, and Bara is more equipped for complicated and high risk deliveries and can perform c-sections, but if the woman has no complications she will still be attended to by a midwife at Bara. Neither hospital setting provides epidurals on a regular basis since there is rarely an anesthesiologist available. Also, women are not allowed to have family present during labor.
Bara is actually beginning to turn women back to their local MOU clinic if they are not in active labor because their resources and staff are so strained. During my 24 hour observations of the Bara and Lenasia South Ob Wards, I will discuss with the women what their opinion of the services and staff is and why they have chosen to deliver at their particular location.
The PRIVATE hospitals and clinics (not governmental) operate in the same manner as hospitals in the US with patients seeing the same gynecologist through the duration of her pregnancy and delivery. I was told that in private hospitals doctors do not recommend that women be tested for HIV because they do not want to offend the women, whereas in the public systems it is part of the guidelines to recommend HIV testing in pregnant women.
Oklahoma Hospitals Vs. South African Hosptial:
So far I have observed in the Chris Hani Baragwaneth Antenatal Clinic and Obstetric Ward and in the Lenasia South Clinic. During my time there I have noted quite a few differences in the infrastructure of the health care systems other than the actual building infrastructure, which is very out of date and ran down compared to those in Oklahoma.
10 Key Differences:
1) Services in the public clinics and hospitals are free of charge.
2) Epidurals are not available in most settings.
3) Families are not allowed in the labor and delivery wards.
4) Governmental hospitals such as Bara and Lens. South are walk-in clinics. No appointments are made. Therefore, patients will wait at the clinic as long as it takes to be seen. There will be two or three doctors at the clinic, and they simply see the next patient in line. The patients line the walls of the hallway at the clinic.
5) Patients do not see the same doctor for each visit so it is not possible to develop a personal relationship.
6) Due to the lack of organized system I have just described, patients carry around a patient card with them that contains their medical history on it. In the ARV clinics, the medical records are kept at the site because it is crucial that the records not be lost or end up in the wrong hands.
7) For the obstetric visits, blood is drawn in the waiting room.
8) The sheets on the bed are not changed between each patient.
9) As explained above, most deliveries are attended to by midwife nurses not Ob/Gyns
10) Lining the walls of the clinics are posters explaining the importance of vaccines for Polio and Measles and how to avoid TB and Malaria and HIV transmission… all disease that at not prevalent in the US or other developed countries.
I set in on the training session for the midwife nurses at Lenasia South Community Health Clinic today. The obstetric ward at Lenasia South CHC is a MOU (Midwifery Obstetric Unit), which means that all babies are delivered by a midwife. In the public (governmental ran) health care systems in South Africa, the majority of labor and delivery attendants are midwives. Women will be delivered by a doctor if she has complications or is high risk initially; very few women fall into this category. Even most HIV + pregnant women will have safe, normal deliveries and be attended to by a midwife.
For this reason, HIV + specific obstetrical training occurs at the MOUs and hospitals on a regular basis. This month’s training is crucial, however, due to the change in SA governmental guidelines for treatment of HIV in pregnant women and in HIV exposed babies.
The 4 major changes being implemented in April 2010 are:
1) All HIV + pregnant women will be initiated on AZT at 14 weeks gestation (as opposed to waiting until 28 weeks)
2) Women who have a CD4 count < 350 cells/ml will begin ART (triple-therapy) (as opposed to just AZT – mono-therapy)
3) Provision of a “tail” to prevent NVP resistance from single-dose NVP. The tail consists of two new ARV tablets.
4) NVP to ALL HIV exposed babies for 6 weeks (instead of AZT)
Another major change that is being discussed is the promotion of exclusive breastfeeding. Currently, the government supplies 6 months of formula to all HIV + mothers. The government is now discussing recommending exclusive breast feeding due to cost of tins of formula. Yes, breast milk carries HIV, but the pathway through the baby does not allow for the virus to enter the baby’s blood… as long as the stomach lining isn’t compromised. Mixed feeding will wear down the lining of the stomach, however, so women MUST practice EXCLUSIVE breast feeding to reduce risk of transmission. This is obviously a controversial issue.
Labor and Delivery in SA:
One common occurrence in SA is that the women who should be delivering at their local MOU (such as Lens. South) are traveling to the larger Baragwaneth hospital when they go into labor, which is causing an overflow of patients and stressing the system at Bara. I will be researching the reasons for this bypassing of local clinics during labor more in depth, but for now the general idea is that women believe that they will be attended to by a doctor at Bara versus a midwife at a local clinic. However, this is false. Yes, there are doctors at Bara, and Bara is more equipped for complicated and high risk deliveries and can perform c-sections, but if the woman has no complications she will still be attended to by a midwife at Bara. Neither hospital setting provides epidurals on a regular basis since there is rarely an anesthesiologist available. Also, women are not allowed to have family present during labor.
Bara is actually beginning to turn women back to their local MOU clinic if they are not in active labor because their resources and staff are so strained. During my 24 hour observations of the Bara and Lenasia South Ob Wards, I will discuss with the women what their opinion of the services and staff is and why they have chosen to deliver at their particular location.
The PRIVATE hospitals and clinics (not governmental) operate in the same manner as hospitals in the US with patients seeing the same gynecologist through the duration of her pregnancy and delivery. I was told that in private hospitals doctors do not recommend that women be tested for HIV because they do not want to offend the women, whereas in the public systems it is part of the guidelines to recommend HIV testing in pregnant women.
Oklahoma Hospitals Vs. South African Hosptial:
So far I have observed in the Chris Hani Baragwaneth Antenatal Clinic and Obstetric Ward and in the Lenasia South Clinic. During my time there I have noted quite a few differences in the infrastructure of the health care systems other than the actual building infrastructure, which is very out of date and ran down compared to those in Oklahoma.
10 Key Differences:
1) Services in the public clinics and hospitals are free of charge.
2) Epidurals are not available in most settings.
3) Families are not allowed in the labor and delivery wards.
4) Governmental hospitals such as Bara and Lens. South are walk-in clinics. No appointments are made. Therefore, patients will wait at the clinic as long as it takes to be seen. There will be two or three doctors at the clinic, and they simply see the next patient in line. The patients line the walls of the hallway at the clinic.
5) Patients do not see the same doctor for each visit so it is not possible to develop a personal relationship.
6) Due to the lack of organized system I have just described, patients carry around a patient card with them that contains their medical history on it. In the ARV clinics, the medical records are kept at the site because it is crucial that the records not be lost or end up in the wrong hands.
7) For the obstetric visits, blood is drawn in the waiting room.
8) The sheets on the bed are not changed between each patient.
9) As explained above, most deliveries are attended to by midwife nurses not Ob/Gyns
10) Lining the walls of the clinics are posters explaining the importance of vaccines for Polio and Measles and how to avoid TB and Malaria and HIV transmission… all disease that at not prevalent in the US or other developed countries.
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