XVI. The Disease of Poverty: A visit to a TB Hospital and to Nyanga

A burst of green hope in a sometimes somewhat hopeless world

Warning: This seems to be the theme of Public Health field trip posts...but this post contains intense and brutal information. Again, it's part of my dealing and learning process to write about it. I saw it. I heard about it. I need to get it out there. Don't read though unless you're prepared to have your day slightly ruined.

Friday was the day of our Public Health field trip this week. We drove to Brooklyn Chest Hospital near Cape Town for our tour of the TB hospital. It was a really interesting day...I learned a lot about a disease I'd never really thought about before but is actually a huge problem here in South Africa. TB by itself is listed as the 4th leading cause of death here, but HIV/AIDS is #1 and most AIDS deaths are actually due to TB, so TB is actually the biggest killer in South Africa. TB is a disease of poverty and isn't really a problem in the States and hasn't been for over a century. It loves South Africa because HIV/AIDS weakens immune systems, malnourishment is TB's best friend, and the overcrowding/lack of space and ventilation in the townships and informal settlements pave the way for smooth transmission.

The Brooklyn Chest Hospital has somewhat intense security for entry, probably because it houses lots of infectious patients, 700 to be precise...some of whom are murderers and serial rapists on bail. Because those people get bail here. And are allowed to be in a public hospital with all the other patients. MDR - multidrug resistant TB, and XDR - extreme drug resistant TB are relatively common in South Africa and obviously huge problems. However, the only hospitals stocked with the drugs to treat MDR and XDR TB are located in Cape Town, so people have to come from all over SA to be treated for those.

The first place I went there was to the children's school an was pleasantly surprised. We saw the classroom that teaches students in Grades 4 - 12, the preschool classroom, and the Grades R (kindergarten) - 3 classroom. They were all small but nice. There is a computer lab where the kids can play educational games. The school building had been renovated about a year ago by American donors so was in great condition. There were lots of pictures and posters and books and toys. I was really impressed by the place. They try and keep the kids in school, covering the basic foundational subjects like maths and English and reading so that when they recover they can go back into school and not be behind. I was not surprised to hear that there is a long wait list for the hospital. We saw the kids - some wearing masks, some beyond that phase, some with IVs and other medical devices - all watching Alvin and the Chipmunks in their lounge room. Friday is movie day at Brooklyn Chest Hospital School!

Some of the kids come from afar and some are from Cape Town. Some see their parents every weekend or even more often. Some only see their parents once every few months. And one little girl now has clinical depression because she has been here for months and has not been visited since she was admitted to the hospital. Ugh.

We then went and visited the older children's ward (5-13 year olds) which was empty since all the kids were in "school." But it's just one big room with lots of beds for all those kids of all different ages and both sexes. The head pede nurse explained that it's a huge problem because the boys want to rape all the girls. I can't even comprehend that problem. These kids whom we had seen just a few minutes ago all sprawled around the floor watching Alvin and the Chipmunks together. And then they come back to the ward and are bored and have nothing to do and are lonely so they turn to sex and even sexual violence and rape to entertain themselves. Kids. All 13 or younger. They had an issue with a five year old boy molesting an infant girl in her crib. We did not go into the adult wards because of infectious risk, we fortunately were not granted clearance. Childhood TB isn't really contagious because they don't cough up sputum so we were safe in there, but adult TB is obviously super contagious, so none of us had any desire to enter the adult ward. But the nurses told us that rape is a huge problem in there too. It is one thing I really do not understand about this country, how sexual violence has such a high incidence and how it goes not quite unnoted but really not dealt with. Rapists get off scott free, even with eye witnesses and convicting evidence. Kids grow up in a world where rape occurs all the time and is effectively tolerated by their society, so they think it's normal. When I was working in Kayamandi on Thursday afternoon, one of the other foreign volunteers told me that a 4-year-old girl had been raped earlier in the week on the street at 11:30 in the morning. And nothing was done about it. It's so far the worst thing that I've heard of or seen here. I don't know why. I don't know how. I just don't get it. Even if someone did choose to prosecute, which of course won't happen, it would be years and years before they even got to that trial. Apparently it's also a normal occurrence around here.

We then went to the baby children's ward and saw kids with all different severities of TB. The kids here were all 2 and younger. Some were running around and seemed relatively alert and active. Some were using walkers and wheelchairs. Some were in their cribs shouting adorable gibberish at us as we walked past. Some were lying down, looking kind of miserable and coughing a lot. And a few very unlucky ones had TB meningitis and were partially or fully paralyzed or had spastic TB (stiff neck) and looked and sounded as if they were in so much pain. That was the hardest thing to see. And the weird thing was there wasn't a single parent in the hospital. Not one. And the hospital doesn't have limited visiting hours - you could hypothetically visit your kid there 24/7 if you wanted. But nobody comes. They can't afford to come. They can't afford to take time off work. They have HIV/AIDS and are themselves dying at home. They live too far away from the necessary care to be able to visit.
TB sucks because treatment for it is so long, starting with 18 months of treatment with gross medications that make you sick. Regular TB is treated with 4 medications, so patients have a cocktail of tablets to take every day and MDR and XDR are so difficult to treat that patients have to take about 32 tablets each morning - and these tablets all make them feel sick. Ugh! I thought I had it bad when I had mono, etc last month.

In the afternoon, we went to Nyanga, one of the worst/poorest/most violent areas in all of South Africa. It is a black township that has the highest crime rate in Cape Town and an unemployment rate over 50%. Fortunately I was in a group of 20 students + drivers + our professor so I actually felt quite safe. I think I have a new standard for feeling safe. I think there is always a healthy alertness underlying whatever else I'm doing. I think it's really good for me though.

Driving through Nyanga was one of the most interesting things I've seen. Despite it being 1pm on a Friday, everyone was outside on the streets. Little kids, school kids in uniforms (who were let out as early as 11 because the teachers just gave up for the day), teenagers not in school at all, and adults. Lots of people were grilling sheepshead and other slabs of animal carcasses all along the streets. It was so smoky and smelled so nasty. After about five minutes of driving through, I noticed that I was breathing in through my mouth and not my nose so as to avoid having to smell Nyanga. But I told myself that I wasn't experiencing it fully if I didn't let all my senses engage, so I started breathing through my nose. It was kind of unpleasant, but I don't think I will ever forget the smells of Nyanga...and consequently my afternoon in Nyanga. Here's some fun biology trivia for you - smell is the fastest memory association trigger because of the way our brain is wired. I don't know if I'll ever again smell something that will smell like Nyanga and immediately associate all the memories that came with that smell, but if I do...I'll be glad I forced myself to smell Nyanga.

Kids in school uniform walking down the street...the smoke and black roof shacks in the background are where the sheep'sheads and other animal carcasses are cooked.

An Etafeni-sponsored garden in Nyanga

In Nyanga, we went to an HIV/AIDS and community resource center called Etafeni, which literally translates "an open space." Etafeni was founded a while ago in Nyanga on literally the only open space in town. It was founded by a grassroots group of people in the community and promotes the environment - and that equates to there being a little bit of grass, three trees (I didn't notice until I saw these trees how there wasn't a tree in the entire rest of the township!), and a giant garden. They plant gardens for people who apply as a means of combatting malnutrition. We actually got to see some of the gardens in the community, so that was pretty cool. We had another lecture about TB by some med students from the Desmond Tutu TB Center. We met some ladies, all of whom told us they are HIV+, who were beading lovely artwork to sell. And we got to meet some college-age people who were learning how to set up email accounts at the computer lab in the center as a component of their life skills/work skills program. I guess in the midst of all of this is hope, the possibility of a bright future. The college-age kids asked us what we were studying and why. They asked us all about Chicago. And we asked them for some music recommendations so we can discover the South African music scene.

 



The director of Etafeni - this super cool lady with big dangly earrings shaped after the continent of Africa that went almost to her shoulders, with blond hair with a dyed-red bangs, and with one of the friendliest smiles I've ever seen - told us about her vision for Nyanga and her passion about this place that is home to over 60,000 people. But she told us how we must all be missing home a lot now because of the tragedies going on in the States, because of the crazy chaos in Boston, because of the hellish week America went through. We don't have internet when we're on our excursions, so none of us had heard about the manhunt in Boston, so we were all rather freaked out and anxious to get home and check the news. This week has made the disconnect seem real.

What a week.

 

"God Bless the USA" by Lee Greenwood