Reflections on South Africa

Dear friends and readers,

I returned from South Africa approximately three days ago and I am just beginning to recover from the jet lag (although I do enjoy waking up and feeling awake at 5am). In any case, I will try to summarize my overall impressions of my experience in South Africa.

One of my first impressions of the country and the one that has remained with me throughout my travels was the incredible vibe that I felt there. There was a political vibe, a cultural vibe, and a spiritual vibe. Politically, the country continues to recover from the apartheid years and the effects of apartheid are still very prevalent; particularly the existence of townships. Culturally, the country is so incredibly diverse that it pulses with diversity and multiculturalism. South Africa has the largest Indian population outside of India and eleven national languages! Spiritually, South Africa is vibrant. We saw this spirit displayed in several ways, from protests to prayer ceremonies. On two separate occasions we witnessed protesters doing the characteristic toyi-toyi dance to demonstrate their cause. One protest was among workers at the local "Pick and Pay" supermarket. The other protest was in a rural area called Tugela Ferry. Protesters there were holding signs that read, "Away with Sex"; most likely because the rural areas have such high rates of HIV infection. Song and dance is used often in South Africa during prayer and other ceremonial acts and is very very effective.

A major focus of our international health experience was the issue of HIV/AIDS. We began to understand why HIV and AIDS are so rampant in South Africa and what is being done (or not being done) to curb the devastating effects of the disease. South Africa is more developed than most other African nations, yet the problem of HIV in South Africa is the worst. I can only explain this by considering that as a developed nation, South Africa has easier and faster modes of transportation. Men, in particular, will leave their homes to work in mines or other faraway destinations. People are undereducated and traditional belief systems are prevalent. Women are marginalized to a considerable degree and many men have multiple sexual partners. Condoms are not widely used. The idea of testing for HIV is nonexistent for many people because of the incredible stigma of being infected. The rollout of antiretroviral medications is extremely slow and only began last year. Traditional remedies of olive oil, potato, leeks, and garlic are still endorsed by the minister of health. Only those who can afford to pay the monthly fee for medications are priveleged enough to have it in most places. Programs implementing ARVs have strict protocols for teaching adherence and only those who will be adherent will qualify for medications.

Tuberculosis is a common comorbidity of HIV/AIDS and more people will die from TB than HIV. People are typically treated for at least two weeks on TB medications before initiating antiretroviral medications. This is done to prevent an immune reconstitution syndrome whereby the latent TB bacteria surge do to a sudden resurgence of the immune system from the ARVs. This can actually kill people relatively fast so prevention with TB medication is necessary.

I am glad to have had the chance to visit such a phenomenal country and to have met so many outstanding people. People who work so hard despite the odds against them. It was an inspiring trip that truly changed my life. Thank you to Inge and everyone else at the IHP for making it happen. Thank you to Costas and Jenny for taking such good care of us while we were there. The group could not have been any better and it was a pleasure having Ann with us in the beginning.

Thank you again and Cheers, Lisa