A Time to Remember

I feel very fortunate to have participated in the launch of the International Health Practicum course at the IHP. Our travel to South Africa was an adventure that I will always remember. The trip was not a vacation, Inge used each day of the 2 ½ weeks to expose us to the various aspects of the healthcare system. We visited urban and rural hospitals and quickly learned of the difference in care that is provided in the private and government funded hospitals. Much of the care that is provided to patients is influenced by financial constraints. Many of the clinicians are burdened by the overwhelming number of patients that are in need of care and their limited ability to care for them. I was shocked to learn that in one particular hospital mothers who give birth are released 4 hours after delivery, if there are no complications, in order to make room for other expecting mothers. The administration of antiretroviral (ARV) medication is also influenced by finances. Patients must qualify with a low CD4 count in order to be considered for treatment. Co-morbid illnesses that occur late in the disease can make their prognosis grim, even with the initiation of treatment. One researcher raised the question of whether or not there should be a cutoff to ensure that the medicine is given to the patients who will receive the most benefit.

Travel to South Africa enhanced my knowledge of caring for patients who are HIV/AIDS infected. It amazes me that in the three years of my nursing training in the United States I have not provided care for this patient population. S. African nursing students are expected to have a thorough knowledge of the disease process and treatment of HIV/AIDS upon graduation. This is necessary since 1/3 of the population is infected. I learned of the physiological and psychosocial needs of this population. Many patients who are infected experience isolation and shame as a result of the stigma that is attached to the diagnosis. Family members may avoid personal contact with the individual for fear that they will also contract the virus. I remember one young woman, age 30, who experienced the hardship that comes with stigma. She was near death when she started receiving ARV therapy. Her family did not permit her to live in their primary residence and instead built a home out of scraps of metal for her and her son. We visited her home and were appalled by the living conditions. There were visible holes in the ceiling and no place for comfortable rest. The visiting nurse who accompanied us explained that this young woman was treated very poorly by her family, especially her father. I went home that evening feeling sorrow in my heart, wishing that I could do more to support people like her.

Despite the stresses of poverty and illness, many South Africans maintain a sense of hope. There was an apparent reliance on God and spirituality. This was evident in the patients as well as in the staff caring for them. One clinic providing ARV therapy interrupted their morning registration process for worship. Staff lead the songs and patients joined in collectively. Following song, clinicians provided a few words of encouragement based on scripture. The importance of spirituality was also evident in a rural hospital in which the staff gathers together for worship and prayer each morning prior to providing patient care. Spirituality is often encouraging and it was nice to see how this culture of people used it in a field where encouragement is most needed.

These are just a few examples of the experiences that I had in South Africa. I learned a lot about the healthcare system and about the history of the country. I hope other groups of students from the IHP have an opportunity to take this wonderful course.

Nikki