I spent my first week in South Africa at Blue Roof Clinic, a free public HIV clinic founded by Alicia Keyes’ foundation, To Keep A Child Alive. South Africa has the highest rate of HIV in the world, and the rate in KwaZulu-Natal nears 50%, and the rate in Durban is estimated to be even higher, perhaps as much as 75%. Blue Roof provides testing, medical care and treatment to anyone and everyone, no questions asked. While there, I saw plenty of black Zulus from the local neighborhood, but also a large amount of coloreds and whites who had traveled much further to get there. Testing can be done for walk-ins, but everyone else requires an appointment.
Blue Roof is aptly named, with a bright blue-colored roof. Inside feels light and airy, and though furnishings are basic, it’s clean. By the front desk is a sea of red waiting-room chairs. Patients often arrive at 5 or 6 in the morning, because it is first-come, first-serve, and they hope to be seen, receive their mediation, and get back to work. There is a nurse’s pre-visit room and a doctor’s office on one end, and a series of nurse’s counseling rooms on the other. At the back is a large dining room and kitchen, as every patient receives a free meal, and upstairs are administrator offices.
I started off the week in the pharmacy, where I quickly learned the names of each antiretroviral (ARV) medication and began to distinguish between regiments – first and second line, as well as pediatric, TB, and additional STIs. The head pharmacist is actually a nurse, which was quite different from the US, but made much more sense when I started learning about the South African healthcare system. However, the two young friendly guys there are clearly the operators of the medication dispensation system, and they quickly put me to work counting large bottles of pills into smaller ones, restocking shelves, and labeling bottles for waiting patients. All ARVs and other medications are provided to the clinic by foundations and other private donors, and are given to patients free of charge. Patients only receive one month at a time, or two if they are trustworthy, so that they are forced to come back to the clinic for refreshed supplies, giving the nurses and doctors a chance to check their progress.
It wasn’t long before I was pulled upstairs for a meeting with Tessa, the general manager of the clinic. Thankfully the other American students who are still here had warned me of her questioning, because she was tough and quick, grilling me for everything I knew about apartheid, HIV, and the South African healthcare system. Several things she said struck me, such as the way she described nurses as running healthcare in South Africa, but undoubtedly the most surprising was her attitude towards apartheid. “It wasn’t so bad” she told me flatly. Sure, the discrimination was wrong, but Tessa felt strongly that there had been some good – communities were more tightly knit, there was less crime, and as she put it, “Corporal punishment kept children in line.” Though she clearly adores Mandela, as most South Africans do, she clearly dislikes Jacob Zuma, the current president who has come to be known for corruption. As a product of the equality generation, her statements gave me a lot to think about, but I’ll have to save the topic for a later post.
Tessa also gave me a whirlwind tour of the clinic, introducing me to every single person who worked there and leaving me to mix up all of their names. I was then ushered into Dr. Nambassi’s office by the nurse, Auntie Yvonne. For two hours, I watched her talk to patients, perform pap smears, and write prescriptions. Far more striking than her doctorly duties was the way she interacted with her patients. She remembered every one of them, often handed out her phone number and spoke of visiting them at work, and provided a slew of tough-love on nutrition, exercise, and ambition. I left the first day feeling inspired.
The rest of the week I spent hopping from office to office at Blue Roof, trying to talk to everyone. Tessa also dropped me off at a nearby primary clinic, so I could experience it for myself. Two moments stick out as especially poignant.
On Tuesday morning, I met Audrey, one of the nurse counselors who checks patients’ adherence, admonishing them if they have more pills leftover than they should, and praising them if the numbers of expected and counted leftovers matched up. Audrey, who had a stroke just two months ago, seemed to appreciate my help in filling out the forms and charts. Audrey is also the nurse responsible for testing for the walk-ins who don’t yet know their HIV status. We got one of these walk-ins early in the morning, a 49 year-old Zulu woman, who spoke in broken English about her three children and her husband, and told us she was worried because she’d been losing weight lately. After explaining the process to her and pointing out the pictures of positive and negative results that were taped to the desk, Audrey walked me through the HIV rapid-test. After I had pricked her finger, gathered up the blood, and dripped it onto the test, we waited. Foggy at first, the lines indicating a positive result slowly appeared, and tears quickly formed in the woman’s eyes as well as my own. Audrey was a citadel, hugging the woman, telling her she was a strong woman, reminding her that she had kids to care for, and that her life was worth fighting for. But when the patient left, Audrey turned to me. “Every night my heart breaks,” she said. “I go home and weep.”
At the back of Blue Roof is office space of a separate foundation, named for Keith “Skido” Joseph, or KSJ. My last day at the clinic, I spent two hours talking to the men who run KSJ, Mr. Joseph and Mr. Quarrie. After explaining to me the basics of what they do (which is, essentially, everything – they help anyone who calls or come to their office sort out a variety of problems, from pensions to deed titles to fixing up their resumes and finding vocational training), the two men must have deemed me trustworthy, and began to tell me the story of KSJ. Skido, the man, was Mr. Joseph’s brother and Mr. Quarrie’s dear friend, a larger-than-life personality who after imprisonment at Robben Island and fighting for liberation, served as Nelson Mandela’s head of security and dedicated his time to what we might call community organizing. While it was initially clear that Skido had passed, they told me the whole story of his suicide (deserving of another promised future post), which clearly broke both men’s hearts, but was also what pushed them forwards. Without any clear source of funding, KSJ has soldiered on for the past three years, doing untold works of good whose measure of success was evident in the waiting room that filled as they spoke to me. Learning about KSJ was a good way to end the week. I think the relationship between the foundation and Blue Roof demonstrates the attitudes of many South Africans. An outside foundation provides for Blue Roof, which in turn offers what it can (office space free of charge) to KSJ, a small group of activists empowered by the memory of another. In a country somewhat desperate for energy and resources, the trickle-down effect is clearly pronounced.
amanda mph 