HIV/AIDS and Health Care

Health Care and HIV/AIDS

So i've somewhat delayed this blog because I am 100% sure I cannot portray this as well as I would like to. I would first like to say read this with a open mind and try not to be judgemental of another culture. Remember that everything we do and think in the US is our cutlure. I am much more aware here of things that are cultural to me as a american that I never realized until I came and lived in a new culture.

SO, HIV. Well to start with I have learned a lot about the culture of AIDS here. I live in a village and my guess is the HIV rate is somewhere around high 20% ish. Not sure. But the rate is 40% for SA in general. So ergo u sleep with 4/10 people have hiv. WOW. So you think of being at risk for aids would mean being young and single and sleeping around...right? No here the married housewife is most at risk. Which is sooo sad. But its a culture of polygamy. So that means when a man is married he can have girlfriends and multiple wives. Also once married you dont use condoms. But this is normal here. Now you may be thinking that that is wrong to cheat on ur wife...but if you remember this is a third world nation where people are lviing in extreme poverty. When a man takes on another wife, it isnt like he just does it for fun. Here they have to pay a laboloa (bride price-money u pay the girls family to take her as a wife) So the girls family benefits greatly from this arangement. Also, if a man has the money to support another family he is helping someone. Also more women in a house hold can help with the kids, the cooking, cleaning, maybe work or sell food to make more money. This all benefits and helps diminish the effects of poverty. So this has been common practice for years. And women instead of going to school and looking for a job look for a man to take care of them. Here I am 25 without kids and pretty much am old as dirt. So mult wifes ergo mult partners is a way of survival. But so then come the hard part. So no one is using condoms. Well only women here go to the clinics or get tested. Men dont complain or feel pain and can tough out sicknesses so they dont go to the clinics. So a women might know she is HIV positive but will not tell her husband bc he would kick her out of the house saying she was sleeping around. So the women hide it, sleep with their husbands while their husbands sleep with their girlfriends just spreading the disease. And once ur married and not using condoms obviously ur husband isnt just gonna start using them because you ask to. This would be suspicous. Also remember, this culture was not so long ago under apartheid where blacks had no right, so its not like this is some strange cultural thing they are holding onto. People alive today felt and lived the effects of aparthied and changing cultural norms doesnt happen overnight. And mind you lack of jobs and such, blacks were under “bantu” education so they didnt really get a education, and were denied jobs. So if your whole life your told u cant be educated or have a good job, that ur second rate...why one day should u just believe otherwise and abandon a culture that has gotten your people through so much?!?! just try to think about it and not be judgemental. Polygomy has its place here in south africa for good reason. Also another obsticle here is that all the education and training is done in english. Well no one at my org understands english...so not really helpful. But that comes from the top down. Government wants english to be the national language. So while its is a good overall goal...it kinda makes for a catch 22 doing good training and development work that not one can understand. Also grandmas are at risk for getting HIV here bc its custom for them to take care of the sick. And people arent educated as much here on how to prevent spread of HIV and a lot more very sick people stay at home here due to lack of health care. Another issue with HIV is the stigma. No ones dies of AIDS here. People die. There are lots of funerals...but always of natural causes...even when the persons in their 30s....Disclosure and privacy issues is a great road block. People here do not trust that the clinic wont tell other pepole in the village their status. Bc its such a small community. And gossip does get around quickly...i can attest to that! But I am learning so much about why hiv is a problem here and I am uncertain of what the rate is in my village bc men, even on their death beds refuse to get tested. So really we only know about the women. Religon plays a HUGE role as well. Some profits and preist will tell a person they they prayed to god and cured themo f HIV so while people get tested...when someone tells them god cured them, they believe it and stop their ARVs and no longer believe they can spread HIV. Also traditional healers say they can cure hiv...tb as well. But remember...while this seems silly to “americans”. My village just recently got a clinic...so their healthcare and the people that have been helping them and curing them are relgion and witch doctors so why abandon that now just because western medicine came?

With that said. I have to say for how horrible aparthied was...and how my vilalge could really not treat me well for being a white person...they welcome me with nothing but open arms. It is overwhelming how happy they are I am here to help them. They have nothing but when I come to visit int heir home (huts) they give me food, want to feed me, buy me cold drink (soda), give me fruit and nuts. Its just overwhelming to see such kindness and to see how much hope a whole village puts into me just one person (no pressure on my part : / ) My village gets a kick out of things when I tell them men cook and clean, they ask then who works and I explain both-its moer 50/50 in the us. And then I explain how in the 50s it wasnt like that and how we've changed. Etc etc. Also the women here found it sooo fasinating that we have more than just a one size fits all condoms. Explaining a magnum condom in another langauge might have been a high light so far for me! Which also might highlight too why people dont wear condoms here too...

Now about health care...Well to start with I miss nursing!!! I miss giving a bed bath. I miss helping people. I miss patients anoying familes. Even if they were a pain in the ass...in the end I still helped them and their loved one. (even if I complained). With that in mind, I have to say I will never (well prob not never) complain about health care in a merica ever agina.! Here if you cant eat and have a stroke...you die. NO feeding tube...not living will...or whats ethical to keep someone alive...you die if u cant eat. Its realy made me look back at my career and readust a lot of my attitudes and feelings. People also here take death much better than in the US. From going to working at the cleveland clinic a world class health system, to the VA (which at the time I thought was second rate health care and now I realize is amazing) to village health care and my clinc/home based care. I remember hating skills check offs and compitanies...and thinking vets dont get as good as health care as others at the VA. Now I realize all and any health care we get in the US is just amazing and we are lucky to have it. To have options...to have such well trained people. I mean even if a doctor messes up hes still trying to help and that person/patient even had the oppurtunity to get that kind of care is just such a privilage. I am pretty sure this experience has changed my outlook on health care for life. Drasticlly for the better. Like while shadowing my a home based carer, I saw a kokwani (granny) that was mentally ill. She was locked in a hut with a matress on the floor and a bowl of food. Now in the US this would be illegal/seclussion etc etc. But hhere, its really dong the best with what they have. Now part of me just wanted to boil some water and bathe her and feed her. But they dont have gloves, the training, supplies to better this situation. This women has stopped eating and was loosing weight rapidly. So sad to sit their and see. She was also blind and a little deaf. But if they didnt lock her in the room she would wonder. And others have to work for food and money so no one can take care of her. But they try so hard to do the best for her. And I challenge you to think what you would do in that situation. With no resources. Also, people here know I was a nurse. But its impossible to explain what I did...neuro ICU. Doesnt exist in the country...yet alone my village.And people with stroke I took care of wouldnt be alive here. To explain a ventilator, pressors, licox, bowman, drugs, organ donation etc...is just impossible...my job in the US doesnt exist her. There isnt critical care here. There isnt even medsurg or floor nursing. Doing CPR here would be pointless. This just blows my mind. My job for the last three years working in critical care...the things we can do and did...just amazing! And not just at the cleveland clinc, but at the VA, the red cross, the free clinic, and many hospital I was at during the time I did traveling/agenncy nursing.

I am not sure if this makes sense...i just kinda write what I think and try to get across how I feel. Also, I can help be be thankful I was born in the US. I still have a mom today bc of that fact. If I was born here, I would be mother less. No brain surgery to remove a tumor. This is why I feel strongly about national health care...having money shouldnt be a precurser for having the oppurtunity to have life. Even if it might not benefit me, I think as a human being you cant help but feel and understand giving people the oppurtunity for health and life (which actually in my new language mean the same thing and have the same word...i kinda like that) is greater than helping yourself.

I know a lot of people have also said they want to send care packages. While yes I love getting mail...i feel its kinda selfish to spend all that money...when I live in such a poor village. I want and need for nothing. I live very well here. And hardly feel I am “roughing” it. While care packages are AWESOME and really a boost to morale here...maybe just donate the money you would spend to a charity, peace corps, an aids foundation, a homeless person etc. But I will still come up with a list! Its a strange pull...i love mail and packages...yet feel guilty for all I have....even just my knowledge is priceless. Welp I think that is enough for today! For those of u who made it threw all my rambling...i heart you :) Thank you for your support. It really does help on those down days when I feel like I am not doing anything and just not helping enough. I really miss my family and friends back home and sometimes cant help but thinking what I am missing out on. Especially hard to be away from my sister...its scarey how similar yet different we are! But I think I am where I should be for now, so taking it day by day. This is an amazing experience. If youve ever thought about diong something like this DO IT! You will have no regrets! Much love