Tuesday, February 24, 2009
The medicine is going well. What has really struck us about HIV/AIDS is that you don’t treat it in an emergency. It’s not like getting in antibiotics “stat”. It’s a bit more like treating diabetes: a chronic, long term, ongoing process. The problem is that if you are non-compliant (or worse, partially compliant) with your diabetes treatment, the sugar doesn’t become resistant to the insulin in the same way that viruses become resistant to HAART (Highly active anti-retroviral treatment). Compliance is incredibly important, and your first shot is your best shot at treating it. So patients have to go for adherence councelling 3 times before starting treatment.
What else do we see: Tb. There are about 20 inpatients with TB right now. Most (I think) are HIV positive. Otherwise, in the out patient departement: Diabetes, Hypertension, colds, coughs, arthritis. And also large fungal infections, odd masses and so on.
Final word: there is a cholera outbreak in Opuwo (about 6 hours away), and up to a few hours ago we thought I (Alice) was going to go and help them out for a week from Monday (1st of March) I was pretty anxious about it. Now it seems I’m not going, but there is a lot of uncertainty about it, but I’ll keep you posted!
Saturday, February 21, 2009
The straightforward way is:
Alice Gwyn or Mark Walton
PO Box 261
However, if the thing is precious then please know that the mail is "reliable" to Windhoek, but we're told not completely trustworthy beyond that. So if you're sending something you really don't want pilfered, please send it to
Alice Gwyn or Mark Walton
C/O VSO Namibia
PO Box 11339
They will bring it out whenever someone comes in our direction
And if that weren't enough instructions, apparently the Post office doesn't put a slip in your box to let you know that a package has arrived, so if you are sending one to Khorixas, do let us know!! Then we can ask for it, periodically
Friday, February 20, 2009
I know people want pics, but I can't seem to upload them. The connection is no longer 3.5 G like in the city!
The hospital is about 1 mile from our house, at the east end of the township area. We often walk to work, at 8 am and 5 pm it’s often cloudy, and not too hot. Our car’s starter engine broke the day after we bought it, so we just didn’t use it.
At work, each doctor has a ward for which they take responsibility. There is a female/maternity ward, male ward, paediatrics and Tb wards. We have been allocated the paeds ward, which is really interesting. We’ve rounded in the Tb ward twice already, which is also fascinating.
This week, a typical day has been: rounding from 8 till it’s done (about 30-45 minutes if there is only the kiddies, 2 ½ hours if we do the Tb ward too) then Mark goes to the “CDC” centre for disease control, where the HIV work is being done. And I go to the out patient department/casualty and see patients. See patients till 1, and as Namibia has a strong tradition of a 1-2 pm lunch hour, but it’s awfully hot for walking home, we bring a lunch to work. Then again from 2-5 pm.
We haven’t been overwhelmingly busy. Currently the HIV clinic is only on a Wednesday, and over the next year we hope to expand that to 3 times/week. I am certainly not seeing the most patients in the OPD, 1 or 2 other docs are on with me, and there are certainly some slow times.
Khorixas is divided in to areas, 3 really. As you come from Outjo (or follow the road on Google Earth) to the right of the main road is the “Town”, where the house lots are quite big, the houses are big (to whit: ours), most, maybe all, have servants quarters. This is where, before independence in 1990, whites lived. After 1990, most moved out, apart from 4 families, apparently. I don’t know when the houses were built, but they are pretty uniform.
To the left of the road is what could be called the “township”, I think. Lot sizes are smaller, houses are small: from the outside they look as if they are 2 or 4 rooms, quite symmetrical, metal roofs, plumbing. Lots of satellite dishes outside of them. Apparently they are crowded with furniture inside.
Further to the south of the township is the informal settlement. I haven’t seen it yet, but houses are self built, maybe with corrugated iron. I assume no plumbing, but I don’t really know.
Namibian health care
HIV has so much attention and so much funding and support internationally and this is reflected in Namibia. I would be interested to know who has to pay for the treatment of AIDS in the US, but it’s free here. Namibia is a two tiered system: there is the state system, which we are working in, and a private system. Within the state system, yes, you can’t prescribe any medication: there is a NEDlist (Namibia’s Essential Drug list) and stocks aren’t always high, but when you do prescribe them, they are free. (for the medics out there: PPIs aren’t on the list, but tramadol is!) A patient who needs it can get transport to Windhoek to see a specialist (on Wednesdays), get a CT, have a kidney removed, whatever. I don’t know what the wait times are, of course.
The doctors we work with
There are 3 other docs here: Dr Everest Nkire, the Principal Medical Officer, a Nigerian who has also worked in Zambia, Dr Reddy from Hyerabad (India, I know I spelled it wrong) who has worked in Jamaica, Trinidad, the Seychelles, the Maldives and Goa!, and Dr Michael Ubunama, who is also Nigerian.
Wednesday, February 18, 2009
We took possesion of the car at 1030 am amd left Windhoek a few hours later, having packed, shopped and gassed up. We stopped after a few hours for a snack under a tree. How to describe it? The roads are very straight and flat (having been made for the purposes of the south African army) There are mountains or hills all around us, but we never seem to go through them, just straight! The B roads are very good (there are no A roads). Every once in a while there is a sign announcing a rest stop in 1 km: a table and benches under a tree. It could be anywhere. Except for the signs warning us of warthogs and flying springbok. Substitute a charging moose, and it could be Newfoundland! There is even a couple of suggestive twin hills, like those coming out of Port Aux Basques into the Codroy valley.
We drive to Otjiwarongo where we meet Mary Anne. She is a volunteer from South Africa, nearly finished her 2 years. She envies us going to Khorixas, for she thinks we’re closer to the good stuff. The grass is always greener. Otjiwarongo has Cymot (Canadian Tire on steroids) and SuperSpar (supermarket). I’m not sure if it has a night life, tho’.
Dark start around 730, when we’re about 40 minutes from Khorixas. We’ve seen big birds, that look like peacocks without tails, an eagle sitting on a telephone pole, little duikers (deer about as small as rabbits) and a fox. So we slow down and arrive safely.
At the gas station, we call Dr Micheal to show us the house. He is Nigerian, and looks about 25 (we find out later he’s 32). He tells us we’re going to the hospital for supper.
What we can see of the hospital is clean, spread out, with covered walkways from area to area. The key to the canteen is finally found, and we eat: tough fried meat (oh Mark the vegetarian), fried potatoes, sliced tomatoes, mango juice, an enormous slab of cheese. There is 1 l of UHT milk, but no cups. Dr Michael takes it.
As we leave the hospital he says: you must take your rations and boxes of food are brought out. Apparently they will continue to give us this untill we ask them to stop.
And so we came to the house: me, Mark, the driver (a traditional leader, and enormous) Dr Micheal and a helper.
Opening doors was difficult. Despite necessity, they broke down the garage door. Apparently the front door can be opened, but is very difficult to shut.
I’d had a day dream (which I knew was a dream) of our “three bedroom house”: discovering it, running from room to room. But life as it truly is: Mark went in via the back door and came out with the information that there are cockroaches. I went in, carrying some stuff, not knowing where to put it down!
There are indeed three bedrooms: in a row, leading onto a large hallway/gallery. In the first bedroom were 2 (hospital?) beds, with thin plastic mattresses, hospital linen and a towel. In the second is one bed, and in the third nothing. After that is a “living” area, eating area, kitchen, pantry, alcove and porch/washing area. At the other end is the toilet, shower, sink: all in rough concrete.
I felt like crying. I was frightened, overwhelemd and somehow scared of this derelict house. There is space, but no furniture. Mark took control, and we made the living room more cosy: sweeping it, putting all 3 beds in and rigging the mosquito net over 2 of them (tying them together with our tow rope!). To cheer ourselves up, we switch on a computer and connect to the internet. There is no service. We turn on the fan (sitting on the one chair) and go to bed.
Now, 5 days later, I still find it too big and not quite clean enough (tho’ I think a valiant attempt was made). It has a new fridge, an old stove and kitchen cabinets that are too rusty to put stuff in. The water pressure was too low (the stop cock was turned off) and that has been remedied. The roof leaks in the kitchen, but only when it rains. We have figured out which doors have keys, and which are just too dirty to attempt to open. We’ve fumigated with Raid and some other insect killer. It isn’t home yet. Yet.
Wednesday, February 11, 2009
Many details really remind me of Bolivia: The flowering trees, grand projects next to construction sites, women selling drinks under trees, the heat, the houses being fenced in and surmounted by protective sharp things (tho’ here it is barbed wire and often electric fences, not broken bottles), taxis sounding their horn to get your attention.
But there are differences: we can drink the water, ice, lettuce, salad, apple peels and so on, you don’t need to bribe anyone when you go to the Police station (to get copies of documents certified, more on that later) there are no men with machine guns in the banks or in the post office. What I find most distressing is that the taxis are not reliable here. They are regulated, but it is easy to make a car look like a taxi-and many do.
I referred to the need to do paper work at the police station before, and just a quick note on that. We had sent an application for authorisation to work as doctors here back in November. Unfortunately, it was never submitted. When Mark and I realised this, we became quite anxious, as may be imagined. We really did not want to be working in any way “illegally” here. And although it might be vaguely appropriate to just go to Khorixas and get stuck in, and worry about the paperwork afterwards, that didn’t appeal to us.
We also started thinking about our return to
the Ministry of Health and Social Services: 3 visits
The Medical and Dental council: 2 visits
(witnessing robbery: once)
The police station: queueing 5 times on 2 different days in the sun
(discovered that Namibians line up with discipline and compassion: pregnant women, seniors and people with disabilities don’t have to line up.)
Phone calls: countless
Completed replies, in writing, that Mark and I have submitted applications for authorisations to work and that this is sufficient to start work : 1 (and there was much rejoicing!!
Saturday, February 7, 2009
It is hot and often dusty
It is so hot, that a Namibian VSO who's husband is from Khorixas finds it too hot
It is actually a bit less hot right now because of the "rains", but will be baking in April
It hasn't rained there in 4 weeks
The people are lovely
Our Nigerian supervisor Dr Nkire is really enthousiastic
We will have a 3-bedroom apartment, and hope for lots of visitors
It is a 5.5 hour drive from Windhoek
Groceries are expensive there
So having been successfully picked up at the airport, and taken to our lodgings (very comfortable) we snoozed and then were taken out for supper by some other VSO volunteers: Sonia and Saskia, Dutch, and Dylan, English. We were joined by 3 others from various organisations, a Dutch journalist and 2 Sweedish volunteers.
We went to La Marmite, which is Cameroonian. Delicious food in wooden bowls. And Mopane worms. Fried. I was starving and ate about 3 of them. They had been prepared in some delicious sauce, but were still rather crunchy, and, well, worms.
So we've spent the last 2 days doing that: getting papers certified at the police station, doing declarations (also at the police station, but in a different queue) going to the Ministry and finding out I'd (Alice) had filled out the wrong form. Doing it all again the next day. Going to the Medical and Dental Council and (Mark) filling in forms for them: Mark really planned ahead and brought his original documents, so he was able to do this...
And in the evenings: going out to different restaurants with Joonho, or cooking. there is really good food!!!
And in the evenings: going out to different restaurants with Joonho, or cooking. there is really good food!!!
Tuesday, February 3, 2009
So we've arrived. The trip started Saturday morning, with a flight to Toronto, then a 12 hour wait in TO. It was incredibly cold! Only -10, but somehow, the damp or the wind, something made it challenging. I was glad I hadn't packed my scarf and hat away, and would have loved my long underwear...
Frankfurt was -1 only and we had rented a hotel room for 6 hours, and got some lovely sleep.
In Johannesburg we had to immigrate into the country to get our luggage: the people in Halifax hadn't been able to book us through to Windhoek.
In Windhoek we figured out that another passenger, Joohon (from Texas) was also with VSO. Lucky him he had a visa already. We didn't, but Mark and I played tag team going out of the immigration area. I felt quite overwhelmed even buying a phone card and phoning the VSO office! Actually it was completely straightforward. And about an hour later Paul arrived with our VISAs
We're just going to post this as a recent thunderstorm has made the electricity a bit dubious