Hardships in a Township

On the last day of our trip, Jon, Susan, and I had the opportunity to visit patients with the community-based carers in Masi Township. A township is a settlement community designated by the government for the poorest of the poor to build their shacks as their homes. These townships are designed to be self-containing with shops, schools, churches, and clinics. Xhosa-speaking blacks made up the majority of the Masi township population.

We traveled with two carers from Living Hope and paid visits to patients in their homes to make sure their daily needs and health are taken care of. The tasks include changing wound dressing, bathing, exercising, clipping nails, checking on blood pressures or blood sugars, and following up on medications. The carers lived in the township themselves and shared their life stories and their difficulties with us between the visits.

I was struck by a few things during the visits. I haven't quite find the right words to describe the poverty and despair in the township, but I will give it a try with this post. Steve Davis visited the carers on Monday and called it hell, and he's not far off. The suffering and pain of the patients are all too visible...the first diabetic patient we visited was so sick she couldn't muster the energy to even engage in conversations. She was laying on her bed (if you can call it that) in her tiny shack, about the size of a small walk-in closet, shared with countless number of people in her family. A patient with such illness would have been rushed to the hospital in the U.S., but not so in the South Africa health system...she's literally rotting away in her own home.

Speaking of diabetes, every diabetic patient we visited during rounds had at least one of their legs amputated. If you have diabetes or know someone with diabetes, you know how important it is to monitor your blood sugars and monitor your carbohydrate intakes to prevent complications from diabetes. A common complication is diabetic foot infection. If not caught early, amputation is generally required--further limiting the patient's ability to participate in physical activity and worsening their cardiovascular conditions.

And one important tool to monitor your blood glucose is a simple device called a glucometer. I found out there is only one glucometer among the many carers and they had to share it during their patient care rounds. By the way, the carers travel by foot and it becomes extremely difficult for them to coordinate their timing in sharing the glucometer. Therefore, many patients did not have their blood glucose checked as closely as they should. In the first-world, checking your blood glucose 3-4 times a day is the standard of care and everyone has his own glucometer; in this township, checking them 3 times a week is a luxury...making the management of diabetes even more difficult is their diet. These patients often lack the knowledge and the funds to acquire food items appropriate for their diabetes. Their meals, if they can afford any, generally consist of processed foods that are unhealthy. And these probably explain the many amputees we've seen.

We visited a 4-year old patient with fetal alcoholic syndrome (FAS) in a special-needs school; her physical size, attributes, and mental/intellectual development are more consistent with a 2-year old. FAS is caused by alcohol consumption during pregnancy. There are also many kids with Downs syndrome and other growth retardation in the school. Health illiteracy is clearly a problem in this township and its consequences are sadly displayed in this special-needs school.

Finally, I was most deeply touched by an HIV+ patient...let's called her T to protect her confidentiality. T is 34-year old woman who suffered a recent stroke that paralyzed the left side of her body. She speaks and understands English. HIV remains a taboo and carries significant stigma in South Africa, and voice carries over in these shacks as they were built so close to each other; so we had to be careful with our conversations. We asked her how we can pray for her and she kept saying her health, I felt there was something more but I was not sure how to proceed under the circumstances.

As I started praying for her health, comfort, and peace, she started weeping and related to us that her ex-boyfriend has found a new girlfriend. And he threatened to stop by later to take down her shack and take all her possessions away from her. In Africa, many women do not have marketable job skills and even those who have them, unemployment remains a major problem. As a result, many women have to find a boyfriend or man as a mean to support themselves. When these relationships do not work out, the women lose their means of support and there is little help these women could turn to. (For those interested in this topic, check out Helen Epstein's excellent book The Invisible Cure)

With T's stroke, she cannot easily get a job and the prospect of finding a new man to support her is poor. There is no women's shelter we know of, and the carers recommended T to contact the police, but I am not sure how much the police could do to protect T. Unfortunately, the rules regulating these visits required us to not get entangled in these disputes and we did not find out what eventually happened in this situation...so brothers and sisters, please keep T in your prayers.

I read these types of difficulties in books, websites, and dissertations, and these readings often ignite a fire in my heart concerning the many inequalities and injustices in this world...but this flame is often extinguished by other distractions. Being here in Masi in person is a totally different matter; I am still processing my feelings and reactions but I doubt that these hardships can be forgotten...T's face has been forever seared into my mind.