Visiting the Clinics

Though I’ve been in South Africa for over 2 years, I’ve never really been to a clinic. I think I went to one once, during a visit to my permanent site over 2 years ago, and met with the “matron” or head nurse. Then again, that was an insane weekend and I don’t really know where all I went. I vaguely remember visiting a sick relative of my principal in a hospital at one time (one of the most awkward experiences of my service….”Hello half dressed, very ill man. I’m a young white woman who can’t speak your language, who has come to sit in the corner and stare awkwardly not-quite-at-you”), and I went to a hospital once to hand out teddy bears to babies with another volunteer (another awkward experience involved scarcely clothed, breastfeeding women and adorable babies). Those were nice facilities in larger villages that were technically hospitals and not clinics.

Now I live next to a clinic. I have since July, and still haven’t gone. If I get sick, I’ll go to the private hospital in town, not the clinic next door. Seems insane? I thought so too, until I went there.

Have you seen movies of overflowing, run down clinics in The Middle of Nowhere, Africa? That’s about what the clinic was like. The facilities were old, but in good condition. However the waiting room was packed with narrow benches without backs, on which sat many old women and babies, squished together as much as humanly possible. The line of (almost exclusively) women and babies stretched down the hall, and women sat on the floor, waiting their turn which was unlikely to come for hours.

I went into what appeared to be an examination room to meet with the “matron” about starting a gardening programme at the clinic, and a huge box of medicines sat on a rickety old table, and medical supplies lined the wall. Everything was chaotically arranged, and I can only imagine what it must be like to take inventory.

I went to another clinic, which was much larger. The wait line was smaller, but the same scene awaited me at the waiting area, just with less women. The rooms were still roughly organized, and women appeared to be crammed together in one examination room I passed (perhaps they were family).

These are public clinics, supported by the government and at little to no cost to the people who seek services there. I hate that I would go to a modern facility in town because I can afford to take advantage of the private services. I hate that inequality has created a system where the people that most need medical help get substandard services.

Yet at the same time, it’s wonderful that my village has a functioning clinic, one which is being used and helping to curb the HIV/AIDS and TB crisis in this country. They are likely understaffed, underfunded, and under-equipped, but the clinics are doing great work.
-Jen

Surrounded by Hunger, Part 1

Since I arrived in my village almost two years ago, teachers have told me that many children at my school go to bed hungry, wake up hungry, and often have only one meal a day-the meager meal provided by the school nutrition programme. Looking around, I believed that was true for some of the learners, but I couldn’t imagine that most of them didn’t have food at home. Maybe I was in denial-I didn’t want to believe it.

The fact is that I am surrounded by hunger.

No, children aren’t wasting away before my eyes from acute malnutrition. Instead, from birth they are set on a trajectory of chronic malnutrition, evidenced by low weight-for-height (underweight), or low height-for-age (stunting). Their unfocused eyes in the first hours of school, heads dropping towards their desks, and slow, shuffled movements prior to the school serving the lunch at 10am tell me that most do not have breakfast. These kids are hungry.

And some are dying.

In fact, 1 in 15 children die before they reach 5 years of age in South Africa. One third of those children die when they are severely malnourished, and 60% are underweight.

Their death certificates don’t state that they died from malnutrition. No, instead they die from things children should be able to overcome. A 14 year old in a friend’s village died a few weeks ago from a dog bite. Not rabies, just an infection from a dog bite. In a nearby village, a two year old passed away last year from an unspecified illness. A friend of mine told me about a horrible incident at her school, where a first grader accidentally killed a fellow first grader by hitting her in the head with a rock. A last weekend, there was a funeral in my village for a learner from one of my schools. He was “sick for a long time”, which translates into “he had HIV”.

Kids shouldn’t be dying from dog bites, bumps to the head, or preventable and treatable illnesses. This happens when kids are chronically malnourished, suffering from protein-energy deficiency. 2.7 million children in South Africa live in homes where there is child hunger. Overall, 12 million South Africans are considered food insecure, and 4 million of those are on the brink of starvation. These are just a few of the stories….but it’s happening every day.

Earlier this week, I recorded the height and weights of all of our Grade R, or kindergarten, learners. We are in the process of identifying who our Orphans and Vulnerable Children (OVCs) are, in order to support them through the school gardens. Finding out the orphans is relatively easy, because the social workers keep track of them and provide a stipend for families who take in an orphan. But the vulnerable children often fall through the cracks. It is up to the school to identify them, and without a standard, it is difficult. I can look at the kids who come to school barefoot, or without coats in the winter, or who wear the same uniform day after day, and I know they are vulnerable. But almost every child in my school is painfully thin-how do I determine who is going hungry? I can’t ask them; they won’t say. So I worked with the principal and decided that we would record their heights and weights and compare them to international standards to determine which children are stunted and which children are underweight.

Out of 39 learners, 18 fall below the 5th percentile in either height or weight. If a learner is at the 5th percentile, it means that 95 percent of children their age in the world are taller or heavier than they are. Nearly half of the class is stunted or underweight. 28 of the learners have a Body Mass Index (BMI) below the 5th percentile. Body Mass Index is a calculation that uses weight and height to determine the amount of fat a person has. Only 1 child has a BMI at the 50th percentile, the rest were below, mostly far below. The 50th BMI percentile mark for a 5 year old girl is 15.1 and for a boy is 15.5.

One of the learners only weighed 11.5kg, or 25.3lb, which is considered underweight for a two year old, and she is 5.

How do we fix this? How do we feed these children? How do we improve this situation?

Stunting has lifelong impacts on a child, even if they receive better nutrition later on in childhood. They rarely catch up with their well-nourished peers. Stunted women often give birth to children with low birth weight, and the cycle begins again. When children have HIV, TB, malaria, or other opportunistic infections, they often do not have the ability to fight the disease, leading to death when it could have been averted. Hidden hunger and parasitic infections exacerbate all of this.

According to the Global Competitiveness Report in 2012, South Africa ranked 107 out of 144 in the world for infant mortality deaths, and 133 out of 144 for life expectancy. In a country that is the economic leader in Africa, a relatively stable economy, and rich in resources, this is a tragedy. In 2011, the GINI coefficient labeled South Africa as the most unequal nation in the world, surpassing Brazil. In a country where wealthy children receive a world class private education and feast on well-rounded, nutrition meals three times a day, rural children are slowly fading away, with empty bellies and immune systems that are unable to cope with the onslaught of physical, psychological, and social maladies. A child raised in poverty in South Africa is four times more likely to die before reaching their fifth birthday than a child raised in a wealthy family.

It is estimated that 30% of children in South Africa are stunted, and 12 million of 52 million people in the country regularly go to bed hungry. In Limpopo, 48% of children were considered stunted in 2005. In 2004, over 800 children died from kwashiorkor, which is an acute form of protein-energy deficiency. Kwashiorkor is commonly seen in places such as war zones, famine relief programmes, and refugee camps. There is no reason it should be seen in a country that has enough food to feed everyone. Kwashiorkor often causes children to have bloated, distended stomachs, and their hair will begin to turn reddish, orange, or gold in severe cases. It is obvious to me that some of the learners I interact with on a daily basis are suffering from kwashiorkor.

What can we do? We can give them seeds and teach them to plant. We can put the power in their hands and help them to ensure their homes are food secure. But I live in the desert. Is it enough?

I’ll write more about ways the government in trying to intervene, and ways in which they should intervene. This country is in a crisis. Food insecurity is a far-reaching problem, which has direct impacts on health and education, and is extremely difficult to overcome. But we must have hope that something can be done.

Otherwise, I’m looking at children who are doomed to be sick and hungry for the rest of their lives, who will raise hungry children, and who will ultimately die prematurely. I am very afraid that this could very well be the reality, unless something changes.
-Jen

http://www.westerncape.gov.za/eng/directories/services/11512/6451
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC201028/
http://www.timeslive.co.za/thetimes/2013/01/30/twelve-million-going-to-bed-hungry-in-sa

Hunger

Grade R learners-notice the hair of the 2 on the left.

Since arriving in my village, I’ve noticed how thin kids are. Since food is harder to get in my village than others, and since the unemployment rate is higher, almost every single child in my school is thin. Last year, there were 2 kids that would be described as pudgy, and that has more to do with them having poor-fitting uniforms than actually being fat. Few children appear to be at a healthy weight, and the vast majority are bony arms and legs. It’s hard to live in this reality. Adults are typically overweight, but kids are dreadfully skinny. This is due to a diet largely based on pap (cornmeal dish) and for the well-off family, chicken and maybe a veggie.

I had been told that most of the learners didn’t have enough food, and many went to bed hungry or didn’t have breakfast. Each child would get a meal at school, and unlike every other school I’ve visited, only a handful would bring other food with them. The meals are small and basic, just some carbs, veg/fruit, and a protein. At most schools, kids bring a “real” lunch with them, but not at mine. Mma N, my garden counterpart, had said several times that most learners don’t have food at home, and was adamant about giving food boxes from the garden to our OVCs. But I honestly assumed she and other educators were blowing things out of proportion. This is South Africa, kids can’t be starving, right?

Then I started looking and noticing. I saw how few kids brought food from home, how many didn’t buy snacks at school or participate in fundraisers. I noticed brittle, reddish-blond hair, a dead giveaway symptom of Kwashiorkor. I saw how sluggish and out of it kids were in the mornings, before lunch was served. Kids stole our garden veggies. I observed how slowly children developed, and how babies and toddlers didn’t walk or talk. I saw how small the kids really were, and it was heartbreaking.

Hidden hunger, or lack of micronutrients, is a dangerous form of hunger. People don’t necessarily die from it, but it has lifelong effects. Kwashiorkor is a form of malnutrition that comes from not eating enough protein, even though you get enough calories. I had noticed how some kids had reddish or even gold-blonde hair, and found it intriguing. These are black kids, after all, so their hair shouldn’t be red or gold-blonde. I noticed that many kids in Grade R, 1, and 2 had this hair, but only a few older kids did. So when kids start coming to school in Grade R, they are served a complete protein 5 times a week, and it is helping them. The older kids look a little healthier, but the littlest ones are so small, so underdeveloped.

Kwashiorkor and malnutrition stunt children, meaning they do not grow as tall as they should. This typically is lifelong, which may help explain why some people here are so short. With Kwashiorkor, which I think is the prevalent form of malnutrition in my village, children lose muscle mass and do not develop as they should, mentally or physically. They hit milestones late and suffer in school because they are not prepared for the demands of the classroom. Some even get red or gold-blonde hair, which is very brittle. In the worst stages, they will lose their hair and sometimes skin, leaving oozing sores. If a child has Kwashiorkor, it is much more likely that they will suffer from (maybe even die from) another infection, like pneumonia, TB, malaria, or HIV/AIDS.

I’m setting out on a project to weigh and measure the heights of each child in my school. I’m looking for funding through the Department of Agriculture to help the school garden, and I hope this information helps. Since we use the garden to help feed the kids, hopefully they will be more willing to support us if they see the level of malnutrition and stunting. If not, at least I’ll know which kids need the food box the most. I know it will be hard to uncover the extent of the malnutrition in my village, but it needs to be done. Yes, this is South Africa, but people still suffer from malnutrition.
-Jen

Grade R having lunch. Notice the light hair.

Grade R making recycled art!

Reflections on South Africa: Life is Good

I live in Africa. This means that I am confronted with some of the worst poverty in the world on a daily basis. Even though I live in South Africa, and the government is fiscally able to support the poor, at the end of the day, people in my village go hungry, kids shiver themselves to sleep, people die from curable or treatable diseases, and children come to school without coats and shoes in the winter. In my village, where I call home.

The level of suffering in my village is hard for me to comprehend, even though I see it often. Kids steal unripe food from the garden, kids eat veld grasses, and nearly every child in the village is small and stunted. When I was in America, I was stunned to see how big and healthy young children looked. The adults suffer too. Hardly any people between the ages of 20-40 live in the village, either because they have died or because they live away from the family to find work. Almost every child in the village is raised by grandparents, many of whom live completely off their pension and social grants, or raise themselves.

Other PCVs are able to do fundraising, such as casual Fridays, where a kid can pay 1-2 rand to wear anything besides the uniforms. They do that once or twice a year at my school, and many children show up in the uniforms because they can’t pay the 1-2 rand. That’s about 25 cents, USD. Most schools have “snack ladies” that show up and sell sweets, biscuits, and crisps during lunch. My schools don’t, and the shops rarely stock such items because nobody can afford it.

Living in this reality makes me realize how truly blessed I am. I didn’t grow up in a rich family, and my parents certainly didn’t cater to my every whim. Yet I never went without what I needed, and my family usually found a way to provide for the things I wanted. I never went a week without seeing my parents, and I grew up in a fairly functional family. My sister and I weren’t passed out to relatives to raise us. I never had to worry about whether my mother or father was going to die. I never went hungry, thirsty, cold, sick….I never had to experience what nearly every child in my village has to experience.

Being a PCV can be truly heartbreaking. But it also shows me how truly good my life is. God has blessed me with so much, and before joining Peace Corps, I took most of that for granted. When was the last time you thanked God for a shower, steady electricity, insulation, carpet, a ceiling, not having to shake your shoes out for scorpions/tarantulas, reliable transportation….In America, we say Grace for our food, but how thankful are we really? How can we be truly thankful when most Americans have never gone hungry? I am incredibly grateful for the simple things in life, because I know what it’s like to live without these luxuries, now.

My life is good, and now I can spend two years trying to make the lives of my villagers better.
-Jen

PermaGarden Workshop

After the previously mentioned insanity trip to Bray, we settled in for a short 2 day workshop on how to set up sustainable gardens in nutrient-poor soil in arid regions-PermaGardening!  When we finally made it into Bray late Monday night, Lorato and I were the “lucky” ones who stayed in the Guest House owner’s house.  I had her teenage girl’s room-complete with at least 6 Justin Beiber posters and numerous other young pop stars-eesh.  Her family was mysteriously absent, which was good because the shower was literally in the middle of the hallway and had no door…I still don’t understand Africa. 🙂

The workshop was split up into 2 parts-the presentations and the garden creation.  A volunteer called Oratile is based in Bray, so we started the garden at her school.  It was fun because we didn’t do traditional retangular plots.  We made a rainbow, a heart, an arrow, a peace sign, and the South African flag.  It was a little difficult to get the shapes right, but fun.  We double-dug the trenches and put compost materials and tin cans directly into the soil (to give it more iron).  At the end of the second day, after a significant rain delay, we got to plant a bunch of seedlings-onion, beetroot, tomatos, peppers, cabbage, and spinach.  The garden looked quite impressive after just 2 days of digging, considering it started out as a bare patch of ground.

The presentations were done in part by an awesome duo-David Patient and Neil Orr.  They were at our IST in the HIV/AIDS session, and they came to our PermaGarden workshop to demostrate how gardens can help HIV-positive people.  They focused on nutrition and the plants that can provide HIV-positive or AIDS patients with the vitamins and minerals their bodies desperately need.  They also touched on income-generation, which would be super cool for the schools to do.  We’ll see if it happens. 🙂

Other highlights of the workshop-I got to play with dogs, I had a warthog suck on my fingers (he was bottle-fed as a baby), and I had the same warthog pen me into a house.  I was going to leave when the warthog came to the door.  I slammed it shut quick, then the warthog proceeded to pound its snout against the door for a bit.  When I asked the Afrikaner owner about it, he said they sometimes let him in the house-a warthog!  🙂  We also visited Oratile’s house, which is insanely tiny-I cannot believe how little room she has.  And an RPCV (Returned PCV, as in, finished with her service) who lives in Bray came to visit with us.  She served about 5 years ago and married an Afrikaner farmer, and now lives in Bray.

Also, Bray is on the border of Botswana, literally.  It was about a 5 minute walk from the guest house-something you could visit during a lunch break! 🙂

-Jen