Food for Thought...

Food for Thought...

Thursday 4 December 2014

“Going rural”...over-glamorised or under-appreciated?


This month I have encountered numerous moments when I have been forced to consider whether living and working in a rural area has been over glamorised. I have met students who have been disappointed by the frustrating systems in place, friends in urban settings who feel marginalised by their rural peers and doctors who question why they came all the way out here "just for this". 

When considering the run up to moving out here, I remember the embellished view I had of the place....caring, productive communities.... inspiring medical staff... functional health care systems that worked in the most remote of conditions. 

In hindsight, I really should have been disappointed with the reality I found....within a few days I had encountered suffering, marginalised communities, over worked staff and failing systems. I arrived to a dirty run-down house with little to no food and a bunch of people I didn't know. I was soon travelling in dangerously dilapidated hospital cars to work in rundown buildings with dysfunctional impoverished people. 

So why was I so happy? Why did I want to tell everyone how amazing it was? Why was I so eager to show my new home off to anyone who dared to come and visit me? 

Recent reflections on this craze of "going rural" for com serve have really made me wonder whether my overwhelming excitement and love for being here was just a facade that I had created prior to actually arriving. With the end of apartheid and the push for a more equitable society, I was fed the rural dream within the first few days of stepping into university in 2010.  I read about inspiring people doing extraordinary things in magically remote places. By that stage "going rural" had become a popular choice for many young health professionals during their year of community service. Needless to say, I was quickly infected by the bug and soon joined a rural medical society on my campus. I began using some of my spare time to attend talks by rural doctors, chat to older OTs about their rural experiences and even spent one holiday in the middle of nowhere volunteering in a rural hospital. But all these experiences only made the desire to "go rural" that much more enriching. I was hooked. 

But now, even as the months have worn on, am I too darn stubborn to see the obvious disappointments surrounding me? Have I refused to submit to an alternative, darker reality than the bright sparkly one that had been built during my time at university? Maybe Ispeak so highly of rural because speaking about the good moments makes the bad ones seem okay. Maybe I over-compensate for all the heart-wrenching experiences and fool myself into believing that the few magical moments make it all worth while...maybe they really do.

Granted, there are days when my heart just can't seem to conceptualise the depth of suffering that is experienced by some of the community members out here. There are days when I really don't feel like working. There are days when I wish I was somewhere else... where the struggles of working within this kind of context were only read about in foreign newspapers.  There are days when I just don't want to get out of bed or when returning to the hospital after lunch feels like the toughest mission in the world. 

But those days and few and far between. On those days there is usually something else bothering me.... Something that has nothing to do with living rural... Something that would have made me feel like that no matter where I was. Never once have I questioned my decision of coming to live in Manguzi. If anything, my choice of working here has been more and more affirmed with each passing month. 

Because as much as this place is filled with disappointments, there really is something magical about it. I experience such a sense of peace and contentment both at work and the rest of the time that I can't help but think that I was not fed ridiculous lies at varsity.... Everything people spoke about came true. My experience this year has far exceeded my very high expectations and I can't help but encourage others to join the rural clan. You won't regret it. 

The choice to come out here is not an easy one and choosing to stay on long-term is far more difficult than walking away from one exquisite year in the bush. As in all things, the rural experience is what you make of it and if you dare to seek out beauty in negative spaces, I can assure you...you will not be disappointed. 

 November Memories...

Kelly, our Speechie, held an art evening for some of the Manguzi ladies at our house
I attended the spectacularly beautiful and outrageously fun wedding of my dear friends Gill and Carl. What a fantastic couple they make!!

Zenia, our Speech Therapist, spending quality time with Sphelele, one of our delights in paeds ward

Pumi, our Occupational Therapy Assistant (OTA) running an aerobics class in the MDR TB ward

Precious, another OTT, bringing patients to the aerobics class. People can participate from the comfort of their own wheelchair!

Meat on the braai at one of the farewell parties we had with the nurses earlier this month

A spontaneous visit by my good friends Denny, Reah and Sean was a wonderful excuse to get away to Black Rock Beach for a weekend!
OTs UNITE! Our OT clan had a group reunion whilst paddling down the pongola river n Norther KZN
Sammy, one of our guides paddling quietly passed some cows taking a refreshing dip in the river

Kelly and Kati stayed on to visit the marvelous Kosi Bay Mouth - what a treat to show them my home!

The mandatory picture at the drift wood tree at Kosi Bay Mouth

Wednesday 12 November 2014

You know you're living rural when....

This month I have constantly been reminded of my rural living with the small comical incidents that occur on a daily basis. While I would love to capture them all through the lens of a camera, this is not possible, but here are just a few to make your smile.

You know you're living rural when...

People take joy-rides on the linen cart as driving an authorised vehicle is a rare and privileged experience

Sunday afternoons consist of driving back from yet another world-class destination with the setting sun in your eyes and a content smile on your face

Clothes and food are mainly purchased on the side of a road (especially after grant collection every month!)

 Braaied meilies are a special treat for any passersby (my favourite stop after a long clinic!)

Rustic living is a part of the process but reminds us that we really don’t need much to enjoy life

Beautiful sunsets plague our daily lives ;)

The hospital grounds are made up of majority beach sand
Road kill is taken home as a victory prize for that night’s supper

Animals in wards and offices aren’t even given a second glance

A normal run involves lakes, hippos and standing on cars

A local car washing business is formed out of a natural river
Therapy is performed in a tree house

Ridiculously tiny animals are found and loved

4x4s are the only way to get anywhere

Competitions at our local retail stores e involve the winner receiving their very own water tank (jojo)
And finally....you get to meet and work with passionate and inspiring people on a daily basis! Check out these gems:

1) Jabu Indlovu (one of my OT supervisors and recent winner of Rural Rehab Worker of the Year). Click here to read more about her on RURESA's facebook page (you may need to scroll down a bit once it's opened).

2) Maryke Bezuidenhout (Head of our Rehab department and one of the Mail & Guardian's top 200 young professionals) Click here to read more about her accomplishments.

3) Margaret Masinga (therapy assistant and secretary of a local disabled people's organisation who is in the process of fighting for the rights of disabled children to attend school in our area) Click here to view a recent Mail & Guardian article featuring Margaret and the current situation of special schools in KZN.

4) Phumzane Nthuli (a local motivated marathon runner making waves in the KZN running scene as he moves up the ranks of top runners). Click here to view his facebook page.

Saturday 4 October 2014

There are no lines in Africa


Whether it’s the physical space between two people in a Spar queue, the row of individuals waiting at a mobile SARS office or the emotional boundary between a health care practitioner and their patient, this month has reminded me that there really are no lines in Africa.

September has been another whirl wind of a month but I have decided to focus this post on a simple statement mentioned by my supervisor when I mentioned that I was going to try and get my tax return at the mobile SARS point one day. As she plainly put it, “Remember Caryn, there are no lines in Africa.”

My SARS line experience
Filing for tax returns can be a somewhat tedious process, as we all know, but when the structured, air-conditioned Durban SARS office decided to reject my proof of address letter written by the hospital HR manager, I thought the process was going to become even more of a mission.

To my misguided fortune, I found out that SARS would be visiting Manguzi Hospital to help employees with their tax returns by using a mobile office they seem to have created. Unfortunately for me, that particular day proved to hold a high patient load and I only managed to arrive at the bustling van at 3pm. I was told that due to my status as a ‘medical clinician’ in the hospital (rather than a cleaner or another apparently ‘less important’ job) I

would be prioritised so I could get back to work as soon as possible. While this all sounded rather classist to me, I wasn’t going to argue with a system that assisted in ensuring I would still be able to see my mounting patient load. My acceptance of this unjust system was further heightened when I realised that the arrival of the SARS van clearly called for a day of rest as lazy government officials left their posts around the hospital to sit on the grass and watch the chaos unfold.

While I was fast-tracked through the first of two queues by the possibly classist HR manager, I was not so lucky with the second queue. After receiving my number in the first queue (I was deemed to be 181 in the building chaos of people), the friendly HR manager told me to return at 4pm so I could continue working while the line subsided and he would then assist in fast-tracking me to the front of the second queue later. The flawed logic of this only dawned on me later as I wondered why I didn’t just finish the process right there and then. Nevertheless, I was now stuck in this mess. I returned at 4pm to find the HR manager having given up on trying to instil the slightest sense of order to the crowd. I was left to fend for myself. Eish. The line had turned into an absolute dog show in the space of an hour and after waiting for 30 minutes without moving from the spot on which I was standing, I realised that this experience was really going to test my patience.

I began asking people around me for their numbers and found a place where I seemed to fit in. I stood patiently and waited for what was left of the line to begin to move in a forward direction. I chatted absent-mindedly to the people surrounding me: being the only white girl in a group of 200 odd people inevitably called for some questions. I returned home twice for refreshments and to fetch my book but always hurried back hopefully, desperate for the line to have become a little shorter in my absence. Tensions rose as dusk turned to darkness and the group of people seemed to subside in only miniscule fractions. By that stage, our assigned numbers had become meaningless and I realised that I’d have to push my way forward if I hoped to be home before 9pm. As the shoving increased and seats were fought over, the three phenomenally slow SARS officials did nothing to quieten the rising resistance movement I was witnessing grow before my eyes. All of a sudden the crowd seemed to move forwards quite drastically and I unwillingly became a part of the scramble for the random empty seats dispersed amongst the group. At that moment, the ridiculousness of the situation hit me and I started laughing uncontrollably at the pandemonium of which I had become an inevitable part. Others joined me as they noticed the young white girl’s reaction to common practice in Africa. Soon the mood had lightened and humorous banter rose throughout the crowd dispersing the mounting tension. I was grateful for Mr 182 as he pushed me forward with every empty seat that became available, as if refusing to leave me behind in this obvious self-centred pursuit of our tax return rewards.

With only 7 people in front of me (and a good 50 people behind), one of the SARS officials announced that they needed to return to Jozini as it was getting extremely late. The crowd erupted into a mass of discontent and I began to consider the power of what anthropologists may call “mob mentality.” When the official submissively stated that it would be difficult driving the large SARS van back along dark roads with many cows to content with, his words were met with jeers, waving hands and further shoving of people towards the crowded van. He wearily looked at the angry crowd, made a phone call, and continued to work. We had won our first battle together. I laughed openly about how the character of the group quickly changed to one of comradery when we had a common enemy and couldn’t help but liken this to the downfall of the apartheid system who had tried so hard to disintegrate ties between people of similar oppressed groups. The man next to me broke through my thoughts as he happily waved me on to a suddenly empty seat with his half eaten stick of sugar cane. After instructing a few other people where he thought they should sit, he squeezed in beside me and chuckled, “perseverance is the mother of success ntombazane.” Oh yes. That night, his words could not have been more accurate.

I made it to the front of the queue after a mere 4 hours of hustling my way through the nonexistent African SARS line. Surprisingly, as I sat near the front I found a lot of 180s around me in the queue, with the odd sneaky 200 and something every now and again. I finished my tax return within the space of 5 minutes and jubilantly bid the crowd a farewell. I was greeted back with comical waves and laughs. I ran home, thrilled to know my tax return was secured and remarkably thankful for my unconventional SARS queuing experience. I was grateful for the chaos, the reminder that I live in one of the most unique countries in the world and felt a strange sense of belonging that I could add my presence to the disorder.

The Clinician-Patient Boundary
The line between a patient and a therapist is frustratingly blurred. While there are obvious lines that one does not cross when treating a patient, I often struggle to know how far to reach into their lives. This month, God turned the tables on me, and to my complete surprise, showed me exactly how far His love can reach.

On one particular day this month, the weight of exhaustion due to poor sleeping patterns rested heavily on my shoulders. I cursed my old creaky bed, my annoying hot room and the powers that be that seemed to be adamant to keep me from my precious sleep. It consumed my mind and I went about my day in a daze, wishing for the moment I could step back into my house and rest my head on my pillow.

My annoying sleeping patterns and inability to get them under control is a continuous struggle for me. I think the worst part is that it affects my job and ultimately the way I express God’s love to the people with whom I work, live and share life. I become an edgy and impatient (well, more impatient) person, hoping only to keep to myself and continue in a quiet manner throughout the day. This never bodes well as my job demands the exact opposite – enthusiasm, patience and a whole lot of energy.

Yet it was on this day that God chose to bless me through the words of a complete stranger.

I was taking a painfully slow walk with a Gogo who had had all the toes on her right foot amputated. Together, we trudged slowly towards the bathroom at the other end of the corridor (her with a walking frame continuously muttering under her breath; me with my head down, hands in my pockets, consumed by my own thoughts). As we finally made our way back to her bed (a good 30 minutes after I had managed to motivate her to get up), a nurse passed us and smiled. “Do you know what Gogo is saying?” the nurse asked me. “No,” I flatly replied, having barely noticed her apparent unintelligible ramblings. “She is praying. For you” the nurse replied simply. I was stunned. This Gogo with whom I had barely engaged, was praying for me!

While I will never know what exactly she said, her actions reminded me that God is with me, no matter how mundane the task may seem. He will never let me get through a day without revealing Himself to me in some small or big way – it is my choice whether or not I decide to see and hear Him. While I always question whether I can ethically cross that professional line to pray with my patients, God seemed to answer my question through the Gogo’s simple action. “Yes, pray for them Caryn because they are already praying for you!”

September memories:
Spring is here!! This beautiful tree stands right outside my house and reminds me what season it is . In the space of a week all the old brown leaves fell off and new ones have started to grow.


I visited a mobile clinic this month and provided rehab services inside the derelict building on the left. 
Cameron (Njabulo), a physiotherapist, napping on our way to clinic in the overcrowded 4x4
Time for some paper mache' with the OT assistants as we built a standing frame for a CP child. Messy but fun!
Who says physios can't make splints? My supervisor, Maryke, made this soft splint out of old wetsuit material and velcro. Check out the difference she has made to rural rehab in South Africa: Mail and Guardian 200 Young South Africans
Home-Based Care visit with Nonhlanhla, a physio technician, to catch up with Nelly, a gogo who suffered from a stroke recently
Nelly practising using a walking frame outside her homestead
Little Zaida, the current princess of paeds ward, discovered herself in the mirror
Adri reading with Zaida in the ward
Kelly, a Speech Therapist, teaching a little girl feeding techniques
Home exercise program for a gogo who can't read

Monday 1 September 2014

My Rural Senses

This month I was touched by the sounds, sights and smells that filled my senses on a daily basis. It seemed that God was trying to remind me of how unique this place is and how I need to take in all the different types of daily experiences that so often pass me by without a second glance. This reminder seems to have come at just the perfect time. With non-stop weekend getaways, remarkably busy week days and a tiring daily job, the constant rush has taken its toll on my body. I have felt a weariness at work this month and have found myself just wanting to climb into bed as soon as I get home. I was also plagued with the flu for a good two weeks which did nothing for my already waning attitude. God seemed to open my eyes to the wonderful and unique sensory stimuli that he provides me on a daily basis...almost as if to say “Keep the fire burning Caryn. Take time to appreciate me and the blessings with which I surround you. Relax and allow me to be your refreshment and strength.”
So this month, I’d like to take you through a normal working day out here in my rural Manguzi and maybe, just maybe, you will be able to experience a small piece of what I do every day. I’d ask you to close your eyes and just imagine all the things I describe but then you wouldn’t be able to read this – oh the joys of blogging!
I wake up to the soothing sounds of my waterfall alarm clock around 6:30 and happily hit the snooze button a few times. The duvet is hot on my skin and I can see the sun is already up and beckoning me towards a hot day, even in the middle of winter. A sharp “cock-a-doodle-doooooo” rings out as one of the many local roosters greets the morning with his usual gusto. A mother hen and her chicks can be heard just a few meters from my window as they search for food and tweet gently to themselves and each other.
I open the curtains to see two large trees standing about 10 meters away. Their roots have covered a lot of ground and I consider how many children must have played at their feet, how many nests have been built in their branches, how many health professionals they have witnessed walk past their sturdy trunks. The blaring of a TV from a nearby parkhome reminds me I am in Africa as the show is clearly a lively zulu morning programme. I shake my head in frustration, irritated that the noise is so loud and has broken the peace of the early morning natural humdrum.
I get dressed, conscious of the fact that I need to cover my body with respectful attire, but knowing that I need to stay cool enough to be able to work up close with patients for the majority of my day. 3 quarter pants, a light t-shirt and slops do the trick. A quick stop in my old, mosquito-infested bathroom to wash my face wakes me up and clears my mind of some of the dusty sleepiness that still weighs down my eyelids. I head to the kitchen for a good cup of coffee and some muesli. The kitchen is still in semi-darkness when I arrive as my other house mates have yet to surface. The back door is slightly ajar – we never lock doors in our house – maybe one of my housemates went for a run? I hope it isn’t a result of another wondering, (harmless) psych patient who has lost their way and entered our back door by mistake (yes, these things do happen!).
After a quick breakfast and time with God, I am ready for the day. I walk the 1 minute journey to our office, making sure to use all my senses this time rather than sending a few messages on my cellphone to family and friends. The first sound I hear (and now appreciate every morning) is the loud singing of school children as they start their school day. The singing is rhythmical and contagious and I can picture hundreds of children dancing and singing as they enter the school gates. The sound of a nurse leading the morning meeting outside also reaches my ears and laughter breaks out among the group – clearly a joke I missed. I notice a few patients walking up that path, one in a wheelchair, another with 2 children in tow. They must be headed to see the SASSA doctor or maybe the dental department. I smile as they pass me by and greet them happily in Zulu. “Sanbonani!” “Yebo, sawubona!” “Ninjani?” “Siyaphila, unjani ntombazan’?” “Nam, ngiyaphila.” I notice a few men working high up on a building next door. They must be re-thatching the roof. Looks like hard (and dangerous) work with very few safety measures put in place.
As I step into the therapy department I am greeted by a buzz of therapy assistants as they prepare for another busy day in the department. They all greet me, ask me how I am and we stop to chat about the new Ebola virus that they report has now entered into South Africa. We joke that it’s not long before it reaches us here in the sticks – “one of the Mozambiquean patients are bound to bring it in” someone jokes. I put my bag down at one of the desks and smell the usual strong tobacco scent wafting through the window. One of the male patients must be sitting outside on the stoop again – 2nd hand smoke anyone? They are also playing one of the new radio releases on their cellphone and I absentmindedly hum along to the familiar tune. At least someone is keeping me in the loop with what’s popular outside of the confines of the hospital! Coffee scents hit my nose as I walk through the department as various team members have walked in with steaming cups of the blissful liquid. I try to check some emails on the one computer connected to the internet during the first 30 minutes of my day but I am distracted by the various stories of people’s weekends and general hospital gossip. Laughter fills the department and I rest comfortably into my seat as I listen to the comical banter and joking that surrounds me.
Patients start to fill the therapy bench outside and soon we are into the full swing of the day. My morning is filled with smells of unchanged nappies, sweaty bodies, strong detergents and gammy CVA hands. I am drooled on by a CP child, clung to by a malnourished baby and coughed on by an old mkhulu waiting for a walking stick. I wash my hands constantly but don’t always feel completely clean. My feet are caked in a fine layer of Manguzi dust and when I take my shoes off to treat a child on the mat, my slops leave dark lines on my feet, marking the place of the shoes straps. The heat hits me in different wards, especially those that are not well ventilated. I breathe through a mask at various times of the day whenever I work with TB patients or in areas when I am likely to contract this annoyingly common disease. Sounds of therapists chatting to patients fill my ears, along with the translation of their English advice to Zulu by one of the assistants. Children cry, gogo’s moan with back pain and a teenager coughs behind a screen as he spits into a sputum cup (to be sent off for TB testing). 
By 1pm the smell of food wafting from the assistants room is all I need as a reminder that it’s time for lunch. I walk home to find my house a cool safe haven, with clean dishes and drying laundry thanks to Bridget, our maid. I find something to eat in my fridge (one of 4 in my house of 8 people) and sit at the kitchen table to chat with the other therapists about their mornings’ activities. Outside I see other doctors heading home for lunch or jumping into their cars for a quick errand. I head to my room for a quick nap and enjoy a few minutes of peace and quiet on my bed. I wake up without an alarm just before 2pm (my body appears to be programmed that way) and I collect my things to head back to the wards. As I leave the house I hear the sound of the visitors’ siren going off, signalling the beginning of the afternoon’s visiting hours. The hospital is all of a sudden flooded with relatives from near and far coming to visit their loved-ones in hospital. Now is my chance to get collateral information on some of my more difficult patients and start the process of caregiver training with those that need it. I wave and greet a variety of people as I head to the ward and stop to chat to one of the admin clerks who seems to have taken an active interest in my time here in Manguzi. She asks me about my parents and when next I will be headed to Mpumalanga to visit my fiancĂ©. We chat for a few moments before carrying on with our days. I run a dance group in MDR and move quickly onto paeds ward to educate two new mothers about malnutrition. These wards are on the other side of the hospital to the therapy department and I walk quickly to get everything done before 16:30. This doesn’t always work though.
Finally, I walk slowly home as the afternoon draws to a close and the sun sinks lower in the sky. The smell of local fires fills my nose and I smile as I notice deep orange rays filtering through the trees. I think about tomorrow – clinic day. That means a long drive to the apparent middle of nowhere where I will assess and treat difficult cases with little-to-no resources. It also means very appreciative patients, a chance to get out of the hospital environment and stop for a great “imdumbi” (locally grown corn cooked over an open braai) after the end of a long dusty day. I look forward to tomorrow. I am suddenly brought to reality with the shouts of two male psych patients as I walk past the fence towards my house. I don’t understand their babbling words and simply smile and wave. I enter my home, take a deep breath in and smile.
Life out here can sometimes be a shock to my senses, but on most days, it’s the most calming and refreshing experience in the world.
August memories:

One of the malnourished paeds patients getting a bath
Nothing like a bit local footie: Manguzi health professionals vs Manguzi Football Club
It was the month for wheelchair maintenance - hard and dirty work but by far the best way to understand how a wheelchair works (and a spanner for that matter!)
More wheelchair fixing to fill our days!
With our brand new stroke unit up and running, we took to educating patients and their families all about this condition. Here, Nonhlanhla, one of the physiotherapy assistants chats to this patient's family about what caused her stroke.
Kelly, our speech therapist, reading to little Zaida who is dressed in her newly donated dress from Westville Methodist Church.
Back to the ward we go!
It was wonderful to spend a weekend at the hospital as it gave me a chance to visit this beautiful little church with two friends from my Bible Study group. The tiny congregation was so welcoming and friendly!
August also called for a night out with the ladies in Durbs to watch Cape Town's very own Jeremy Loops
I was privileged enough to have my parents drive all the way up to visit me in Kosi Bay - what a special time it was!
Mum and dad got the opportunity to test out their new trailer-tent when we camped by Kosi Bay Mouth.

Monday 4 August 2014

Picking My Battles

God is great. He seems to be revealing his grace and beauty to me more and more. I have been so aware of the magnificent sunsets, the soft human touches and the smell of good wine and good company. I seem to feel more and more blessed the longer I stay here. God also allowed me to really experience His love this month as my boyfriend of 3 and a half years proposed to me on top of my beloved water tower right here in Manguzi! Surprise doesn’t even begin to describe how I felt, but it was such an amazing reminder that God is holding me in His hands and has a purposeful and joyful future prepared for me. To my now beloved fiancĂ©, this song is for you! No matter where you are, I’ll be there.

Moving on to my reflections as a maturing OT, this month has reminded me of a number of hard truths I’ve had to learn over the last few years as my understanding of the Christian OT role has developed: 

1) I can't save the world (as much as my heart has always wished I would). 
2) If I take the crisis out of any situation, I always find a far more rational and empowering solution than what I would have initially expected.
3) I need to pick my battles. 

I learnt the first two truths early on in my university journey - and experienced much anguish (closely followed by overwhelming relief) as a result of coming to understand them. The third one has become more and more apparent as my time in Manguzi has come along. There are times when I need to let the hardships I face each day pass me by without becoming involved or overwhelming by them. There are patients who I have treated on a superficial level and allowed to walk out the department despite the unhealed wounds they hold on the inside. While this is never an easy choice, I have learnt that in order to save myself for further service down the line, there needs to actually be a line. While God often calls me to go beyond the role of a mere occupational therapist, there are also times when I have had to step away, to let go of a situation and give it to God.

While out on one of the clinics I attend on a monthly basis, I came face to face with the reminder that I need to pick my battles. Sometimes someone else’s hardship is not for me to solve. And that is unbelievably refreshing. The extract below provides insight to my thought processes that occurred soon after an incident at the clinic this month.

Today I was defeated by bureaucracy. My tears fall hard and hot from my face as we travel away from the clinic we had been working at all day. The bumpy sand road brings out the worst of the already rickety old yellow minibus taxi as we travelled through clouds of heat, petrol and dust back to our base at the hospital. The more I think about it the harder my tears fell as my frustration within the situation overwhelms me. Thankfully my sniffing is drowned out by the laughter of the other health professionals in the bus as they chat away, relieved to see the end of the long clinic day. 

The bus driver, along with the rest of the passengers in the bus, appears unfazed by the incident that had just occurred. They have most likely become numb to the injustices of this place. Or maybe this isn’t their battle to fight. Maybe it isn’t mine either. I wonder whether they would still appear so unperturbed if it was their relative lying on the bed rather than a faceless stranger.

The clinic is situated over an hour’s drive from the hospital and involves navigating a tricky sand road along the way. As I was packing up my last therapy devices, I noticed two patients lying on nearby beds with drips in their arms. They had been waiting for an ambulance to take them to hospital all day. But the sun was soon to set and the ambulance was nowhere to be found. Naively I thought that we could just squeeze the two patients in the minibus with us on the way back to the hospital. The nurse in the opposite room was relieved by my offer as I could see she was worried about the clear lack of emergency services. 

But little did I know that taking patients in hospital cars is clearly not allowed. A simple, but undoubtedly firm "no" from the bus driver left me confused and frustrated. His explanation of "is not in my mandate" or something similar, left me oddly stunned as this was not the first time this week that I  had encountered similar sentiments by other people working within the hospital context. I told him I will make some calls to his superiors and others in positions of power but he seemed unperturbed by my threats. Clearly this was a rule and not one I was going to get around today. I returned to the eagerly waiting nurse inside the clinic. I apologised and explained the situation as angry tears filled my eyes. She comforted me sympathetically and explained that she'd had similar situations in the past. “We will just have to pray that an ambulance arrives before the patients’ conditions become critical”. Her gentle words only added fuel to the raging fire within me and despite my valiant efforts to control my emotions, the tears spilled down my hot face in front of a room full of patients still waiting to be seen by the local clinic nurse. I had been defeated. And everyone seemed okay with it. Why was the bus driver so unashamedly stubborn about this? Why did the nurse's sympathetic words sound so knowing? Why the hell was I crying? 

I guess in the back of my mind all I could think about was the oath I took as I completed university last year: an oath to serve people who needed me, to fight for justice and beneficence. Everything I promised seemed to be slipping through my hands. The weight of accessible health care rested heavily on my shoulders as I climbed wearily into the bus. Maybe I should've done more. Maybe I should have fought harder in the moment. I found myself questioning how these situations still occurred after 20 years of democracy. The disappearing clinic seemed trapped in its rural impoverished world, unaware of the riches and wealth of the politicians it voted into power. Why were the people so supportive of a party who did nothing to assist their current situation and appeared callus to their basic needs? Some days this place all makes sense to me. But today is not one of those days. 

In hindsight, the hospital’s policy is an understandable one and is underpinned by the need to keep the hospital out of tricky situations which could hinder its overall functioning and desire to help and heal. I also noticed an ambulance travelling slowly towards the clinic on my way back to the hospital (the bus driver was all too happy to point it out to me as if to remind me not to mess with a system I did not understand.) I guess all is not lost and the fact that there is so much to improve on means that I get the opportunity to be a part of a struggle far bigger than my own.  This place and its people have stolen my heart and that, undeniably, is worth fighting for.

This theme of “picking my battles” was further confirmed this month by a lesson I learnt from my Bible Study group. Over the last few weeks in Bible study, we have focused on reading a chapter a week of the first book of Timothy. This has been an enlightening time for me as I was forced to get into God's word and apply it to my current context. 

One of the many revelations I had regarded the role of family when caring for a old, sick or needy family member. 1 Timothy 5:3-4 reminds me that while the church and fellow Christians should be helping those in need, it is the role of a person's family to support and care for them prior to the person becoming the responsibility of the church. As a Christian working within this context, I have often found myself urged to go beyond the bounds of my job to assist a patient in need, to work hard at uplift the plight of the suffering and to be a light in an often difficult context. While this is often needed and even expected of us as Christians, there are times when we need to step back and allow a person's family to take their rightful place as carers for their aging gogos and mkhulus. 

The "bleeding heart" Christians, as my mum likes to call them, can actually do more harm than good. Their generous efforts to rectify what appears to them as a crisis situation often creates a sense of dependence to those in need. As an OT, I have learnt that the core of my profession is focused on enhancing, enabling and empowering people to reach their potential. Giving, doing and immobilising people in their own weakness is no way to ensure this. Sometimes I need to pick my battles and consider the way that I help someone before getting involved.

July Memories:
Engaged to the love of my life!
 A fantastic visit from two old friends from Westville. Thanks for visiting Megz and Kim!

Fun times climbing the water tower for sundowners.

The arrival of Bernie and Giles, two med students from UCT, called for a trip to Swaziland and hanging out in trees.

What a beautiful little country we have found nestled within out borders!

Mozambique & post-engagement adventures...what a fantastic group of people!

The opening of the new female ward at the hospital caused for great celebration (and photo-taking!)

Two thumbs up for the new ward!

Teaching a young caregiver how to push her Gogo through sandy areas to prepare them for their home context

A 4 month old baby in gallows traction to help the healing process of a broken femur

A creative mkhulu who used a high chair leg covered in colourful 2litre wrappers as a walking stick

Making a standing frame for a CP child out of boxes and glue

Fun in the department when one of my stroke patients decided she was too cold for rehab

Me and Mama Buthelezi, my first and favourite stroke patient!