Only a five minute drive from the boarding school where I work is a sprawling township called Zandspruit. They know very little about us and a constant sense of fear is fostered on campus about them. Most recently, protests erupted in Zandspruit because necessary services like electricity had been cut off. People took to the streets, setting tires and cars on fire. We all received intense emails warning us to take alternate routes and avoid Zandspruit all together. I was stopped on my way to the grocery store by a police barricade. This is the kind of message we are sent about our neighbors and I find it disheartening.
This sinking feeling of othering and distancing that starts with the gated communities of Johannesburg must be broken down. So, I am looking for ways to get my students, particularly those interested in public health, off campus, which brings me to Isaac and Project Hope.
I spent almost three hours on Saturday following two Community Health Workers around the roads and gullies of Zandspruit.
The roads were unpaved and the sewage system ran between rocks and piles of garbage. Finding homes was hard. The numbering system appeared makeshift at best; graffiti letters and numbers painted onto refrigerators or prominent components of shacks. We often had the wrong phone number or address. Sometimes the patients told us that they had been transferred to the Zandspruit clinic without us knowing.
We found Isaac by accident. While looking for F45 we stumbled onto G167 and Isaac, an older man with a green t-shirt, called out to us. The homes in Zandspruit are hard to describe but this one appeared to be two rooms with a slip of a porch attached to the front. Isaac sat on a bench that took up most of the spaced provided by the tiny porch while we took his Blood Pressure and talked to him about why he had defaulted on his most recent appointment with Project Hope. I could not understand a word of the Zulu being spoken by Isaac and Genevieve, the CHW, but afterwords I gathered that Isaac had lost his health card. His BP was 180/111, which is exceptionally high. Genevieve tried to convince him to come to the clinic today as her phone began to go off. The other CHW took the call outside of the makeshift porch. Isaac refused–he had to go to Randburg today and no other explanation was given. He said he would come on Tuesday.
On the one hand, I was struck by the onus of spending hours traipsing around this township and still being unable to convince a patient of the severity of their condition. But, on the the other hand, I saw the importance of this follow-up. Isaac was on the verge of a major cardiac episode. I only hoped Genevieve’s reminder was enough.
We only found three of the ten patients we were looking for. But I was told that this was actually a pretty good number.
When we got back to Project Hope I got a full tour of the community center, Emthonjeni, which translates in Zulu to The Well or The Fountain or The Spring. The health clinic is attached to the community center and focuses on diabetes, hypertension, and sometimes HIV, pap smears and cataracts.
The center itself is beautiful and reminds me at times of Village Health Works. There is a bakery run by a few women from the surrounding area and a garden that is used to teach cooking lessons and sell healthy vegetables to the community. The Community Health Worker Program goes out into the surrounding area to hunt down hypertensive or diabetic patients who have defaulted by not showing up to their clinic appointment.
This was day one at Project Hope but my goal is to get ALA students out into the community and into the crowded streets of Zandspruit, a Classroom Without Borders. I want the health enthusiasts, of which there are quite a few, to begin to see social determinants of health and the biosocial health storm that envelops this part of the world first-hand. Only with the images of real people and the stories of real suffering in mind, can we speak meaningfully about healthcare solutions in the classroom.
As I was leaving, the program director, Maggie pulled me aside, “everyone thinks HIV is the leading killer,” she says. “But, no one talks about diabetes or hypertension, the silent killers. HIV is manageable now, you can take your pills and live with HIV for a long time but not hypertension. At least now people in the community know what hypertension is. At least now they are talking about it.”
In other words, at the heart of good health is good education and building up a vocabulary adequate to the problems at hand. I was struck by the idea “at least now people know what hypertension is.” The real injustice of building walls and borders is not access to material goods but access to information.
This piece is the first of a series as I chronicle the challenges of building a student outreach program. Stay Tuned and please leave any suggestions if you have them!