My Community Service Adventure Begins!

I have now been in Ingwavuma, Kwazulu Natal, South Africa for one week; 8 days to be precise, and have finished my first week  as the Community Service Occupational Therapist at Mosvold Hospital. I decided to write this blog because I wanted to give friends at home an opportunity to hear about what I am experiencing, but also because I want to document my time here and the adventure it is sure to be. For this first blog entry, I’m going to give an introduction to my placement here at Mosvold Hospital and describe my first impressions of Ingwavuma… Read on further through the mundane explanations for some funny stories from my first week of work at a rural hospital!

What am I here for??

I ask myself that sometimes :) South Africa has a system whereby all newly qualified health professionals are required to work at a government hospital (with a pretty good salary) for 1 full year before being allowed to practice in the country. This is called Community Service (comm serv). Or, according to some of my friends, TORTURE! The problem is that we do not have very much control over where we are sent. Many people are sent far away from family and friends, to unfamiliar and (often rural) places where there are many challenges; culturally, occupationally, socially, emotionally and spiritually. Feelings of isolation and loneliness can make it a very difficult time. Most people seem to have an overall positive experience and learn a lot, and a number of people choose to stay on to work for another year or two at the hospital where they were placed for comm serv. 

Personally, I have looked forward to this year since I first knew about it. I saw it as an adventure; an opportunity to experience things that I have only heard about before. I’ve always felt a yearning to go to a rural place for this year, learn to speak an “African” language more fluently if possible, challenge myself as an Occupational Therapist, live in beautiful and unfamiliar natural surroundings, learn to be independent, and make lots of new friends. I saw it as a time when God would decide where to send me, and I could open myself to being used by Him in a whole new way. I knew that there would be challenges and it would certainly not all be fun, but I was keen for the experience. For these reasons, when I had to send in my community service application with 5 different choices of hospitals in the country, 4 out of 5 of the hospitals I wrote down were rural places that were far away from home. Mosvold Hospital was not one of them, but I was very happy when I heard I was placed here. My contract is from the 3^rd of January to the 31^st December 2012.

Ingwavuma, in the heart of Zululand

Mosvold Hospital is in Ingwavuma, a small rural town in the Lebombo mountains, on a road studded by potholes and surrounded by cows. There is an amazing view of Swaziland on the one side, and of a beautiful valley on the other side. People seem to be very friendly here, and it is incredibly beautiful. Being up in the mountains, it is lush and green in the summertime, and significantly cooler than the villages we drove through to get here. The lifestyle is laid-back and there is time to relax.There are very few “white” people that live in this area, and it seems that the majority that are here live on the hospital premises and work in Mosvold Hospital. Some others work in the school, and there is steady trickle of volunteers or elective students from other countries coming for the African experience. 

In terms of civilization, there is a Spar Supa-trader grocery store, a Pep clothing/general store, a building supplies shop, some Chinese shops, a Post Office, Police Station and some road-side stalls. Even these shops are quite different to the equivalents back home in Cape Town. A prime example is the Spar frozen meat section. In Cape Town (well at least in Bergvliet) we do not have pig’s heads and chicken feet chilling in the freezers!! The cell phone and internet reception at the hospital is very good (thank-you Jesus!). Other than that it is quite far away from conveniences; it is a 90 minute drive to Pongola, where there are a few more shops and a Standard Bank. The beach and swimming pools are far away which is an adjustment in this heat, but there are some non-Zulu people who have settled in Ingwavuma permanently and have been here for many years which is encouraging to me because they seem to love it here. 

Mosvold Hospital

Mosvold is a 240 bed district hospital with 10 clinics that it services. The doctors are generally from cities in other parts of South Africa or from overseas, the therapy department mostly consists of community service therapists or those who have stayed after comm serv, and many of the other hospital workers are from Ingwavuma or surrounding areas. From what I can work out, the hospital has a fund called “Friends of Mosvold Hospital” that give bursaries to people from Ingwavuma who study medicine or health sciences, and these bursary holders have to work at the hospital during their holidays, for their community service year, and for 2 years after comm serv.

At the moment there is a major shortage of doctors at the hospital (only 4) and doctors are appearing from surrounding areas for a few days every week to lighten the load. There are many other positions in the hospital that are not filled, and the therapy department is lacking a head physiotherapist (who would be my supervisor). There is one permanent Occupational Therapist (Toks) and one permanent physiotherapist (BJ) who are both bursary holders from “Friends of Mosvold”. The two dieticians are returning in the next few days, and there is currently no Audiologist or Speech Therapist, a big challenge for the therapy department. Contrary to my expectations, there are only 2 Community Service placements here at the moment – Tracey the physiotherapist (my housemate), and me. Most of the English-speaking people working at the hospital have families and are in a different life-stage to us, so we are hoping that some other young single people will come to the hospital soon.

Adjusting to work at the hospital has been a big challenge for me this past week. I will paste here the letter I wrote to Ruresa, a Google group that has been started for rural therapists in South Africa:

 I have officially completed my first week as the community service Occupational Therapist at Mosvold hospital in KZN. Wow, what a challenge! I am generally an adventurous person and tend to feel quite confident in my ability to meet the challenges that life brings, but I certainly did not feel competent this week. Having never worked in a hospital setting before (somehow all my blocks as a student were in schools, community, rehab centres or an old age home), I did not feel at all prepared for the job when I saw what I needed to do here. I cannot speak to or understand my patients so assessment is very difficult, I don't yet know the hospital system and how things are done here, I have to work out how to carry out treatment that I last heard about in a lecture in 3rd year, and there is little structure for assessment or note-taking which I am not used to at all. Let's just say that I felt a bit incompetent at first! Having said this, I must also add that I am quite excited about the possibilities. There is a lot of room for learning, for improving my skills, and for helping a lot of people. If I set my mind to it, I'm sure I will learn a fair bit of Zulu, and before long I will be far more confident in my own abilities. I just need to get over the initial shock :) 

On the positive side, people are friendly here, my accommodation is reasonable, there are many beautiful places to visit on the week-ends, and there are plenty of funny stories to tickle my funny-bone. I have already seen a CVA gogo [translation for blog: old woman] who tried to bite the physio’s finger, another gogo in the corner of the ward who's diagnosis we (therapists) don't even know because she became so aggressive when we tried to take her file off her lap, I have heard ridiculous stories about psych patients, and seen more shameless nakedness than ever before! [The women here do not like to expose their knees, but they will lie topless in their hospital beds without any embarrassment.]

Another funny story from this week:

Tracey’s (comm serv physiotherapist, remember?) speaking voice is in the lower alto range. When my mom and I met her back in Cape Town, one of the first things we noticed about her was her low voice. Now on Thursday, Tracey was sorting out some paperwork at the HR office, and after she had said something to one of the people there, a Zulu man who works in HR walked up to Tracey and said in the typical Zulu accent: “Ooooo, your voice… your father’s hormones, they are STRRONG!” Waha!!  

Working with people from a rural African culture is quite different here. I have had a lot of experience working with people of other cultures in Cape Town, in the informal settlements I worked in such as Gugulethu and Khayelitsha, and in Malawi when I went on elective there last year, but it is a completely different story when you are living “in the middle of nowhere” and you live amongst the people. Well… we actually live quite separately from the people here on the hospital premises, but it is certainly very isolated from the life I have known before, with many people of my culture to socialise with and the comforts of city life so easily available. So far I have found that a sense of humour is a major part of what keeps you going, keeps you feeling positive, or sometimes just keeps you from feeling like you might go insane! [Haha, that’s quite dramatic I know, and I’m only in my first week, but I’ll keep you posted!] A major part of our humour so far has been aided by our great friend, Trevor Noah the comedian. Giggling at the differences in culture and enjoying the craziness of some of the things we see on a daily basis really helps. So far I’ve only seen one of Trevor’s shows, but I’ve heard him quoted so much by Tracey and Kath (the 2011 comm serv physio who left this morning) that he feels like an old familiar friend!

My Little Cardboard Home

When I first arrived at my house here on the hospital premises, I had a good chuckle. My friend Robs (working at Bethesda hospital) had teased me that I would end up in a park home like the one we saw on the Mosvold website… and we hadn’t liked the looks of them! Well, Robs can laugh at me now because I ended up in park home 118, a little house that seems to be made from cardboard. The bathroom seems like it belongs in the inside of a caravan, and the floors make quite a noise when I stomp across the house (sorry Tracey!), but apart from that it is actually pretty decent. Tracey and I have a 3 bedroom place to ourselves, there is air conditioning in the lounge (a big blessing!) and it was fully furnished… well, mostly furnished. My little room has been decorated as well as I can with the possessions I brought with me, and my keyboard is set up on the one side of the room which makes me very happy. I’ve been a bit hesitant to play and sing because this house is certainly not sound proof and I know that the noise will carry to all the surrounding houses so I’ve actually only played/sang once since I arrived here… I went around asking for other places to practice and there are other possibilities such as the chapel on hospital grounds, the therapy department after hours etc., but my keyboard is heavy and I would like to be able to practice on a daily basis. When I’m finished writing this blog post I’m going to brave the embarrassment and give it another try!

A Church with a View

I went to church here for the second time this morning. I can’t remember the name of the church, but it is an English-Zulu church where everything is translated sentence-by-sentence. The majority of the church is Zulu-speaking local people, with more than half the congregation being children and youth. The pastor is English-speaking, and the worship songs are a mixture of Zulu songs and more contemporary worship songs that I’m used to from home, so it is a lovely mixture between familiar and stretching my comfort zone, which I’m excited about. The people there are really friendly and I already feel like it’s my home church. When I arrived today at church on my own I was feeling quite sad and missing my family/friends back home, but the children remembered me from last week and about 4 little girls surrounded me and kept me company :) I also met some more of the adults and said hello to those I met last week, trying to remember people’s names. I found the service really encouraging, although I had to choke back tears a few times… Isn’t God amazing in the way that He speaks to us just when we need to hear from Him? The worship songs and the message reminded me that God is still with me even when I feel far away from home, and I must keep on honouring Him through what I do. I want my life to reflect Jesus, and this year away from home familiarities is a good time to practice being faithful to what God wants me to do, and trusting that He know His plans for me; plans to bless me and to bless others through me. I’m glad I can rest in the knowledge that He is the one that chose to send me to Ingwavuma! He knows what He is doing, that much I know for certain. 

Week-ends in Zululand and Beyond

On Friday 5 of us from the hospital went to Kosi Bay, stayed one night at a little lodge there and went to the beach for the day. The walk to the beach made me a bit hot and bothered, but when we got there it was stunning!! Once you’ve hopped across the blistering sand, the sea is a beautiful blue. Kath, Tracey and I went for a walk on the beach, and it felt like we were walking along untouched sands. There were lots of crabs scuttling across the beach, and Tracey and Kath were determined to catch one. The crabs are very sneaky, though! They liked to run into the water when you run towards them, and swim away without looking back. We tried to herd them away from the waves but it wasn’t very successful. They also had a habit of hanging out right next to their little holes in the sand, and as you tiptoe closer they disappear into the ground leaving you frustrated! I took quite a few videos of Tracey and Kath pouncing on the holes and digging like little doggies urgently looking for a bone. They carried on trying for over half an hour, without success. It was really funny to watch them getting super frustrated, but Tracey just became more and more determined to catch one. Eventually we found one (probably a Gogo crab) that we managed to outsmart. With our powers combined, the three of us cornered the crab, threw sand on top of it, and felt very proud of ourselves when we picked up the little crab and posed for a photo! I think the guy fishing nearby may have been quite confused by the sight of us pouncing on the sand… he was probably very entertained :)

A Big Adjustment

I’m missing my family. It’s strange to be so far away! I’m so glad I’ve come here and I’m looking forward to what the year will bring, but it’s not an easy adjustment in the beginning. I miss my friends, my church back at home, being able to sing without feeling like someone is listening or I’m being a bother, going to a sokkie on a Friday night… I miss my uncapped internet and the comforts of home, our pets, the Cape Town ‘vibe’, knowing people everywhere I go, being surrounded by others of a similar background, and the familiarity of beautiful Bergvliet. I can see that I will adapt soon enough though, and I will enjoy the chilled life here. I will come to love the people with their quirks and the richness of their culture, the family of medical staff at the hospital, and the difference I’ll be able to make in people’s life if I strive to do my work to the best of my ability. I will commit this year to God, trusting that He will lead me through this time and draw me closer to Him, making me more into the person He created me to be. I will trust that His plan is the best thing for me, and that right here where He wants me to be is the best possible place for me!