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Monthly Archives: June 2012

More Work Photos

Here are some more photos of our workplace and the outreach clinics we travel to!

This photo is taken at the Groot Aub Outreach Clinic. This clinic doesn’t have a computer for dispensing, so all of it is done manually. The pharmacist (or pharmacy assistant or pharmacy student!) sits in this chair, greets the patient, counts the remaining pills that the patient has brought with him/her to approximate adherence,  checks the prescription in the health passport for validity, and dispenses the medication to the patient.

Below is a picture of myself with a licensed nurse (or Sister, as they are called) on the left and 2 adherence counsellors in the middle. Mom, I took this picture especially for you because I wanted to show you what the licensed nurses’ uniforms here look like. There are approximately 8000 nurses in Namibia and of these, roughly 3000 are licensed and have completed 4 years of training, and the remaining 5000 are assistant nurses. The nurses wear shoulder badges, as seen here.

Here’s a picture of me at the KHC holding a VERY cute baby who was in the queue with her mother to see the doctor.

This is a picture of one of our dear co-workers, Anastasia, and I on lunch break at the KHC! Together Anastasia and I love singing out loud to Lady Antebellum’s “Just a Kiss” while we’re not busy at work.

Here is a photo of the road to Dordabis, the furthest of the outreach clinics the KHC services. Dordabis is a very remote village, consisting of a health clinic, a house for the nurse to stay at, a police station, a gas station and general store all in one, and a Telecom office.

 

Arriving in Dordabis:

The health clinic plus nurse’s house:

The Dordabis health clinic pharmacy:

-ERIN

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Posted by on June 30, 2012 in Uncategorized

 

KHC and a Bit About Healthcare in Namibia

Erin and I started working at the Katutura Health Clinic (KHC) on Tuesday, May 29th. We work from 8AM (on Wednesdays and Fridays) or 9AM (on Mondays, Tuesdays and Thursdays) to 4PM, five days a week.

Linda in the Pharmacy

We work early on Wednesdays and Fridays because those are the outreach clinic days.

On Wednesdays we travel about 30 minutes to a clinic in a very underprivileged area called Otjomuise. People live in tin and aluminum houses and there are very few places with water service. There are a few public toilets and some public taps, but not enough to be considered acceptable, let alone sanitary.

Otjomuise from the MOHSS (Ministry of Health and Social Services) Truck

Otjomuise pharmacy

Friday’s outreach locations alternate between two locations, the furthest of which is Dordabis. I haven’t been to Dordabis yet, but I’ve been to the other clinic once. There I met a man who travels two hours on a cart pulled by donkeys to get to the clinic for his medicines every month. He looked kind of intimidating at first but he had some of the most beautiful eyes I’ve ever seen. He just lit up when I tried to talk to him in Oshiwambo. I don’t mean that to sound corny, but I think it reflects how there are so many hardships here, but then, almost unexpectedly, you get to see this beauty and the friendliness in the nature of Namibian people. It’s really amazing. The short conversation we carried still stands out to me.

On Monday, May 28th, before we started our placement at KHC, we had an orientation session that was led by the Dean of Nursing and Public Health at UNAM (University of Namibia). Between that and the first hand experience we’ve gained over the past month, I think that we’ve acquired a decent amount of understanding of healthcare in Namibia.

There are a few insights that I feel qualified enough to lend, but I am strictly speaking from my limited experience, within the context of KHC and the experiences of my fellow volunteers.

Here are some of the biggest differences I’ve seen between pharmacy in Canada and pharmacy in Namibia:

1. Health Passports

Remember the E-health scandal? Well Namibia has a health record. It’s definitely not state-of-the-art but it’s a lot less expensive than the consulting firms McGuinty hired!

All Namibians have health passports. It’s a paper booklet that patients take to every health-related centre that they go to. Their patient history and notes are all recorded in this booklet that the patients keep and carry around. They are fairly small paper booklets, and once one has run out of fresh pages, the patient is issued a new one to attach to the old one (with staples, tape, stickers, etc.). A lot of these booklets come in to the pharmacy in tatters or with questionable stains on them, but for the most part they are very legible and pretty easy to use.

Other challenge with these booklets are when patients lose them or don’t bring in the older parts of their health passport. Overall though, I am honestly surprised at how few patients present with these problems!

At KHC all of the follow up blood, doctor, counselor, and pharmacy dates are hand written at the end or within the patient notes. Erin and I have seen patients that have missed their follow-up appointments simply because they cannot locate the date within the notes. In response to this Erin and I have developed an idea for a stamp system. Erin had made a template for a stamp that has a symbol representing the service (a bottle of pills for pharmacy, a stethoscope for doctor’s appointments, etc.) and a box beside it. The healthcare provider would stamp the passport and write the follow-up date in the box to make the dates stand out for the patient.

Another project we will run is an evaluation of patient wait times. There was a survey and subsequent changes made at KHC to improve patient wait times at some point in the past, but there have been no follow-up evaluations of said changes. Erin and I will survey the changes in wait times and do an initial evaluation of our date stamp project.

2. FREE HIV Care

approximately/maximum 1 week's supply of two main mediciations (combined, they are first line therapy for ARV nieve adults)

In some ways HIV patients are getting better health care in Namibia than those that are not HIV positive. That is a very bold statement to make, and a controversial one at that. So I’ll take this time to reiterate that I am speaking from a very limited context, although I stand by what I’m typing here.

All HIV-related services are FREE in Namibia. All testing, doctor appointments, MEDICINES (this is especially different from Canada where HIV medications can lead to catastrophic drug costs among HIV positive Canadians), are completely free.

The free medicines were initially provided by the Global Fund and PEPFAR, but recently they withdrew their financial and/or medication donations (more information to come). Now the government of Namibia provides the funding for all ARV (antiretroviral) medicines.

They even provide free condoms (both male and female condoms).

One really funny experience I had at the beginning of my placement started when we first toured the KHC facilities. There’s our ARV clinic (meaning it’s an AIDS clinic with a very limited scope of medications), and a sister clinic in the building next door that has a full pharmacy. When we were visiting the other pharmacy I saw all of these orange boxes that were labeled “Smile!” and there was a picture of a smile on it. I pointed them out to Erin and was like: “Wow! Check it out – they must be as in to teeth whitening as we are back home! It’s weird that those are in the pharmacy though…” and then we shrugged it off and continued with the tour.

(I’ll get a picture of the boxes asap)

Turns out that those boxes are full of free condoms!! So not quite the smile I originally thought they were referring to!!

Smile condoms are free for everyone. Each individual box comes with three “dotted” condoms (which means studded). Pretty fancy for free condoms if you ask me, but I maybe that’s where they get their name from? I don’t know! Either way, it’s made counseling patients to use condoms a lot easier!

Speaking of recommending condoms!

As I mentioned, I’ve been learning some Oshiwambo. That’s the most common language among dark skinned people, and has been immensely beneficial to my counseling at KHC. I recently learned how to say (what I thought was) “Use condoms every time”. Every time I speak Oshiwambo the first response I get is either a look of shock and surprise or laughter. So when patients were laughing while picking up their smiles, I figured it was because I was speaking Oshiwambo unexpectedly. It wasn’t until my boss, the Zambian pharmacist, Ms. Kunda said “who taught Amber these condom words?” that I realized something might be wrong. In fact I had been telling patients to “use condoms EVERY DAY”, all day! No wonder they were taking so many boxes of smiles!!

3. Pharmacy VS. Counseling

The last thing I’ll touch on here is a bit more of a negative. In Canada we’re taught to have a dialogue with patients. We are expected to verify that the medication prescribed is the best medicine for the patient and then tell patients what they can expect from said medicine, how best to take it, what the potential side effects are, and how best to manage them. In Namibia, pharmacy is still very much a dispensing process. Patient education is left to counselors and is done in another room with little record of what was discussed.

At first I really hated this because dispensing, while it is very important, is a task that is being shifted more to registered pharmacy technicians in Canada. It is less in my scope of education and practice as a future pharmacist in Canada. Interestingly, pharmacy assistants (PAs – similar to pharmacy technicians) can dispense independently here.  In fact there are full days when the pharmacist is away. This is actually kind of scary. PAs and pharmacists don’t have to sign or keep a record of their dispensing. Everything is documented in the heath passport, but accountability is rather low. Furthermore, there are no double checks. One single person will handle the full dispensing process. I say this is scary because these are circumstances that can easily lead to errors! Erin and I are trying to brainstorm ways to enforce double checks, but the workflow seems so entrenched and there are so many patients that need to be seen, that it’s difficult to think up a solution/have a conversation about implementing procedural changes at the clinic.

As for the counseling vs. dispensing in pharmacy practice, I have overcome this challenge by being stubborn and counseling anyway. I think that, for the most part, patients are able to understand my English or Oshiwambo. I hope that they take what I say seriously because I am a very different source of information, compared to what they are used to. Erin and I are the only white people in the pharmacy, and so we’ve become a bit of an attraction to some patients. We’ve also made a big effort to reinforce that patients are welcome to ask questions. Healthcare at KHC is still very paternalistic compared to practice in Canada, and hopefully Erin and I will help give patients the confidence they need to start dialogues with their regular health care providers.

Anastasia (a PA and coworker), two new little friends, and I at Otjomuise clinic - waiting for the driver

 
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Posted by on June 29, 2012 in Uncategorized

 

More Kapana Photos!

Warning for Hana (my youngest sister): the following contains graphic images of raw slabs of slaughtered animal and are not to be viewed unless you are in the presence of others willing to take care of you in the event of a vasovagal episode.

For all others: you’ll probably be okay.

Just to explain: I’m laughing WITH Hana, not at her. While Hana has quite a few embarrassing fainting stories under her belt, I have my own fair share of them, so I can’t make fun of her.

Amber did a GREAT job explaining the kapana experience to you all, but here are a few more photos of our first time eating kapana at Single Quarters Market in Katutura. Our fellow colleagues at work were more than excited to take us for kapana at lunch one day. Being a rather picky meat eater (I like my plain boneless, skinless chicken breasts), I found that although I loved the experience, the food (well, the meat – I enjoyed the Ovambo bread and tomato and onion salad) wasn’t necessarily my cup of tea.

I’ll share with you one of my encounters with one of the vendors. On the little grills (some of which are balanced on top of old grocery carts), the vendors cook literally EVERY cut of meat possible. Strips of the ENTIRE animals are used, and I am NOT exaggerating.  As Amber said, the vendors offer customers small pieces of their meat to sample before buying and are eager to have a customer claim that their meat is the best meat. While I was being offered samples, I would often ask what part of the animal the piece came from. I would point at a bunch of different cuts, and had so far seen liver, kidney, and intestines being grilled up. One particular piece I was pointing to was a long organ and it didn’t look too familiar to me. When I asked what it was, the vendor said he couldn’t remember the word in English, but it was “something like p-p-panus maybe?” Horrified at the idea that I was about to sample some cow penis, I politely declined and moved on to the next vendor.

However, I’ll have you all know that I was VERY relieved to find out from one of the nurses who was with us that the vendor was grilling PANCREAS, not PENIS. Gotta love that panus meat!

.Below: myself with George (in red) and Bryan, two of my co-workers from the KHC, at Single Quarters Market.

Below: one vendor prepares our tomato and onion salad with lightning-fast hands!

Alas, the MEAT!

-ERIN

 
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Posted by on June 27, 2012 in Uncategorized

 

MEAT.

One thing that I’ve heard about since arriving in South Africa is how Namibians are known for meat-eating. It is the most common thing to have at a social gathering. I don’t mean ‘meat and…___’, no. There is no ‘and’. They just eat meat here. And a lot of it.

Sarah with some meat for a braai among a small gathering of friends

Those of you who know me well know that I do my upmost to eat only organic meat (save for those two chicken wing discrepancies during the 2010-2011 school year). However, I made a conscious decision to eat whatever I feel like while in South Africa and Namibia. I didn’t want to pass up on a cultural experience or delicious meal because I was being too picky. I am SO glad I’ve been traveling with this mind set!

Here is a list of reasons why:

1. Biltong

I posted about it previously. It’s SO GOOD!! Biltong is very much like beef jerky, only better! So far I’ve had beef, kudu and ostrich biltong, and I would rank them from best to worst in that order. I’ve been told a few times that orynx is the best biltong. I’ll have to try that next and let you know where it lands on my list of top animals for biltong.

2. Joe Beers

This section is going to be divided into a few parts because so many animals were eaten in one sitting at this restaurant!

We went to Joe Beers on our first Saturday night in Windhoek. All ten Canadians were there and it was a super fun restaurant. We were at long, wooden cafeteria-like tables, seated on wooden benches. Every one ordered a drink and got to reading the menu.

menu

We learned cool things like: “The maturity of a kudu bull can be told by its horns. Each turn in a kudu’s horns represents roughly two years of life.”

2. A) The Game Knuckle

Jordan was looking though the menu and Aaron (our coordinator) suggested that he try the Game Knuckle. No one knew what it was and Aaron isn’t the most forthcoming with information. I’m sure we all would have let the comment slide if Aaron hadn’t told Jordan that he didn’t think he could finish it in one sitting. Now, you got a taste of Jordan’s personality a little earlier, but what I don’t think is reflected is just how competitive he really is.

So – of course – Jordan ordered the Game Knuckle.

We still don’t know what meat it was or what part of the animal it was exactly (although the bone tells us it was one of the legs), but IT. WAS. HUGE.

Jordan - The Start

I can’t believe Jordan ate it ALL.

Jordan - The Finish

He actually stood up and gave a victory/thank-you speech afterwards. I don’t remember all of the people Jordan attributed to his success, but I know his Mom and Dad were part of it, as well as Aaron and his nay-saying.

2. B) Zebra

Kate and I split our meals. Here’s the zebra stake I ordered.

It was AMAZING. I don’t know whether or not I feel bad saying that, but it was SO GOOD. The only thing I can use to describe it is that the texture was most comparable to pork chops. But even then…

Zebra

2. C) Kabobs

Kabobs!

Also delicious! From the top of the kabob, that’s corn, ostrich, crocodile, beef, zebra, green pepper, onion, kudu, chicken (I’m pretty sure).

Ostrich tastes surprisingly like beef and crocodile is fishy but as a little bounce to it while you’re chewing.

3. KAPANA!!!

Kapana is so fun!

Have you ever gone to an open meat market somewhere South of the US border? If you’re nodding ‘yes’, then it’s likely to remember the heat and the flies… Kapana is just like that.

There are flats of dismembered and uncooked cow parts out and by the grills. Each grill operator has what I would call a table to store their uncooked meat.

When the meat is cooked it’s grilled on an open air barbeque (which is called a ‘braai’ here). There are containers of some sort – usually the bottoms of cardboard boxes – that hold spices and salt.

When you walk through, the cooks will call you over and offer you a sample of their meat. They’ll cut you a little cube of meat and you pick it up, with your fingers, right off the grill. You then dip it in the spices to taste, and pop the delicious nugglet right into your mouth! If like it, you can buy more. Once you state the amount you’re willing to give, the cook will grill and cut an appropriate amount of meat. You then stand by the grill and eat it there, or they can put it onto a piece of newspaper so you can take it with you! (My mom is just cringing at this thought, because I will admit, kapana isn’t exactly known for being hygienic.)

While you’re eating your kapana, you can also have traditional Ovambo bread (sweet fresh bread), fat cakes (fried bread, kind of oily), and/or salad (finely chopped tomatoes and onions in oil and spices).

kapana

Other than all of this meat, I have been eating pretty standard meals. We shop at Pick N Pay and Fruit and Veg about once every week. My bill has never been more than 400 Namibia Dollars and I’ve been eating well. The most expensive thing is trail mix, but that’s not very different from at home. My biggest luxury food item so far has been Cadbury milk chocolate peanuts.

So that’s all I can say about eating here without getting too hungry myself!
I’m off to make some shrimp and bean salad!!

-Amber

 
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Posted by on June 26, 2012 in Uncategorized

 

Braai at Leon’s

One Wednesday night, Amber and I were invited by Leon, the coach of the Windhoek Harriers, to a family braai at his house.  We prepared a pasta, bean, and vegetable cold salad to bring along before being picked up by Leon’s son and driven to the family’s home in Hochland Park, not far from where we are staying. They have a lovely house with a very homey feel and the whole family was SO welcoming and friendly!

When we arrived, we joined Leon, his wife, his son (also Leon) and his girlfriend on their covered patio to chat while Leon was braai-ing the chicken. While waiting for dinner, we were offered some biltong to eat and sherry to sip. Braai and biltong, you ask? Yep, life is good! It was not long after the biltong came out that we were introduced to a very special member of Leon’s family: Jada! Jada is a BEAUTIFUL mixed breed dog who loves beer (yes, beer!), droewors (sort of like dried pepperoni sticks), and like any Namibian, a good braai. Jada is also incredibly smart and impressed Amber and I with her many tricks. Two of my personal favourites were ‘kom ons dans’ (rough English translation: let’s dance) and ‘moenie vat nie’ (I think this means ‘don’t touch’ or ‘leave it’). When you say ‘kom ons dans’ to Jada, she gets up on her hind legs and puts her front paws in your hands and dances with you! So cute! With ‘moenie vat nie’, Leon instructs Jada to lie down, and then places two pieces of droewors on her front paws and then says ‘moenie vat nie’. Jada then doesn’t touch the meat until she’s given permission. Super cute!  Molly (the Ready dog) – we might have to add these two tricks to your repertoire when I get home!

Check out the picture of Amber and Jada dancing:

Here is a picture of Jada looking longingly up at Leon during ‘moenie vat nie’. Note the droewors on her paws! Good Jada!

The passion Leon has for running seems to be matched by his passion for good food and company. The chicken that he cooked on the braai was delicious and it was accompanied by a potato salad, our pasta salad, and some garlic bread. For ‘pudding’ (dessert in Afrikaans), we were served homemade waffles with syrup and ice cream. Amber and I went home with full bellies and smiling faces. Leon and his wife not only sent us home with leftovers, but they also gave us some homemade breakfast rusks (a very popular food in Namibia and South Africa, kind of like biscotti) to try! Baie dankie (for all you at home that means thank you very much in Afrikaans), Leon!

Below: a photo of Leon and his outdoor braai on the patio (top) and his braai station (below) to the left of the braai. Note the ‘Moetsowees’ signs. I believe Leon says it means ‘must be that way’ in Afrikaans, but I’ll have to double check!

.

-ERIN

 
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Posted by on June 24, 2012 in Uncategorized

 

HIV Prevalance in Namibia – Some Facts and Figures

 
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Posted by on June 22, 2012 in Uncategorized

 

Jordan

Everyone but Erin and I are getting class credits for their placements here in Namibia. They have to write weekly reflections on the internship, and so I asked if they wouldn’t mind sharing them with me so I could share them with you! Now you’ll get to hear a bit about what my new friends and roommates are doing, and get to know them a little too.

Jordan is the man of the house and he’s HILARIOUS. When I’m around him, I’m easily laughing more than 80% of the time. He’s got a heart of gold and an extremely inappropriate sense of humor. He’s super loud to boot. He’s dubbed the women of the house his BABs (Bad Ass Biddies) and likes to keep tabs on us to keep us safe

The women here LOVE Jordan. Partly because he looks so foreign (i.e., white) and partly because that imparts status if they’re seen with him. I choose to share this picture of Jordan (from Lizz’s camera) because it was taken while Lizz and Jordan were at work, promoting PAY (Physically Active Youth – where they work), and it shows exactly what I mean!

Ladies Man

Below is Jordan’s first reflection, and he talks about our first week in Namibia, settling in, and his introduction to PAY. (I have truncated his reflection for the sake of the length of this post).

                As I sat awake during the night of our twenty two hour bus ride from South Africa to Namibia, I started counting how many stars in the sky I was able to see. I have never viewed the night’s sky light up by that many stars; the sky is usually overshadowed by street lights, billboards and sky risers in Toronto. I believe seeing this view was a metaphor for one of my reasons for wanting to travel to Namibia; I wanted to be able to live a more simplistic lifestyle and appreciate the smaller things in the world that make the big difference. Unfortunately, the view of that explicit evening would be the last time I would be able to accomplish that specific goal for quite some time.

                Living in Namibia thus far has not been the slightest bit of simplistic and I have been unable to fully take the time to admire all of the smaller miracles that life has to offer here. This may be the case because we have had a non-stop week filled with plenty of excitement, a plethora of knowledge and many cultural reflecting experiences.

                After riding the Double Decker bus tour in Cape Town and seeing the ghettos of town where many people live in huts with no running water and barely any living space, it is hard to cope that living in UNAM village encourages a basic style of living. I am living with five other students who are all of the opposite gender and this was a key factor I was preparing myself for. Thus far I cannot complain and actually think we are meshing well together with the help of a constant dialogue of communication, problem-solving skills such as compromising, and all of us having similar interests. Without playing up to any gender roles, I am very protective and worrisome of the whereabouts and activities of my roommates. Hochland Park, where UNAM Village is located, also known as our home, is a gated community which helps bring a sense of security in a country I am unfamiliar with.

                I personally believe it is truly sad how fast we have to depend on technology as we made sure to sort out our cell phones and internet on the first day here. When I take the time to critically think about this, I have to laugh that during my first day outside North America in a foreign country this was one of the first tasks I accomplished instead of exploring and embracing my new environment. However, since I was brought up in a Western society, I know I link these technologies to productivity, communication and safety, therefore making this a huge priority.

                Having our Visas stamped at the Eros Airport solidified that our whole group were officially in Namibia. However, the Northerners backpacks were stolen out of the car quickly after that. This rapidly made me put a halt on my “honeymoon vacation attitude” phase here.

                Keeping the “Physed Spirit” alive, working out at Nucleus Gym has become a daily occurrence for our whole household. I was personally flattered that my female roommates came to me for advice and allowed me to take a lead, facilitating a circuit workout. It was a pleasure to share the knowledge I have gained from the faculty with others from the University. Nucleus is comparable to many facilities back at home and provides us with a community atmosphere. I am creating a few friendships at the gym and it is a setting I feel extremely safe and comfortable in.

                Physical Active Youth (PAY) is the organization I am placed with; however, there has not been one day that feels like work yet! Being a CTEP student I had expectations, instructional strategies, and various learning tools prepared before even starting my placement. Most of this preparation and knowledge can be thrown out the window because the culture, effective practices, and learning styles are extremely different here. In no way, shape or form do I intend to play the fictitious “White Hero “role helping and saving the non-realistic “radicalized suffering group.” Instead, I take on the mentally of doing my part and trying to help the PAY participants like I would any student in my own classroom with a few exceptions. Unlike the Ontario Education System, PAY allows and encourages us to build friendly relationships opposed to strictly professional relationships; this specific factor is one I absolutely value. Wilhelmina, Ester, and Kayla, staff members who are all the foundation and inspiration of PAY are very young, encouraging and motivational role models who act as constant resources to both the children and me to reach any goal imaginable.

– Jordan Frost

 

 
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Posted by on June 22, 2012 in Uncategorized