Joburg!

As most of you know I’m now in Johannesburg, South Africa for my summer project.  Sadly, it’s not beautiful Cape Town.  However, the city isn’t as bad as people have made it out to be.  Yes, it does have its fair share of problems (more than others in many cases), but it’s like any other city—you need to be aware of your surroundings and act as if you belong.  The best way to describe it is like a massive, overpopulated Detroit: public transportation is either nonexistent in places or too dangerous to use, everything is rundown (but not abandoned) and could use a good scrub-down and it’s unsafe to walk around.  Many of the suburbs, i.e. Emmarentia where I am staying, are actually quite lovely.  Once you look past all of the electric fencing, high gates/walls, barbed wire and colourful signs exclaiming the security company that is protecting the premises, the houses are like those that you’d see in the States (large, with manicured lawns and large cars parked in the driveway).  For the most part, the weather has been pleasantly surprising.  Everyone keeps complaining how cold it is, but it has been hovering around the 20’s (high 60’s, low 70’s) if not warmer since I’ve gotten here.  Only one day has been cold and cloudy.  I’d kill for these winters (but not for the brownish-gray layer of smog that covers the region)!

My in-country supervisor was kind enough to allow me to stay in her cottage, which is behind her house.  As previously stated, I’m staying in the suburb of Emmarentia, which is about a 10-15min drive from my workplace in Hillbrow (the city’s centre). Apparently one of my friends from Connaught has family who lives in this suburb!  Crazy.  Anyway, it’s quite cosy—a one-bedroom room with a kitchenette and bathroom (it’s bigger than my room at Connaught and is the first time that I’ve ever had to cook for myself because I’m not living in some form of residence hall!).  It feels safe, and I’m happy with it.  Unfortunately the cottage lacks an Internet connection.  I’ve decided that I’m not going to get a wireless modem.  Getting the USB doesn’t seem to be cost effective for the short time that I’m here.  It would be nice to have the connection at home so I don’t have to spend working hours doing personal things (i.e. sending emails, video chatting on Skype or blogging), but I’ll surely be able to manage.  The Internet-free time allows me to read, finish project-related tasks, etc.  I feel rather disconnected from everyone and everything, though.   

Like all of the other areas, one can’t escape the World Cup fever (and fervour).  There are flags of all of the qualifying countries everywhere—on my supervisor’s house, along the roads, along the outside of the building where I work, under motorway bridges, etc.  A game is always on somewhere (EVERY bar and restaurant has turned on a game) and one can’t escape the random honk of a vuvuzela, the [highly irritating] plastic trumpet-like horn that sounds like a drone of bees (last Wednesday, Bafana Bafana, South Africa’s national team was playing and throughout the day the frequency of the vuvuzelas increased up until the match, while everyone was wearing the yellow with green trimmed soccer jersey and some form of the South African flag on their person—wig, scarf, face paint, etc.).  

I also like my place of work—the Reproductive Health & HIV Research Unit of the University of the Witwatersrand.  It has got a great reputation for doing world-class research and the staff is great, especially my research team!  It’s kind of odd to think that I’m in charge of a team of about five people, all of whom have been/will be helping me with things like translating surveys, accompanying me to do my interviews and facility assessments and logistical tasks like going through files.  Thanks in part to them, I have a feeling that my project will go well!

Speaking of the project, if you don’t already know:

The title is “Acyclovir for managing herpes simplex virus type 2 (HSV-2) and HIV-1 infection in South Africa: Experiences of guideline implementation by policymakers, health providers and patients” and the objectives are to:

• Understand and document clinicians’ knowledge and opinions regarding HSV-2 treatment and care, and how this outlook influences treatment practices in primary health care (PHC)/STI clinics compared to HIV treatment clinics.
• Describe and understand former randomised controlled trial participants’ experiences and attitudes toward STI and HSV-2 treatment, and their experience when trying to access acyclovir at PHC clinics.
• Understand and document experiences of policymakers in drafting and implementing the new guidelines and whether this process was influenced by the WHO guidelines on genital ulcer disease management.

The study will provide important insights into the potential challenges to policy implementation from multiple perspectives. The results are likely to be relevant for service providers and policymakers by identifying factors that may influence treatment access more generally.

I’ve been here for one week now (five to go).  During that time I’ve been meeting with my research team to establish the process by which I select the patients, healthcare providers and policymakers, as well as visited some of the clinics.  The clinics were in Orange Farm, which is a “rural area” about 30-45min drive outside of the city centre and from the RHRU offices in Hillbrow.  I’ve also been meeting the RHRU staff and going through the RCT participant records with the intention of selecting them for interview.  On Friday, I went to the Wits Human Research Ethics Committee meeting, which was reviewing my project protocol.  There were some clarification needed, so I’ll have to wait about another week until [hopefully] it is fully approved.  Mostly it has been logistical things, with little to no data collection!  Apparently research isn’t all research!    

Within the next couple of weeks I will be conducting my interviews and facility assessments.  I will be presenting my work to some of the RHRU staff and writing up the work for my thesis.  I’m also going to be able to do some shadowing as well, i.e. doing a ride-along on the RHRU-associated mobile clinic!  There are three other LSHTM students in Joburg, two of which will be working at the RHRU, so the weekends will be devoted to exploring the greater Joburg area and possibly further. 

I will try to blog about these experiences on a weekly basis.  However, as you know, I’m not the best at keeping up with this thing…so please have patience.   The slow Internet at work and absent connection at home will make it a bit more difficult to keep up. 

Last weeks in London

Hi everyone.  Sorry it’s taken me so long to post.  Things have been quite crazy lately.  Since the last post I’ve had three weeks of reading weeks in preparation for my two exam papers, which occurred on 14 and 16 June.  Each was three hours long and I had to answer four questions within that time period. 

The first paper was on my Term 1 courses: Intro to Disease Agents and Their Control, Basic Statistics and Epidemiology and Extended Epidemiology.  I chose to skip the Health Policy, Processes and Power question because I figured it’d be wise to focus on epi.  Answering a question on Basic Epi was compulsory, so I revised for three subjects instead of spreading the limited time among four different topics.   The second paper integrated all that we’ve learned over the past year, with an emphasis on infectious diseases of course.   The exams went well (or so I think/hope!). Time was of the essence for both papers, in which I had to scramble to finish my final thoughts (more so for Paper 1, even though I did four mock papers and had plenty of time for them!).  The examination conditions were uncomfortable and unpleasant, though.  We were put in a conference centre with rows and rows of desks.   Like everything in London/Britain/Europe, the space provided was extremely limited.  When we got in the room the invigilators, a bunch of old and cranky Brits, kept yelling at us that we were “in exam conditions—NO COMMUNICATING WITH YOUR NEIGHBOUR IN ANY WAY”, “TIME’S UP; WRITING UTENSILS DOWN”, etc.

It was a relief to finish the exams, which always seemed to be months away.  However, with relief came sadness as the time had come for people to start leaving (me included!).  I didn’t realise what good friends that I had made and how attached that I had become to so many people.  My Connaught Hall friends had already started to leave as their courses had finished (pretty much everyone finished before LSHTM, even the postgrads!).  By the time to sit exams came round, it was pretty much just me and the other LSHTM students.  It didn’t feel like home anymore.  I was getting sick of saying “goodbye” and became mentally ready to leave as well.  The end of the year party, which was a blast, was an excellent distraction from the thought of what was to come later on in the evening.  All good things must come to an end, though.  Laughs soon turned into tears as the final song played and we stumbled home for the last time in our separate directions.   

Although the ‘year’ together had come to an end, I wasn’t particularly depressed.  I had the strong feeling of comfort because I knew that I’d share a future rendez-vous or two with all of those people who were important to me.  Maybe I was more ready than I thought to move on to my summer project, medical school in the fall and my career/life after that, but I couldn’t wait to let these people go do and experience the wonderful things that were waiting for them.  Our chosen field of work/interest is small enough that we will surely bump into each other once again, if not more.  Each of us is a future leader in our respective public health endeavour.  The meetings, whether by chance or intention, will be due to personal reasons if not for work!

Within this time frame, both before and after exams, I had a few visitors as well.  They were able to get my mind off of the stressful and seemingly gloomy events of the first weeks of June.  A très bonne amie from Alma, Nicole, came for a day and an afternoon and so did Denise, the cute German young woman who I met on the train from Croatia to Germany, for a job interview outside of London. 


Now, I'm in Johannesburg, South Africa to complete my summer project.  More about this will be in the upcoming post (I need to take and upload some pictures for it.).  Stay tuned!