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.