First Newsletter from Johannesburg, Nov 4, 2007

“The largest hospital in the entire Southern Hemisphere of Earth”: this is what I was first told about Baragwonath Hospital, where I now volunteer as a child psychologist ¹. I discovered Baragwonath by reading a newspaper article about staff putting newborns in cardboard boxes as they’d run out of cribs. I did some of my own investigation and learned that children with psychological problems were placed in adult psychiatric wards until late 2006. My instincts told me that I must find a way to volunteer in this establishment. I had an inclining that I would find many children in need of psychological support inside those walls.

As we drove past the security check point on my first day, I was busy trying to refrain from bopping up and down on my seat with excitement. I couldn’t believe where I was and couldn’t imagine what I would experience in just a few short minutes. My positive energy was zapped, however, when my colleague casually informed me, that six days previously a medical student had been raped adjacent to the area where we were about to park. The doctor warned me to be careful, as I stepped out of the car I couldn’t help looking behind me every few minutes, expecting to be assailed at any moment! Yeah, Joburg could be considered a tad on the dangerous side.

Bara



This is Thabo. He is 7.
Thabo spent 9 months in bara. This picture was taken at the Soweto Hospice.
If you would like to know more about his story let me know and I can send you my diary entry about him

The first patient I ever met initiated my introduction to the South African use of psychological theory as a method of explaining pain reactions in children. The patient was a fourteen year old boy who had had a burst appendix, subsequent botched surgery, which turned septic and now a he had a gaping hole in his abdomen. Obviously, the boys screaming, grinding his teeth, shivering/sweating and groaning were due to that thing, what do you call it? Mind reading... predicting the future - ah yah psychology. “It’s just cause he can see the hole, it’s all in his mind” explained the hurried doctor in the Intensive Care Unit. Tying children to beds or putting them into a completely over-drugged condition, in which all they can manage to do is sleep, drool, or sing ‘Jesus, loves me’, are also common practice here! Surprisingly enough, the doctors do listen to my medication recommendations and alternative diagnosis’s. I have been able to work with many children who have suffered from AIDS related delirium or other forms of psychosis.

South Africa - Joburg is a vivacious place - there is a lot going on, commotion and tension fill the air. The people group together, in order to achieve what they deem as fair. In the last ten years there has arisen what I consider as a “striking culture”. People strike, first it was the bus drivers; they even burned some of each other to death inside their buses. Then it was the teachers and the kids were out of school for months. Then it was the staff at the largest hospital in the Southern Hemisphere, and this resulted in the medical mismanagement and premature deaths of many patients. Kensani’s story exposed me to the deplorable effects of bureaucracy and unethical medical practices.

Kensani’s Mother was referred to me for a psychological evaluation; she was having angry outbursts at nurses and people thought she was hurting her baby as she forcibly stretched the baby’s limbs and insisted on feeding the baby (she was on a nasal gastric tube). As it turned out, Kensani like most babies in the pediatric ward was HIV+, had hydrocephalous and meningitis (there is a vaccination for this!!!). She did not receive the shunt insertion operation to relieve the fluid because of the strike. Sandra observed her baby’s head grow larger as the fluid built up, worsening limb stiffness and inability to suck. What struck me about working with Sandra was how much she loved her child, how bewildered she had been when I first told her what was going on medically with her child. No one had taken the time to talk to her - it was easier to just say that the baby would be fine.

Eventually, months later she couldn’t take anymore and took her child to a traditional healer and I never heard from her again. Seventy-eight percent of the people here in South Africa believe in traditional healers and witchcraft. Sandra gave up on our western medicine and the doctors/nurses who did not communicate with her. There is a “class” component to this lack of communication: patients are often too afraid to ask questions and medical staff too important to spend a few moments of their time explaining.

Candles



Painting



Swinging

The main issue I have taken on whilst working here is the lack of stimulation that the pediatric patients have. There are no books, pictures on the wall, teddy bears, toys, pens or pencils. There is an occasional TV displaying local soaps that the staff enjoys. I never see any of the staff interact with the children unless it’s to perform a medical procedure, cleaning the windows numerous times per day is much more important than holding a frightened and lonely child in your arms. Some of the patients are here for extended periods of time (6-9 months) without their parents, many are orphans. More often then not, my eyes are bombarded with images of children losing the desire to live. Most of my referrals are made by frustrated doctors who are concerned that their patients have lost the will to keep up the battle. Yes, I know that there are too many patients and not enough medical personnel. However, I still believe in compassion and a calling to care and not just physically but psychologically and spiritually as well. In this culture, where children are not a priority, many people think I am weird as I enjoy playing and talking with children more then with most of the adults! “Why would you want to play with a child? Don’t worry about educating or stimulating the child whilst he is in hospital, he can go to school once he gets better.” These are some of the statements that I’ve been told. I wish it were true, that the sick children will get better and go to school, but the reality is such that most of these children have chronic and terminal illness, being in hospital IS their life. Most of the children I have been with are in the last stages of AIDS and I feel that it is imperative to give them the best quality of life before they pass on. So many of the children I have met crave affection: for their hand to be held, a chest to snuggle into, to be read a story - ANYTHING!

This is why I have started a special project in which two days a week I have created a “daycare” away from the hospital at Soweto Hospice ² . Whisking the kids away from Bara every Tuesday and Thursday is just as exciting for me as it is for my little friends. I along with my best friend here, who is a volunteer teacher in Waldorf pedagogy, work with groups of 10-12 pediatric oncology patients and HIV+ children-many are in the terminal stages of their illnesses. I have been provided a huge room, which we have decorated and filled with wonderful toys and books, it has even got a spa that a local company donated to me. Inside our haven, we bake, do arts and crafts, read books, in a dollhouse the children can go inside (Helga and I built it ourselves). We sing songs, eat healthy foods and engage in other non-directive psychological practices aimed at making each child feel that he/she is special and loved.

It is my hope that one day in the near future, children can be a priority in this culture.

Simone



Kahiso - wearing my glasses. His last dream was to have a lion mask, he wanted to wear it for his mother.