Phepelani sesame

Date: 11 June 2006 Town: Prieska Province: Northern Cape The Journey from Norvalspont to Prieska was tough with long roads and no change in scenery. It was eerie how the flat the landscape was. The roads all throughout have been surprisingly good, with minor potholes being the only flaw. We arrived at the train exactly on time, even after getting lost in colesberg and adding an extra 100 odd km’s to the journey. Hopefully we did Rhodes proud by being the only people to reach the train on time. The town is small but neat; most of the residential roads are dirt with the main road being tarred. There are three banks, one church, a Pep store, a Jet store and a Chinese shop. The staff are all very friendly, especially the security and the hotel students who have been here for 6 months already. The organization and running of the train is done by a select few people; Dr. Lillian Cinca being quite a hands on person does most of the management of the train and is surprisingly famous too! We met Lizzy our Pharmacist who gave us the “low-down” on how to counsel patients and where everything was in the pharmacy. Supper was good, with wholesome meat and veggies. Ant sampled the dessert and said it was “sweeeeeeet!” We were approached by the University of Pretoria’s Dentistry students who set about interrogating us about what Pharmacy was all about and how Rhodes life is. We were pronounced academics and told that we were destined to become lecturers…nah!! Date: 12 June 2006 We woke up before dawn, not an easy thing for me. It was made easier by the fact that I hadn’t really gone to sleep. The top bunk is very narrow and I was sure I would fall off. Wake up call was at 06h30 and was beautifully done with music and a good morning in just about every language imaginable. Breakfast was amazing, the eggs and bacon were even prepared in olive oil! I filled myself up with muesli thinking things would get busy and I’d be very hungry by lunch. Things picked up in the pharmacy at around 10h00 with the scripts coming in at a manageable pace. The pharmacist in charge dispensed the first 5 and let us take over after we had a good grasp on how it was to be done. The patients were friendly and grateful to us for coming; they mainly speak Afrikaans with the occasional Xhosa speaking person in between. At lunch time we were surprised with yet another cooked meal, I think by the time I leave I am going to be a few sizes bigger. We finished for the day at 16h30 after capturing all the data on the computer. I learned how to use unisolv software, how to counsel in Afrikaans, and just how impractical most drug regimens are – many important “rules” could not be advocated as the patient’s literacy levels were just too low and we had to make things as simple as possible. We even risk disulfiram reactions with metronidazole and alcohol containing cough mixtures because one cannot expect the patient to understand how to space the drug ingestion. Supper was again wonderful; we had veggies and roast beef. Ant said the pudding was great – this time it was a strawberry pudding with custard. Today was hard because of the knowledge that these people only get this kind of service every two years. I saw a child with the worst case of shingles I have ever seen, all over the side of her face. I couldn’t believe it had been allowed to get so bad. Today was fun because I knew we could help many of the people. It was also great interacting with the other students. The dentists are the most sociable with the nurses coming in a close second. Still I have had no interaction with any psychology students and the optometrists are a little snooty. We ended up talking shop for most of the evening, discussing all the different dental diseases, surgery, anesthetics, muscle relaxant etc. Exams came up and we were glad to report that ours were mostly over, with only the SAPC exam to write. I expect a busy day tomorrow with many new challenges. Date: 13 June 2006 This morning wake up call was just music this time, which meant, of course, that I slept right through it. Ant and I managed to get the air con working so our cabin was snug and warm the whole night making for peaceful sleep. I went to breakfast around seven and ate some honey muesli, yum! The pharmacist, Lizzy expected a busy day but still the people only came in dribs and drabs. Dr Cinca came to tell us that this was new for Phelophepa to have so few patients and she was going to go out and find the gogo’s and the oupa’s and bring them to the train. We saw many patients with UTI’s, STI’s and gogo’s with PID. Lunch was fish and chips which everyone seemed to enjoy. The only thing is the lunch hour is the only part of the day that goes quickly The afternoon went on as the morning had, very slowly. We counted pills, captured data on the computer and saw to the few patients that came. We finished at around 16h00 and made our way back to the student’s coach for some socializing. Supper was great as usual; I’m going to get fat on this train. Today was hard because we were bored and in a confined space with six people who had not a whole lot to do except get in each other’s way. Today was easy because there wasn’t much work and the patients that we saw were relatively healthy. Today was fun because I got to see some of the kiddies with their new glasses; they are so adorable with the huge frames looking comical on such little faces. It’s good to know the children may now find learning easier and will not be mistaken for stupid just because they can’t see. Date: 14 June 2006 The morning was great; we were again motivated by Dr. Cinca in more languages than I can count. We had a morning workshop with the local home-care givers and herbalists. They were genuinely eager to learn and I really felt we were able to give some of our knowledge for the first time. The workshop was only meant to be about and hour, but we stayed for two and a half and enjoyed it thoroughly. When we returned to the pharmacy patients were starting to form queues which promised some work for us. We spent the rest of the day counseling and data capturing. I learned that my Afrikaans is not as bad as I thought, and I felt quite proud of myself because the people seemed to understand. I spoke slowly to the gogo’s and oupa’s and made them repeat everything back to me. It was very rewarding and I really pray they take their antibiotics properly. After a long day we still had stock to unpack and the pharmacy to clean, but it went quite quickly and Lizzy remarked that Ant and I would be excellent in a clearance department, wasting no time in packing away so that we could go off for the night. I am pleased that the pharmacy is so clean. Many retail pharmacies are so dusty and dirty, especially the cupboards, but this train is sparkling. There are many things I have come across that are not ideal, such as counseling from behind iron bars; having huge families gather round to hear about gogo’s medication or meneer’s erectile dysfunction; the overuse of antibiotics and seemingly reckless abandon with which some drugs are prescribed. But overall I see the good far outweighing the bad. I feel a better computer programme could be utilized, and training of pharmacists in its use is essential. Date: 15 June 2006 This morning I awoke earlier than yesterday as I wanted to take photographs of the sunrise. Breakfast was swallowed quickly and I was out onto the platform trying to take the best photo’s I could. It was bitterly cold and the dew that settled in the dustbin black bags was steaming as shafts of the morning sun hit them. I didn’t think many people would brave this cold, and I was right, for a couple of hours nobody came. Many people remarked that the Northern Cape health services were very good and could cater for the small number of people in the area that was why they were not as eager as some people in the rest of the country to come to the train. They also seemed not to want to come unless the bus would transport them, a far cry from some areas where people apparently wake up at 04h00 to walk to the train and queue for medicine. I felt that this was a good thing; it means that at least in some parts of South Africa, people have good care, albeit modest. After lunch, when the sun was out, people appeared from the woodwork and we found a backlog of prescriptions when we re-entered the pharmacy. We ploughed through them at a rate of knots and worked like a well-oiled machine. The interpreters were almost pharmacists themselves by days end, having had to interpret the standard treatment regimen to just about everyone that came along. “Ouma moet die kursus voltooi”, “Oupa moet die sjokolade pilletjies in die oggend sluk”, “Mevrouw moet die room in die aand gebruik”. I was impressed by the interpreter’s eagerness to learn, and the accuracy of her interpretation. In previous experiences I have hated having interpreters, but this particular lady is excellent. She is a local from Prieska, as they all are, interviewed and chosen for just this week. I feel people like her should be given the chance to go further in life, perhaps this experience will initiate a great change in her life, but sadly I think it will just become a fond memory of the time she helped her community and spent some time on a medicine train. Date: 16 June 2006 Morning broke an hour after I had awoken. I was already packed and had the road ahead in my mind. This is the longest I have ever driven single handedly, roughly 1600 km. We had to work the morning and skip lunch in order to leave early enough for it to be safe. As luck would have it (thank you Murphy!) Patients were packing the platform before our breakfast was even served. The dentists were full by 07h15 and had to turn people away. I found myself getting angry, why had these people not come the first few days? Now they were not going to get treated at all and it was purely their fault. We managed to work at a fast pace and dispense, counsel and capture everything before 14h00. There were people left on the platform that couldn’t be served, but one has to pack up and leave some time. The train had to move on. It was over I drove at a steady pace through the lunar landscape, the car warmed with the afternoon sun. A cool drink was needed half way and it afforded a couple of photo-ops. The afternoon faded into evening and one of the most beautiful sunsets I have ever seen. My camera was full so I couldn’t even take photo’s…typical. We arrived at Norvalspont early in the evening and got some supper before bed. It was good to be sleeping on more than a plank and we awoke quite late. The sun was shining and it presented a good opportunity to view the !Gariep Dam and meet the local Gnu. In this case the saying “no gnu’s is good gnus” is correct as this fellow is quite aggressive, locals warn of his “wheep! wheep!” and deep grunting as a sign of anger. Of course the animal lover in me thinks he’s just lonely and his vocalizations are merely to attract attention. Poor old Gnu We finally made our way back to G-town, to civilization, and to work…oh boy!