Barney The Bear

Corine got tickets for all the creche kids to see South Africa's first-ever (or fourth, depending on which sign you believe) appearance of Barney, "that purple bear," as she called him. It was at the theme park Gold Reef City, a nightmare only in that there were hundreds of other children who were pretty much completely indistinguishable from our group. It wasn't so bad at first, because all the other buses of kids unloading in the parking lot got off with standard elementary school field trip mechanisms in place, such as matching smocks, bright shirts, group leashes, or some sort of buddy system at the least. But then the generous geniuses running Gold Reef City decided to hand out white Barney t-shirts to every single child -- a perfect storm.

A major portion of the day was spent in the bathrooms. Our kids would all pee with the stalls open, and when we requested that they please wash their hands, they stood in line to be boosted to reach the soap and water, splashing and giggling and then going to the back of the line again until we caught on. Between their giddy excitement, free sugar, and overstimulation, and our not knowing or properly pronouncing their names, it was a miracle we left with all our own children. More than once throughout the day, we would spot a small quiet child waiting patiently in line with our group for a ride - a dead giveaway that she did not come from Sparrow. We would tote her around, shouting "This one's not ours," until some adults would recognize her and then scold her for their negligence. Our kids were also frustratingly fond of impulsively darting into crowds, spotting a dragon ride or bumper cars, and running for their lives.

One interesting phenomenon was that the Sparrow children seemed to have never seen real live white kids before. They have been around plenty of white adults (though they still love stroking my unfamiliar hair over and over) and watch enough American movies and television to know white kids exist. But one of my girls simply walked up to a small blond girl just her height, peered into her eyes, and then cupped her cheek in the palm of her hand. They just stood there gazing at each other, as if madly in love, until rent apart by the girl's mother, who yanked her daughter's hand and barked, "Let's go!"










At the end of the afternoon, the buses were late picking us up, and we had to kill an hour in the parking lot keeping children from flinging each other into traffic. Once the novelty of our digital cameras wore off, we let them climb all over us, do our hair, show us tricks. We led them in all the playground games we could remember, then started making them up. At one point a schism broke spontaneously into a rousing rendition of "Happy Birthday," which I somehow never recognized before as lacking both a beginning and an end.


Here is a poorly lit montage of singing and dancing:


Now watch kids go round and round on rides:

The Deep End

The kids only get to go on outings outside the orphanage if there are enough adults around to take them. In December, Corine took a small group to look at all the Christmas lights and decorations. They got so excited, they were cheering at every traffic light because they thought they were seasonal, too. As Corine put it, they don't get out much.

So we took Cluster One to a very nice public swimming pool in a nearby suburb. You know times have changed when suburban parents allow their kids to swim in a pool with 20 AIDS orphans. The pool probably knows Sparrow, and the families may or may not have recognized the van. Regardless, the kids did look like ragamuffin orphans, wearing ill-fitting “bathing costumes”, or t-shirts because they don’t own a suit. Many appear ill and almost all are underweight. And none of them could really swim.

We accompanied Caroline, a volunteer who is allergic to chlorine, and Mama Gogo, head of the cluster, who does not swim. Once we got everyone changed and were perched on the edge of the pool ready to plunge in, Gogo told us the youngest had never been swimming before. Then we asked how many others had never been swimming before, and one by one about half the group raised their hands. Some were dying of excitement to get in, while others seemed scared to death. There was a kiddie pool but the smallest ones refused to swim there, because they wanted to stay with the other children, petrified and panicked as they were. One girl, Phindile, visibly trembled with fear and clung to the wall even while obstinately refusing to get out of the pool. But by the end of the day, we got everyone in the water, everyone having fun, and everyone at least making the motions of a flutter kick.


The children's wiry delicate frames get so cold so quickly, and it was a breezy afternoon. They started shivering right away and after just 10 or 15 minutes they were climbing out one by one to lay out on the sunbaked concrete deck. They looked like turtles to me, all lined up under towels for shells, scrawny and vulnerable. When taking individual children for a "swimming lesson" across the width of the pool, you could feel the shivering of their bony bodies and the palpitations of their racing hearts -- probably equal parts cold, excitement, fear, chronic lung disease, and deconditioning.

Food For Thought

There are many fat, happy children in the HIV clinic, but there are also many sad stories. Kemi saw a 13-year-old boy who had never been told that he is HIV-positive. His parents do not believe he is old enough to know the truth, and although the legal age for disclosure here is 12 years old, the doctors have agreed to let them tell him in their own time. He has grown up thinking all his medications are just for TB. And the clinic shows no indication that it is specifically an HIV clinic, for fear of stigmatization.

I saw the young mother of a beautiful 28-month-old girl, who looks to be no more than 12 or 18 months. Her CD4 count is still relatively high (29% of expected for her age), and with that news the mother shouted for joy, "Yesss, I am doing a good job!" The problem is that the child needs to be started on antiretroviral treatment, because though she has survived this long with only treating infections such as TB and pneumonias as they arise, the sooner ART is started in children, the longer death can be delayed. Although the mother herself is HIV-positive, she is well enough to not have started treatment yet either. At the doctor's pronouncement that it was time to start her baby on ART, the mother shook her head and burst into tears. She does not want her to start treatment, because she feels her daughter is developing well without it. She is afraid because she believes the medications are poisonous for children, and says she has seen their effects with her own eyes in neighbors' children. After a bit of ineffectual back-and-forth, the doctor finally refers her to the on-site counselor who has the time to discuss all the issues with parents. It is hard to sit by and watch, because my instinct was to shake the mother to her senses and yell, "Yes, there are side effects, but the alternative is a slow, agonizing, and inevitable death for your baby." Instead I just handed her a Kleenex and patted her on the back.

There are many parents at the clinic who deny they have HIV, even if all their children have been born positive. They refuse testing or lie about having been tested in the past. Even if they take very good care of their children and stay on top of all the medications, they believe their child acquired the virus through some other means, like at the hospital or from an unknown episode of rape or sexual abuse. Although sexual assault and abuse is a frequent mode of transmission for many children, including several of the children at Sparrow, the vast majority of these cases are vertical transmission - the virus passing from an HIV-positive woman, who may or may not know her status, to her baby in utero, during birth, or while breastfeeding. Breastfeeding itself is an incredibly controversial issue, since the virus is known to be passed this way. Formula feeding in theory should prevent these cases, but formula is expensive and often inaccessible, as well as culturally unacceptable to many people. Even if the mother is willing to exclusively bottle-feed her baby, she often must breastfeed in front of her husband or mother-in-law to avoid being beaten or kicked out. And it turns out that the worst combination for infants, in terms of risk of acquiring HIV, is mixed formula and breastmilk feeding. (One theory is that early food or formula causes damage to the infant GI tract, allowing easier entry for the virus whenever the baby receives milk from the mother.)

In a lecture with a dietician, we got to see one of the food baskets that are handed out every month at the clinic. A foundation donates 100 parcels every month to the clinic to distribute to the most needy families, as determined by staff dieticians. It includes a bag each of mealie (corn flour), sugar, beans, and lentils, with four small cans of fish and two jars of a high-fat, calorie-dense, fortified powder made from peanut butter and soy. There is also ample soap and toothpaste. The food often goes to feed a family that includes not only the sick children and parents, if they are alive, but grandparents, aunts, uncles, cousins, and whoever else may be around. It is really only enough food for a few semi-nutritious meals, if that. The provincial government provides mothers of HIV-positive infants with 6 tins per month of Nestle NAN milk powder (known as “HIV formula” here), about half what is needed to feed an infant for a month. There is also a small grant provided, and there are stories of women who intentionally do not take antiretroviral medications while they are pregnant, so that their baby will be positive and they can qualify for the grant.












The South African government, specifically the current president, the health minister, and ANC president Jacob Zuma, have notorious reputations among the local and international health communities for their stances on HIV and AIDS treatment and prevention. Zuma, leading contender for the next presidency, for example, has been quoted as advising women who have been raped to take a shower afterwards in order to prevent HIV. Embattled Health Minister Manto Tshabalala-Msimang routinely advises natural foods such as garlic and lemons to prevent the development of AIDS. And Thabo Mbeki, the outgoing president, has stated that HIV is not the direct cause of AIDS. His beliefs led to the delay of the roll-out of publicly available ART for years, finally made officially available in 2004, too late for many children and adults in this country. Such attitudes are incredibly frustrating for physicians here, because many people who may not have other sources of information incorporate these stances into their belief systems, and go against the advice of their own physician or pediatrician.

Straight For The Jugular

Several days per week we attend the pediatric HIV clinic at Bara, the behemoth hospital on a former army barracks in Soweto. (See attractive exterior at left.) On Fridays there are about a dozen other medical students there, which has been very interesting for us. Med students here complain about many of the same things we do -- long hours, scut work, unfair treatment, administrative problems. The whole "Humanism in Medicine" movement has yet to evolve here, evidenced both by the students' attitudes and behaviors towards patients, and physicians' opinion and treatment of students. They definitely get a busy, hands-on experience when they rotate through this hospital, however, which cannot compare even to some of my classmates' hectic experiences at places like Harlem Hospital.

I was sitting in on a visit with a 2-year-old girl and her teenaged father. The doctor said she needed to draw blood, and one of the students I was with jumped up and said he would do it. He then asked the father to leave the room, had his classmate pin the baby down, and proceeded to draw straight from the brachial artery. I was confused because they only needed routine bloods, and he had not even attempted to look for an accessible vein (which is both safer and less painful for the patient). When I asked whether this method was routinely used, both students and teacher replied that they generally go straight for an artery in any child age 3 or younger. In fact, the physician joked that she tends to go straight for the jugular vein in this age group. Later, when Kemi and I asked the resident Sparrow physician about this, he was similarly shocked and said he always attempts a vein in the arm or hand before resorting to other routes. As I have said though, we have never seen him miss a blood draw, in any age and under any circumstances.

We have also gotten to see some of the inpatient wards, which are nothing short of heartbreaking. Each hallway contains glass-enclosed rooms with row upon row of metal cribs containing wasted, desolate, dying babies. Many young mothers were at the bedsides of the healthier children, feeding them and chatting with each other. We even saw one father playing with his infant daughter and feeding her a bottle. But in other rooms there were no parents, who likely are already dead, and the babies lay on urine-soaked cloths, ribs showing, alone and too weak to look around or even to cry.

Perhaps the most poignant moment to me was when the head clinic physician described a visit to New York City in 1998. By that time, ART was already widely available in the States. She said she looked around the clinic there and saw all these hardy, thriving kids on ART. Next I thought she was going to say how amazing it was to see the transformative effects of treatment (which routinely bring a skeletal, miserable child from the brink of death to normalcy in a matter of weeks or months). But instead she remarked simply how unfair it was -- to see the miraculous effects in these American kids, knowing what awaited her patients back at home, which was nothing. Now 10 years later, although theoretically all her patients who need treatment can get it, the complex issues of diagnosing children and getting them to start and continue proper treatment, and the prevention of mother-to-child transmission, lag maddeningly behind the capabilities of the currently available medications. Thus the cycle of death continues here seemingly unabated, even while the scourge has been all but eliminated from children in most parts of America.

As far as the famous area of Soweto, I had heard it has gone tremendous transformation over the years into a popular area of the city, with desirable residences and nightlife. We have found it to be indeed bustling and full of evidence of an active economy, but the dirt roads and tin shacks can still be seen everywhere. Certainly it has more commercial action than today's townships, with stands and stores on every corner, but it does not look like the trendy if gritty suburb I expected.

Una Mas Sweeties

The children of Sparrow eat like fiends. There is a general attempt among the staff to keep the children plump, with the intent of fostering nutritional reserves for times of illness or wasting, to stave off weight loss and failure to thrive. There is probably also an element of easy pleasing, treats being for the most part readily accessible means of enjoyment or reward for the kids. All the food is donated regularly by surrounding restaurants and grocery stores as it nears expiration. And finally, there is the perspective that in the bigger picture of these children's lives, some overfeeding and unhealthy attitudes towards food are not worth the effort to avoid, discourage, or correct.

Being orphans they just have a begging reflex, or habit. This morning I was walking with a banana and a nectarine to our car, and a group of them was playing behind a nearby fence. Even the oldest started shouting our names pleadingly, ignoring our friendly hellos and attempts to chat, saying, “Please! I want a banana. Give me fruits. I want fruits. I want sweeties. Can I have money?” Practically everyone they see hands out sweets. They are definitely not hungry because, as I have said, they are fed constantly here. And they do get fruit. It just seems that they want whatever someone else has, I guess because it is usually better than what they have.

Many children’s teeth are rotten, for lots of reasons. As we discovered, they don't always have their own toothbrushes and don't always brush their teeth. They are given candy all the time - at church, at the doctor, for being good or for being bad. They drink a Kool-Aid-like substance at every meal. Past bottle age they drink no milk. Of course it’s expensive and hard to store here. The water is not fluorinated. For any trace of calcium and other minerals, they are given Sejo as a snack, an expensive soy meal cereal, similar to Cream of Wheat but more calorie-dense. Some of their many medications also contribute to the tooth decay. They are always chewing on something, plastic objects or bits of balloon if not candy or gum. It is all in all a dental nightmare. Hence our toothbrushing campaign.

Here is a video of a trick a visitor taught the creche children one day:

Failure To Thrive

The funniest thing we have seen happened during Monday night clinic at the babies' hospice, and tragically we could not capture it on camera. The babies' hospice is where the sickest, dying infants and toddlers live out their lives, provided for by two caretakers who spend all their time making bottles and changing diapers (in only a few regimented time slots per day, regardless of need, because they're unionized). The hospice is just a small room with about 6 lead-painted cribs, 10 children, and a baby gate at the doorway. The kids range in age from newborn to 3 years old, but none of them have any real verbal skills and only one or two can walk or even stand. The others who are old enough just have not had the strength or time spent with adults needed to acquire these developmental milestones.

They are ravenous for attention and human contact, though, down to the smallest and most feeble among them. Every time someone walks by the doorway, the ones well enough to be playing on the floor (though I've only seen one toy) will rush over to the gate, crowding it and begging with their hands and eyes to be picked up and held. Some can say "ma" and repeat it over and over plaintively. If you give so much as brief eye contact to one baby, who lights up immediately, the others will hit or scratch the lucky one and attempt to push him out of the way. The acoustics in a dome are amplifying, so that if they are all crying simultaneously, the chorus of lonely unanswered misery is deafening. It is a mad, mad world.

Yet when you play or hold one of them, you discover that they can play peekaboo, or imitate words, or feed themselves with a spoon. They are loving and adorable and easily entertained. Of course, regardless of age, they will put on a heartrending stare of disbelief and bewilderment when you finally have to put them down and wave goodbye. If they are sated, they will blow you kisses in return, but more often than not you leave the overwhelmed caretakers with one more wailing baby.

ANYway, the babies' hospice is in an adjoining dome to the adults' hospice, some of whom have children (who may or may not be sick). One of the women living in the hospice has a friendly, fat little toddler named Dorris. On this particular evening, Dorris was leaning over the baby gate of the hospice, watching all the action, when she suddenly figured out how to open the gate. She gleefully swung it wide open, and instantly the gaggle of mobile babies started spilling out the door. They looked for all the world like they were sprinting for freedom, in any way they knew how - one toddling, one sitting and scooting impressively fast on her diaper, and one crawling strangely on her knees and elbows like an inchworm. Within a minute at least four of them had escaped and were headed towards the living room dome. They were easy to catch up with and collect, and seemed to enjoy their brief respite from their monotonous lives.

Here is a slideshow of that night's clinic:

Is That Johannesburg?!

Everyone says that Joburg is easy to navigate. Indeed, the roads are flawless, smoothly paved out to the far reaches. And we have an atlas. I don’t think I’ve used a real atlas since 10th grade geography class, but we refreshed our skills and have put it to frequent use. The problem is, the street names on the map do not correlate with the signs on the street, or with names people know. The names of everything have been gradually changed to mark a fresh start after apartheid. But not everyone knows the new post-apartheid names (which are frequently pre-apartheid, non-English, non-Afrikaans names), and not everyone remembers the old names. Furthermore, street signs are placed haphazardly, backwards on a post or in tiny font on a curb halfway down the block.

One day recently we were lost again, driving in circles and perfecting the art of the left-handed stick-shift u-turn. All of the sudden we looked up and saw the city skyline outlined just ahead of us. This was only remarkable in that we had been under the impression that we were very far outside the city, and aiming for a suburb in the polar opposite direction. Let’s just say we’ve put a lot of kilometerage on the car thus far, and have gotten to see some (in)famous areas of the city where tourists, and residents, don’t go without a very good reason. But between my (clearly inept) navigational skills and Kemi’s experience with manual transmissions, we have begun to streamline our travels and remind ourselves to turn where the street should be, and pay no attention to signs that are invariably misleading.

So far in Johannesburg, sadly, I’d say we have spent the most time in malls – fancy malls, strip malls, pedestrian malls, practically out of business malls. They are the only location we can find for internet cafes, light lunches, and "aircon." Regardless of level or location of the mall, there is a standard issue of stores at each one. Otherwise you would not know you were in South Africa, except the up and down escalators being switched. The music is almost exclusively American, both the latest hiphop and R&B and ballads of the 80s. Whitney Houston and Michael Jackson still have a huge presence, and I've enjoyed reliving my first awkward dances while jamming to "End of the Road" on more than one occasion.

A theater-sized screen in the food court at one of the malls, showing the provincial soccer league.

Everywhere we've been is oddly both very diverse and very segregated. We have yet to see any interracial couples or groups (except us). People are very interested in us and our accents, and especially Kemi, yet are hesitant to ask where we are from for fear of offending. One lady told us that wealthy blacks in South Africa tend to put on American accents, which may explain the negative reaction some people have had when Kemi does not respond to them in Zulu. On the other hand, we have seen no instances of real racial tension, and certainly we have felt comfortable and welcome everywhere we've been in public.

Film and Flowers

Banner hung this morning without announcement, explanation, or celebration.

Other events of this Valentine’s Day included the kids getting to go to school in play clothes, out of uniform. Also, Kemi’s and my boyfriends (who do not know each other) had flowers and wine delivered coincidentally by the same Johannesburg florist at the same time. The cards were in identical handwriting, and all the ladies in the office where they were delivered had clearly read them by the time we were alerted to their presence. Strong work, gentlemen.

A “sister” (nun/nurse) loads all the kids’ meds up each and every day into Kodak film canisters, hundreds and hundreds of them lined up on the counter to be checked and doublechecked. They are delivered to each cluster in baskets, administered between 7 and 8 o'clock, day and night, 365 days a year. Any caretaker or chaperon must learn all the medications and be able to store and give them properly. Some kinds need refrigeration, some need mixing from a powder to a solution, and some are giant pills that children must be tricked into taking. This obviously makes for a problem with social events and overnight trips for these children.

Sweeties Service

Last Sunday, we attended the morning chapel service held at Sparrow. It was an informal children's service that was mostly pleasant chaos. The first half hour the kids filed in and out, trading seats, boys on the right and girls on the left. The youngest ones all sat on the girls' side, where they were bullied less and cuddled more. Later, a young woman named Esmeralda came to teach some new songs. They've been having an ongoing battle of the sexes, with the boys in the lead last week. The electricity was out, however, so they could not use the CD player for music. Instead, they had a biblical trivia quiz, with the girls winning handily, 3-0. One of each team's three balloons would get popped for each right answer. The winning team got two sweeties, and the losing team one. But Esmeralda made the fatal mistake of handing the candy out mid-service, so that everyone immediately lost interest in learning or participating in anything else. Eventually everyone got yelled at and the singing contests were canceled indefinitely. There were some groans but soon everyone contentedly filed out to play in the sunshine. Anyway, posted here are an assortment of clips from the morning. Sorry, my computer and I aren't ready for proper editing or scene transitions yet.... The first one is about 6 minutes and the others are 1-2 minutes each.

Rainbow Nation

There are 11 official languages in South Africa. Most people speak some English, the news and radio are in a mix of English and other languages (even mid-interview or mid-sentence), and public schools are largely taught in English. The black people here descend from different tribes, so they grow up speaking their tribal language, e.g. Zulu or Xhosa or Tswana. But it seems Zulu is the common language, especially when speaking to children or any black stranger (like Kemi). Afrikaans is the default for whites, and is also the official language of some of the prestigious universities. Sparrow has one girl, Palesa, who attends an Afrikaans school, because her father left her a fund to pay for it. Afrikaans is also being taught in public schools as a useful skill. Notably, the Soweto Uprising (1976) started with schoolchildren who refused to speak Afrikaans, the language of the ruling apartheid class, in school.

One afternoon we tried helping our friends Night and Thato with their homework. For Afrikaans class they were supposed to memorize a song that teaches them names of body parts. They kept asking us what things meant in Afrikaans, even though we explained that we don't speak it and furthermore, no one really speaks it outside of South Africa. They are just so used to adults, and especially whites, being able to help them with it. We said in America another language people speak besides English is Spanish, but they had never heard of it. Or Spain. Or Mexico. We spoke some Spanish for them and riotous laughter ensued.



Now learn some Zulu:

Sawubona - Good day.
Yebo - Yes.
Unjani? - How are you?
Ngikhona. Wena unjani? - I'm fine. How are you?
Nami ngikhona. Ngiyabonga. - I'm fine too. Thank you.
Hamba kahle. - Go well.
Sala kahle. - Stay well.

Even when speaking English, everyone here initiates any interaction with this exchange. Just to ask in a store where the restroom is, or buy groceries or gas, you must first ask after each other's health. Many people start conversations with us by saying, "Fine thanks," which makes it hard to know what exactly to say next.

So far we haven't really worked up the courage to try these phrases out with people we don't know, but I think this will be the week when I start speaking Zulu.

Toothbrushes and Sex

This week some important visitors (i.e. donors) are coming to Sparrow, so there was a village-wide cleaning effort to pull the weeds and hide the litter. Every year Caroline organizes the Piki Tup Campaign, named for Joburg's municipal garbage service. Kids collect trash and trade bags in for signatures, which then count towards small money prizes. Understandably, no one gets too excited about the whole thing. But even worse, this year, a few kids somehow broke one of the brick brais, so everyone got in big trouble - no TV for two weeks (though we are told this will likely be reduced to two days, since 250 unoccupied orphans could make much worse of an impression than a little litter).



Not only did this punishment dampen everyone's enthusiasm for trash collection, but it affected us too. Kemi and I were ready to start our "Women's Health" discussion series for the teenage girls (boys later), using a movie as an icebreaker and springboard. (We decided on "Sisterhood of the Traveling Pants," which covers a lot of 16-year-old girl issues, even if it takes place in a different world than our adolescents live in.) But the session, since it included a movie, was deemed to be too fun and was therefore forbidden. Instead, we started on our "Oral Hygiene" didactic series, deemed not fun at all and so permissible. Everyone did seem to enjoy getting the personalized toothbrushes we made though.

Kemi engraving toothbrushes and modeling for our instructional poster.

Cluster 7 gets their toothbrushes.

Oh, Freedom!

This morning Kemi and I set out for a nice faraway suburb with the most pleasant (and cheapest) internet cafe we have found - The Milky Way Cafe. We sat down and plugged in, I bought a Coke Light, then decided to go to the bathroom. The girl handed me a key and gave me directions to a passage across the courtyard. The women's room, like most here, had an iron gated door you can lock from the inside, so no one can follow you in. The key was stuck so I went back and got the girl from the cafe to come help me. She showed me the trick for the sticky lock and made sure I locked it from the inside, and then left.

When I came out I tried the lock, but the key would not budge. I was stuck. Resisting panic, since no one was around, I leaned through the bars straining to spot anyone. After about 20 minutes, I heard someone in an elevator across from me. I yelled for help but the doors closed. The woman must have heard me though, because I saw her get off on the next floor and walk down the steps towards me. Luckily she was a cleaning woman with all the bathroom keys. I sheepishly explained my situation and she tried her key, without luck. She called over some of her coworkers and before long, I had a group of cleaning people trying all their keys and shouting out ideas. They were having a raucous time, either because they were bored or were getting a break from work. They said I was lucky to have been discovered because on the weekends there are usually very few people around.

Finally, they announced they would call a security guard, a suggestion to which I heartily acceded. He arrived half an hour later, armed with a butter knife. Everyone set about jimmying the lock, to repeated shouts of, "Don't break the knife!" I suppressed the urge to shout I would buy them a new set of knives if it would get me out. Eventually the security guy concluded the knife was not working and he needed a crowbar. The nearest crowbar, however, turned out to be at his house. Don't worry, everyone said, he lives close by. Once he returned with the crowbar, he quickly pried the door open, almost disconcertingly easily. After over an hour, I was free! Back in the cafe, Kemi was in a near state of panic, though the cashier had come by to tell her where I was a while ago. But she was left with all our stuff and couldn't leave. We devised a new rule: no separating without taking the cell phone. Not that I would have known who to call or how to find the Milky Way's number. Still seems like a good rule.

Apartheid Amusement Park

Kemi and I finally got some time to ourselves, so we headed out for the Apartheid Museum. Interestingly, we got two different reactions from (white) South Africans when we said where we were going. One countered, "I'm waiting for the day when I can go to your apartheid museum," and the other said, "Oh... where is that again?" I don't know if this was telling or not. Also, the museum was empty. About five foreign tourists were there. Nevertheless, it was a fascinating, exhausting experience. It is a modern and starkly designed space, reminiscent of the Holocaust Museum in Washington, DC. The strangest part, however, is that it is at an exit of the highway in a place called Gold Reef City. There is a theme park (about the gold rush, not apartheid) and a casino on the same grounds as the museum. Surreal.

Roll Bounce

Take a tour of Sparrow Village:



You may notice the domes are cracked at every angle, and that is true of all domes, old and new. Sparrow is actually involved in a legal battle with the man who built them, who promised that they would stand forever despite being cheap and quick to build. I got to see footage of them going up, which basically entails laying brick around an inflatable dome mold. I’m no structural engineer but it seems obvious that this method of building has no architectural basis in balancing angles or distributing forces.

The domes are organized into 10 clusters, each housing about 24 children and one rotating house mother. Like our lodge, there are three offshoot domes with bunkbeds for each kid, and they share a set of lockers to keep all their clothes, books, and private things. We are told the house mothers are generally childless widows above age 50, purposely selected to have few outside responsibilities. They apparently vary widely in their “parenting” style and competence. There is ongoing debate about whether to group the kids by age, which allows some caregiver specialization, and also prevents bullying, or to set them up more like families, so they feel like siblings and can help each other out.

Since the government roll-out program of HIV drugs in 2004, children have been surviving longer and longer, so that now for the first time, there is a whole cluster of teenagers. Both caretakers and administators have no idea what to do with the older kids, who don’t fit in with the flow of the orphanage. They are remodelling a cluster just for them, and efforts are underway to search for separate housing or a different set-up entirely that children can “graduate” into as they get older.

Throughout the complex lie loose litter, rusty bikes, and single shoes, seemingly abandoned mid-action. One volunteer remarks that orphans get everything in the world donated to them but can choose nothing. Therefore they feel a sense of entitlement and at the same time little valuation of property, so that it is very difficult getting the children to care for or about their few belongings. Someone donated bikes of all sizes a year or two ago, which the kids love to ride yet leave out to rust and break, so now they all got taken away.

There are also many abandoned projects throughout the village. Individuals, corporations, and other organizations donate large sums for the implementation of various ideas, but nothing to maintain it or follow it through. The regular staff here are overwhelmed and underpaid, so no one except the occasional volunteer takes any interest in reviving these efforts, and these are always transient. That being said, these children are so confined and their world so limited that any stimulation, however brief, serves them well. For instance, there is a Marimba band here (traditional southern African music), and the whole group got to fly to the UK to perform two years ago. They still love talking about it.

Therefore, tonight we are having a movie night with the older kids in the "homework" dome, which features a small TV and a billion beanbag chairs. Corine encourages movies starring African-Americans, so Caroline picked up a basketball movie she had never seen called “White Men Can’t Jump.” When we explained it was about a little more than basketball, she handed us the reins. Apparently Grease and Hairspray are big hits with this crowed (though I'm not aware of any non-white actors in either). I decided on a junior high roller skating story starring Lil Bow Wow. It features some jive 70s music and group roller skating dance scenes, so hopefully they'll dig it.

The Mandela Burger

Unbeknownst to me in my Soweto Toilet induced stupor, Kemi spent all last night throwing up her delicious deluxe dual Mandela burgers. So this morning, after setting her up with one of our new buckets and some nasty black currant oral rehydration solution, I joined Corine on a journey to a township an hour outside the city. There is a government building there that was never put into use, so a local group obtained permission to open a new AIDS hospice on the grounds. The nearest clinic is 30 km away and the nearest hospital over 50 km (125 miles). They estimate their potential catchment area at over 20,000 people. Corine predicts it will quickly become a de facto “casualty,” delivering babies and handling stab wounds on weekend nights.

We spent hours organizing a medicine cabinet overflowing with donated expired everything, from mouthwash to skin creams, olive oil, ginkgo biloba, aloe, various elixirs and “African blood cleanser,” in bottles that appeared to be from the 1950s and vials without ingredients or expiration dates. There was one bottle of Zyrtec from 2005, many vitamins and supplements, and no antibiotics. We also found a WWII-era Ambu bag in a leather case that was pretty cool.

We traveled out with Pastor Leonard, a small old man whose grandson, Joy, died at age 13 at Sparrow last year. He is going to manage the dry food stores at the hospice and live there full-time. He was supposed to move in this weekend, in anticipation of the first patients arriving Monday, but right before we left him something flooded everything. So now it will be another week, or two or three, before the official opening.

On the highway, there were beautiful hills and fields on either side, occasionally blanketed with herds of scrawny cows in every color. Women sold mangoes and peaches at intersections, sitting under umbrellas for shade. School children in uniform marched up and down trying to hitchhike (thumbs down here) when the thunderclouds approached, or racing each other to invisible homes. There is a wildflower called cosmos, little pink, white, and purple flowers, delicate yet hardy. They are a sign of fall’s approach, because they are in full bloom in winter.

Inbetween the open fields, neighborhoods would suddenly crop up on either side of the highway. On one side, however, would be essentially a shantytown -- corrugated metal of a diversity of bright colors, dirt gardens, women washing and children running around. Directly across the road would stand large Spanish-style homes with red or green tile roofs and stucco walls. The same dichotomy was repeated multiple times. I am told the shacks are likely filled with unwelcome Zimbabwean refugees fleeing Robert Mugabe. I don’t know which side sprang up first, whether there was a collective resource like water nearby, or whether all the intervening land is owned or marked for farming or herding or mining.

The township around the hospice is slightly more developed, with a cell phone shack and the same tin houses everywhere. Rocks hold roofs down. Outhouses are spray painted with 4-digit addresses. The red dirt roads are labeled with incongruous names like “Casablanca Street.” The gardens were impressive, with a plethora of burgeoning fruit trees, fancy flowers, high fat mealie (corn) and other vegetables. Babies were strapped to backs and waved happily if they were old enough.



We stopped for lunch with all the workers on the way home. If you’ve been wondering, McDonald’s is exactly the same in the outreaches of Joburg as anywhere in the States, with the following exceptions: a grilled chicken foldover (pita) on the value menu, perhaps because of the proximity to a Muslim area; fries being “chips”; the prices in rand; and the presence of a very large blue Insect-o-cutor overhanging the dining area. I saw bugs but no zapping.

The Soweto Toilet

Tonight Dr. Karl came by to see if we all wanted to go out for dinner to celebrate him getting approval on a research proposal he wrote for his Master’s degree. It was our first venture out of the Sparrow gates at night. We drove to a nearby suburb called Greenside and picked an outdoor township-inspired restaurant, Mama Themba's, complete with corrugated tin roof, picnic benches, toilet paper rolls as silverware stands, and chalkboard menus with dishes named after famous South Africans. Kemi had the Mandela burger, and I got the non-eponymous oxtail stew, which was delicious, with a side of pap (like cold Cream of Wheat dressed with salsa). I drank Windhoek Lager, a solid Namibian brew I think I have seen in the States. To finish the waiter insisted we try the house specialty shooters, which looked like tiny Guinesses and tasted like chocolate. In the bottom of each glass was a small pile of drizzled chocolate sauce, which we worried was a worm or caterpillar. But when we saw the name of the shots on the bill - “Soweto Toilets” - it became clear what this was meant to represent.

Of Cakes and Clinics

So far we have participated in two clinics at Sparrow. Every Monday night, a young doctor from Coronation Hospital comes to Sparrow to see the HIV-positive kids who are sick or need blood drawn, to check their white count, viral load, or other labs. We saw about 30 patients with him over 4 hours. Most of the kids speak English, though several were accompanied by an aide who would whisper to them in Zulu or Xhosa if they got scared or too shy to talk to us. They ranged in age from 1 to 11, but most of the older kids looked about 7. Almost all are physically developmentally delayed and some mentally or socially delayed as well. Dr. Karl let us examine the patients and alert him to any significant findings, then he would check them himself and draw bloods. The findings Kemi and I missed most often were clubbing and axillary lymphadenopathy (because we didn't think to check). The findings we couldn't help but pick up were some diffuse crackles and massive hepatomegaly.

Dr. Karl could draw blood from a rock - it was amazing to see. Using bare 22-gauge needles and a single vacutainer, in dim light, he was able to get blood on the first try from every child there, all ages, whether stoic or hysterical, and get them to smile afterwards if not during. The younger and chubbier the child, the more difficult to palpate a vessel. The sickest children were malnourished, with severe failure to thrive because of AIDS, or had lipodystrophy as a side effect of antiretroviral treatment. Either way, they have very prominent veins, but luckily these were few and far between. He has been known to take blood from the necks of very ill children when absolutely necessary. Yikes.










The other clinic Kemi and I ran with two nurse's aides during the day, as regular check-ups for all the well children. The older kids get back from school around 2pm, so then the aides brought in a group of the teenagers, who apparently routinely skip out on their allotted clinic times. They were a funny group. They are completely dumbfounded that Kemi is black and only speaks English. They would try speaking to her in Zulu and Xhosa and could not understand, despite repeated explanations, why she has the same accent I do. They didn't believe us when we told them there are lots of black-skinned people in America who only speak English. Finally, one girl gave a look of recognition... "Ahh," she said, "so your father is white!" No, said Kemi, but after a while we gave up explaining and just let them giggle.

Kemi blocking one of our many onlookers from entering the clinic room:

Meanwhile, our housemate Caroline, a middle-aged hospice nurse from Ohio who spends 3 months every year volunteering at Sparrow, invites small groups of kids over to our house to bake cakes for whoever has a birthday coming up. They learn to read, measure, tell time, and lick bowls. This week we hosted Night (age 10) and Thato (age 12). Night proudly tells us how he was the first child at Sparrow, found abandoned when he was just a few months old.

Above is a sign we made up for the pictures, which the boys say signifies "scissors." Below they found Zorro masks and, later, got the cake safely to the birthday boy, Pule (age 9).

Shedding Load

Our home dome is unbelievably nice. It actually consists of a large central dome, which houses the living and dining areas, and four offshoot domes comprising the bedrooms, kitchen, and bathrooms. We have all the modern amenities, except electricity, telephone, and internet. This, it turns out, is a new set of domes built across the road from the orphanage and the old visitor dome (that did have internet). Hence the blogging delay. My apologies.

Adding to the power difficulties, it turns out that: (a) Johannesburg is apparently the most lightening-hit city in the world (so far it has been sunny every day with thunderstorms every afternoon), causing daily power outages; and (b) South Africa is suddenly in the throes of frequent electricity shortages, causing surges whenever power returns. Eskom, the national power utility, schedules sweeping outages they call "load shedding." I actually saw this in the New York Times the week before I left, but they reported the outages as "scheduled," whereas no one here is aware of any schedule or geographic pattern to the load shedding. Oh well, Citronella candles keep the mosquitoes slightly at bay.

I could get used to this life - sleeping with a sheet and a fan, sipping cool wine in the dark with a background of radio and crickets, drying our clothes outside and cooking all our meals. I might have done well in the 1800s, for a month anyway. Of course, we also have a housekeeper, Elizabeth, who comes almost every day to clean and do laundry (but alas, not dishes). Like I said, not too shabby.

For a tour of our domes, please see slideshow below. If it goes too fast for you to read the captions, click "pause" in the beginning so you can control it yourself with the arrow buttons. Let me know of any problems!

Bob's Cruises

The 18-hour flight on South African Airlines was delightful. Announcements were made in English, Afrikaans, and French. Between on-demand movies, sleeping, and Will Shortz (Café Crosswords and Sunday Sudoku), the time flew. One day faded into the next and we simply savored the wine and meals (spicy beef stew and polenta, real mashed potatoes and scrambled eggs, fresh Portuguese-style rolls). A quick stop in Dakar, Senegal to change crews and we saw our first African sunrise.

It was only the company that was less than ideal - we found ourselves surrounded by elderly Canadians struggling loudly and longly to pronounce words like "rand" and "Cape Town" (pronounced "rand" and "Cape Town", respectively). The woman next to me was fascinated by my Sudoku skills, so much so that I had to put it away. Suffice to say that we were relieved to get to Joburg Airport and wait in line with about a thousand people and no air conditioning at Immigration. It was there we discovered the Canadians were on an excursion run by a man named Bob, whose luggage was all labeled, inscrutably, "Bob's Cruises." We befriended a couple in line behind us, Afrikaner ex-pats who had left during apartheid and were returning to Cape Town for the first time since its end. They had similar views on airline cruises sponsored by Bob or anyone else. The man turned out to be a physician who trained at the same Johannesburg hospitals we will be at, and their children live in Manhattan. They gave us some pointers and wished us luck.

We were greeted outside with a laminated name sign held up by Corine, the director of Sparrow. She is a small older woman in a faded black Harley t-shirt with a giant gold cross hanging from her neck. Her shirt said, "Let It Ride," and on the way home in the Sparrow Ministries dusty white VW bus, she told us all about Joburg, Sparrow, and herself. We couldn't understand a word she said, between her accent and low voice, the wind from the windows, and the fact that both of us were sound asleep within 5 minutes. It was a long but pleasant journey and we arrived safely with everything we brought. We were greeted at the Sparrow guest dome by Caroline, a middle-aged nurse volunteer from Ohio, who had dinner and wine all set up for us. She settled us in and we basically slept for the next 24 hours....

A welcome sign from Naniki greeted us in our bedroom.