A day of blitzing and football (but not at the same time)

19 Nov 2008:

I left this morning expecting another day on the wards, but when we arrived, we were told of a once-a-year opportunity to join in a TB Blitz! The Blitz is a community outreach project where the iTEACH (integration of TB in Education And Care for HIV/AIDS… cumbersome, I know) program of which I am a part and several other local anti-TB campaigns (as opposed to the many pro-TB campaigns) join together to spread the good word about TB. It was very interesting, actually. Nine of us from the iTEACH office started out by getting lost on the way to a small field in a township where this event was to be held. We waited for a bit while the other teams assembled, and then we headed out door to door just talking to people about their living conditions, asking if anyone was coughing, and handing out literature on TB in English and Zulu. (Apparently literacy rates are such that usually at least one person per household can read; these brochures were written at a fairly high level, eg at least middle school English.)

The door-to-door experience was an interesting one… the township was composed of mostly small brick or corrugated aluminum one-room houses. However, I was quite surprised that the insides of some of them were quite well-maintained; one even had a television that the kids were watching! I only saw a handful of homes, some of which were single-mother and others of which were two-parent (half-and-half of the small subset I saw). We didn’t find any suspicious TB cases or other health problems to refer, but we did engage people in a discussion about HIV and TB at each home. Several of the parents had already been tested for HIV (most often as part of prenatal testing). We also helped fill out a bizarre, poorly organized demographic survey that the organizing group had given us; I have no idea what the point of this was given the limited scope of our canvassing efforts. All in all, this was no well-oiled machine, but it did give me the closest contact I have yet had with a township.

After the door-to-door, we returned to the field, where a large open-air tent and stage had been set up for a good old-fashioned health fair. People descended from the townships to get their glucose, BPs, heights, and weights checked (I didn’t see a BP lower than 156/80) and to learn more about TB. Off to the side stood smaller, enclosed tents where patients could go for a “VCT” (voluntary counseling and testing, which is what they call an HIV test). Patients enter, meet with a counselor and a technician, take the fingerstick blood test, and learn their results within minutes! The test is very sensitive but not terribly specific, so if the result is negative, there is no follow-up, but any positive screening test is followed up with confirmatory testing. There was a steady line outside these tents all day, sometimes as long as 40-50 people. I asked one of the other volunteers what fraction of the tests he expected to be positive; in keeping with the prevalence rate in the area, he expected that about 40% would be. I suspect it may be a bit lower, since the incidence of newly positive results must be lower than that, but still, it was powerful to think how many people would be learning that they were HIV positive today, some likely already with AIDS, while the rest of us enjoyed the festivities.

And there were festivities. A group of youngish DJs played a hip-hop song called “TB Free” (this was the name of the organizing group) with mostly Zulu lyrics but occasional English phrases about taking your medication and getting tested and “you can be better”. They brought children (who had been let out of a nearby school for the occasion) on stage and had them take turns trying to fire up the crowd by saying “TB it is curable”, then they had a dance competition. Then a public health worker and a social worker addressed the crowd for a while, followed by skits about the symptoms of TB and the importance of finishing treatment. Most of the proceedings were in Zulu, so I only followed what I was told by my iTEACH colleagues. The ceremony dragged on (given that I couldn’t understand a word of it), but otherwise it was an interesting day. The event was very well attended (I guess I have no frame of reference), with several hundred people assembled.

We got back to Edendale Hospital in the afternoon and I worked on a presentation for the interns for next week. I decided to prepare a session on EKGs they might commonly see. It can take up to a full day for labs to come back, and while EKGs can be logistically difficult to obtain, at least the results are immediately available, so one could argue that it is even more important here than in the states to be able to interpret them in the absence of other data and recognize ischemia, electrolyte abnormalities, pericardial effusions, etc. Of course, one could take this argument one step farther and say that since there is not much to be done about any such abnormalities, what’s the point… but that’s not entirely true; heart attacks can be treated with thrombolytics, hyperkalemia is seldom treated (I’ve seen Ks of 6.9 a full day after they are drawn that are just noted in passing) but certainly could be if there were EKG changes, and pericardial effusions are nearly always TB here and could be treated as well.

In the evening, I went out with some of the iTEACH crowd to a bar in PMB to watch South Africa play Cameroon in the finals of the Nelson Mandela Cup, a pan-African soccer tourney. South Africa were the underdogs, but they played well and jumped out to an early 2-0 lead on a couple of exciting plays before giving up two goals on set plays to concede a tie game heading into halftime. The second half was tense, but with about 10 minutes remaining in regulation, South Africa put one off a rebound on a frantic play to take the lead! They got a penalty kick several minutes later and the game looked over, but the forward who had scored the first to goals hit the post, so they had to sweat out another 8 minutes of Cameroon chances before pulling off the upset win. The players were ecstatic, my co-workers were ecstatic, the Cameroon coach was all pissed off about some sort of administrative snafu getting into South Africa and refused to answer questions about the game, it was fun.

Before the game, Mandela gave a taped address to the crowd that was broadcast on TV. The entire crowd in the stadium and at the bar came to a complete hush; nobody spoke, nobody moved, the waitresses stopped serving, and everybody just listened. He wasn’t even saying anything too dramatic, just about how the game benefits his Children’s Foundation, and good luck to both sides, and whatnot. The power of this man to draw the attention of the people of South Africa, even today, is amazing.