‘Those two are stupid, don’t bring them back’ was the greeting I received from the paediatric nurse looking after 8 and 11 year old siblings I had admitted to hospital for tests for tuberculosis.
I’ve just finished my first month working as a doctor in the rural east of Namibia. I live in a village in the Kalahari desert called Epukiro Pos 3 (all the villages around here are referred to by numbers due to the length of their real names – my village is actually Omawewozonyanda and others are even longer) . For the next year I’m one of the two doctors providing healthcare for the San Bushmen tribe in the region. As in the first paragraph, two of the main problems facing the San here are tuberculosis and racism.
The San bushmen are one of the oldest tribes in Africa and are famous for their ancient rock carvings and rock engravings. Their traditional skills as hunter gatherers in the Kalahari desert are no longer valued and in my area they are now the poorest of the rural poor. Their poverty, overcrowded shacks, malnutrition and lack of access to healthcare means they have one of the highest rates of tuberculosis in the world. They are also disenfranchised from mainstream Namibian society and are the only ethnic group to have worse economic and health outcomes than before independence 25 years ago. Racism against them is rife.
The work I’m doing is a mix of clinical tuberculosis work, tuberculosis research, primary care at the clinic, and outreach sessions into the desert.
I diagnosed a family with TB a few weeks ago and they came for a review this week. They were all doing well clinically but I asked them how they got to our clinic: they had set off on Sunday morning and walked a long distance down a sand track with their 4 year old son in tow. They tried to hitchhike to the clinic on the Sunday but couldn’t get a lift so slept by the side of the road in the -4 degree overnight temperature. Finally someone stopped for them late morning on Monday and took them the hour long drive to our clinic. I reviewed them, gave them their medication, gave them some food, updated all our records and watched them set off for the same journey back again. The positive feelings from their improved medical condition were reduced, thinking of the disaster of a journey they will have to continue to make to stay well.
There have been super fun parts in my first few weeks. A Saturday morning watching the district ‘cultural dancing’ competition was incredible. Each of the different tribes from the local schools dressed up in their traditional costumes and performed the dances from their culture. The San groups were amazing and won two of the three age categories. My personal highlight was one of the older San groups performing the most famous scene from ‘The Gods Must Be Crazy’. (An entertaining slapstick comedy film involving the San bushmen, with some of the old guys from my village knowing the San actors in it). I also loved the Namibian equivalent of a naked streaker, which was an 8 year old boy running across the back of the ‘stage’ desperately trying to grab hold of his donkey again.
My village is pretty rural, 150km from the nearest town and hospital, but there are even more rural areas. Every week we have outreach days further out into the Kalahari desert. Last week we were in a place called Donkebos, 3 hours drive away with the last hour via a deep sand track. We saw about 40 patients in the few hours we stayed there but my absolute favourite was a patient’s husband.
He was about 60 years old and gigantic for a San at about 5 foot 10. He was busy using a solar powered hand drill to make holes in small pieces of ostrich shell for his wife to make into jewellery. I saw that he had a home made bow and arrow next to him and was totally amazed. The traditional San hunters don’t exist in the area close to me due to previous overhunting of animals, laws requiring permits for bow and arrow hunting, and general loss of skills due to more westernised lifestyles.
I asked our translator questions for him and he said that hunts alone most weeks,(he doesn’t trust anyone else to be silent enough), tracking antelope such as springbok or kudu. He showed me his bow + arrows and the snares he had for catching smaller animals. Meeting him was a highlight of my week and a reminder of the traditional life that I had read about but not seen.
Life is different in Epukiro. The hostels attached to each primary school are for children to stay in if they come from a distant village. We were driving back from the local town and saw a collection of young San children walking along the road. We recognised one of our young patients and stopped. He told us they were walking home as it was a weekend the school hostel was closed. They had walked 15km already and had about another 15km left to go to get to their collection of villages. They were between 6 and 11 years old. We had 41 children in the back of our ambulance (about 2/3 of the size of a British ambulance) on the first trip, and then had to go back to pick up the other 43.
I hope writing this blog semi-regularly will give friends and family some idea of what I’m doing over the next year.