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ROBBEN ISLAND: Monument to the Freedom Struggle
Today the Delegates on Nursing visited Robben Island, located approximate 7.5 miles off the coast of Cape Town. Departure to the island is by ferry from the Nelson Mandela Gateway at the Waterfront. The ferry ride is ~30 minutes; from there we embarked on a bus tour of the island that took us to historical locations.

In 1961, the Prisons Department built a maximum security prison on the island with the intent to exile, imprison, isolate and banish hard common criminals as well as political leaders against the Apartheid Regime, such as Nelson Mandela of the African National Congress (ANC), and Robert Mangaliso Sobukwe, the Pan Africanist Congress (PAC) leader.

During the bus ride our tour gui...

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Today we visited Karl Bremer Hospital (KBH) located in Bellville, Cape Town in the Tygerberg Health District of the Metro Region. The facility was established June 1st, 1956 and named after a former Minister of Health, Dr. Karl Bremer.

There, the Delegates on Nursing were greeted by Miss WJ Nieuwoudt, Nursing Service Manager. According to Miss Nieuwoudt, funding comes through the Department of Health (Provincial Government of the Western Cape).

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Due to the financial constraints during the past years, KBH was induced to close wards and reduce the number of beds available, which has had a serious impact on the hospital’s ability to provide services to private patients.

In addition to the financial constraints faced by KBH, they also suffer from a nurse shortage. Again, the common theme that persists is that nurses are over worked and under paid. In most cases, they accept better job offers outside of South Africa because the working conditions and the pay are better.

The situation is problematic and it is compounded by the impending public servant strike due to take place Friday, June 1st, 2007. Service workers demanded a 12% increase in the salary, but the government only approved a 6% increase, which left the meeting deadlocked. The service workers plan to strike, which will affect hospitals and clinics all over the great nation of South Africa. What this means is that the nurses who are already overworked and doing more than they are qualified to do will now have to cook, clean, change bed sheets, run errands, mop floors, and all other tasks that would be done by a public service worker.

Currently, the emergency department at KBH is 258% occupied. Even with the high capacity of patients coming in, KBH, by law can not turn away any person seeking medical assistance. There only option is to contact surrounding area hospitals to take KBH patients, but often times they do not because they are overloaded and full to capacity themselves.

I have come to my own conclusion that the South African Healthcare System is in shambles and is on the verge of collapse, unless there is a Reform of the Healthcare Policy. At this juncture, I do not know the solution to the dilemma. Do you? Help is needed here in South Africa immensely.

KBH is in great need of all medical supplies, such as retractable needles. At one time they did use them, but they can no longer afford them in their budget. Currently, the healthcare professionals are at risk of having needle stick injuries – approximately 4 to 6 per month, according to Miss Nieuwoudt.

Today we visited the University of the Western Cape (UWC), which is located in the City of Tygerberg, the northern suburbs of Cape Town. It is surrounded by natural beauty: a viable nature reserve, and the mountains of the Cape Peninsula and Stellenbosch.

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Based on my own observation, UWC campus is a place were cultural diversity is thriving. However, historical the university struggled with discrimination and oppression against the indigenous people of South Africa. UWC was a white school until the late 1950s when Parliament adopted legislation establishing UWC as a constituent college of the University of South Africa for people classified as "Coloured". The classification included all people of non-white heritage (excluding black Africans). Not until 1987 did the school implement its open admissions policy to black Africans seeking a higher education. During the Presidency of Nelson Mandela, UWC received accolades from the president for transforming the university “from an apartheid ethnic institution to a proud national asset."

UWC received over 2500 applications for the nursing program. Only 300 were accepted based on the universities criteria and first come first server basis. There are currently 30 lecturers at UWC. The ratio of teacher to student is 1 to 50. During the meeting, UWC nursing students were invited to sit in with the Delegates on Nursing to assist the lecturers in the discussion and to answer our questions. Afterwards, we had an opportunity to eat lunch together and further interact with the students.

9:30am

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Professor Thembisile Khanyile was the first to speak. She is the Head of the Nursing Department. Her background education includes T.D., PhD (Natal), M Ed (UNISA); BA (Nursing) (UNISA), Honor Nursing Education (UNISA); B Cur, RN, RM, RNE, RCHessor. Prof. Khanyile discussed nursing education in South Africa specifically the strategy to maintain an adequate supply of professional nurses. A couple of ways the healthcare system and the government are strategizing is to improve the income to attract more nurses in to the field, and to improve the nurse to patient ratio so the nurses will not be over worked and the patients receive the proper, adequate healthcare they seek.

The main reasons for the professional nurse shortage is due to the low income for the profession in South Africa, this leads the nurses to accepting higher offers from outside the county leaving nurse assistances and aids, who are not highly qualified through education and experience, to do the work of a professional. This in itself is why the demand for professional nurses is high in South Africa. According to Professor Khanyile, they struggle with challenges as more nurses are trained the more they migrate to other countries, and the need for nurses is greatest in the rural areas of Africa, but most nurses want to work in suburban and urban areas.

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RR Marie Mosdeste was the second speaker. She is a student of nursing and a fellow Golden Key Honour Society member. The focus of Miss. Mosdeste’s discussion was examining the HIV/AIDS pandemic and the impact on the nursing profession.

Here are some startling facts about the HIV/AIDS crisis mentioned in the lecture by Miss Mosdeste:
• In 2005, South Africa HIV prevalence was 18.8%
• South Africa has the most severe HIV epidemic in the world
• Approximately 50% of the South African populace is infected with HIV/AIDS
• United Nations & AIDS (UNAIDS) estimates that 5.5 million people in South Africa are living with HIV as of 2005: 240,000 are children under the age of 15 years of age
• Approximately 350,000 people in South Africa died from AIDS in 2006 – most of them women
• ZwaZulu Natal Province has the largest percentage of HIV/AIDS in all of South Africa and they are higher than the national level: ZwaZulu Natal 39.1% HIV/AIDS; South Africa national average 30.9%

The impact of HIV/AIDS on family life is sad to say the least:
• 1.6 million children under the age 16 has increased in the number of orphans due to the death of parents from AIDS
• In the African culture the man is usually the source of the income. If he is sick from AIDS or if he abandons the family because the wife is sick from AIDS there is a loss of income, which increases expenditure.
• Family life is disrupted if children lose their parents. Often the grandmother will step in and raise the children or the oldest sibling will fill the role.
• There is still a stigma and discrimination attached to HIV/AIDS in South Africa. People are given a choice to take a blood test or not to check for the disease, even if the healthcare professional suspects or sees signs of the infection. Most people choose not to know if they have the disease. But if they do know, they keep it a secret for fear of being ostracized by their family and community. In some cases they will be killed by their own neighbors.

So, what is South Africa doing about the pandemic to raise the awareness to all people? It is apparent through my own observation of the clinics, hospitals and lectures that the healthcare professionals are doing all that they can to educate the community. Here are just a few ways they are making a difference:
• In 2002, South Africa made Anti-Retroviral (ARV) available for rape survivors and Preventing Mother To Child Transmission (PMTCT)
• Life skills programs are implemented in schools
• Media based prevention on safe sex explaining how to be safe
• Education on infant feeding choices for mothers infected with HIV/AIDS and the child is not
• Due to the lack in healthcare resources, there is support through home based care and community based organization
• At the national level, funding has increased since 2001
• The workplace is educating their employees and offering testing.

Even though there is a huge effort on at the local level and national level to promote awareness, South Africa is still faced with its challenges:
• Not enough human resources; there are capacity and infrastructure constraints
• There is a slow rollout of the much needed treatment, ARV: In 2005, 711,000 needed the treatment; only 255,000 received treatment
• Changing the behaviors and social changes are a long process
• There is still a huge stigma and discrimination surrounding HIV/AIDS
• Africa is deep in culture – there are still gender inequalities. If the man does not want to wear a condom, even if the women asks him to so, he does not have to and the women accepts it as it is.

As I go through this experience, I find myself reflecting on the information I am absorbing about the condition of the South African Healthcare System. I have one statement to make, “I had no idea how bad the HIV/AIDS pandemic was and the shortages of resources faced by this great nation”. My eyes are open and I am learning so much from this experience. In America, I know that the disease exists, but I do not hear or see information flooding the news about the epidemic. So it is out of sight out of mind – before South Africa I did not see HIV/AIDS as a pandemic. Today, I can not say that, because I no longer believe that. For a complete report on the HIV/AIDS epidemic, which includes North America, please visit www.unAIDS.org. If you would like more information about the University of the Western Cape please visit their website at www.uwc.ac.za.

Who Am I? I am defined by my experiences of who I am not. I must first know who I am NOT through life experiences – to further define who I am and who I am becoming. My decisions are based on my highest truth, which will lead me to my highest version of my highest vision I ever imagined of myself. I choose be the change in my life and the lives of others. I choose to make a difference in my chosen field. I choose to grow from this great experience in South Africa. I choose to keep moving forward without looking back. Who are you and what do you choose…..?

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I arrived in Cape Town at 8:10pm (11:10am Pacific time) on May 22nd, Tuesday, with the rest of the Delegates on Nursing. Once we arrived at Cape Town Lodge (our hotel) we were ushered in to the dining area for a small dinner and then debriefed on the upcoming events for the following day. Later, all of the delegates retired to their respective rooms to rest before our 6:00am wakeup call for breakfast. By 8:30am, orientation began.

8:30 am
Our Faculty Advisors, Lillian Barron and Margaret Bassett, discussed the educational goals, learning objectives and educational outcomes of the International Scholar Laureate Program (ISLP). The success of the delegates experiencing a life changing outlook on life and humanity as a whole is primal.

Some ...

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The opportunity to go to South Africa came as a surprise. I was finishing my bachelors degree in Kinesiology at California State University, Fullerton when I received news of my nomination. The Golden Key Honour Society (GK) nominated me to represent my university and community by traveling to South Africa on behalf of the International Scholar Laureate Program (ISLP) – Delegation on Nursing. The ISLP brings exceptional college and university students from around the country to an experiential educational program.

I joined GK because I was invited to do so because of my academic achievement. However, I also joined because GK encourages leadership, scholastic achievement in diverse academic disciplines, personal growth, and the oppo...

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