Reflections from Cape Town

Our visit in Cape Town started with a kind welcome by the leader of the exchange program at the airport even if she was on research leave. Our private bus driver drove us from the airport passing two of the most known Cape Town characteristics: the Table Mountain and the townships.

In Cape Town, contrasts seem to be very big on many levels. On our way from the airport we passed square kilometers upon square kilometers with different kinds of townships. All from mural houses built by the ANC government, to small tin cabins and tent-like shelters. You can see many people, and even horses, cows and sheep grassing along the highway. And then you enter the modern parts of Cape Town with exquisite housings, office buildings, the olympic stadium and Waterfront – a world-class metropolis. Homes made of recycled rubbish on small flat pieces of ground everywhere, even near the highway, are contrasted by big villas and modern apartment complexes.

The contrasts are huge. History seems to linger: The poorest still have dark skin and the legacy of history of discrimination still affects coloured people most. 

During our stay, besides many cultural and social experiences together with the physiotherapy students, we visited 6 different public healthcare institutions and the University of the Western Cape. The university was established as a segregated university for the coloured people during apartheid. This is still expressed by the diversity of students we met and by the strategic placement of the university. The main-campus was a gated property, as were most of the healthcare institutions we visited.

In the beginning the hospitals gave us kind of flashbacks to Norwegian jail due to all the security and bars before entering the hospital/institutions or even different floors. 

On the other hand they really made an effort to decorate the hospitals especially for the children departments. The bars gave the children and employees more safety/protection. The paintings and decorations resembled nearly a museum of/for children’s art. We were really impressed by the effort to make the hospital look so nice.

The hospitals covered many of the same clinics we have in Norway, but at the same time also many other clinics such as tuberculosis, pediatric dialysis, differentiated ICUs,

gunshot wounds and many severe burns. The physiotherapists are educated in more medical skills than the norwegian physiotherapists are. This might be due to the need for this competence in the intensive care units. The South African students also learn much more about testing and medical care/diagnosis compared to the Norwegians. It seems as if the Norwegian students are more challenged to work less hierarchically and at the same time more relationally and cross-sectional within the hospitals.  

We were quite surprised by how big the patients’ rooms were, often shared with many others, from 6 to 20 patients. In the stroke department there was installed a nurse-monitoring-station where the severe patients were stationed close by. As they became more healthy they were moved further away from the nurses station. We reflected upon if this kind of system gives more security to the patient, as the nurses are so close and as they can see that they progress to the more healthy section. We also talked about how in Norway patients often want to be in a room alone and get stressed about sharing rooms. Norwegians seem to be more private than South africans. However probably most SA patients also would prefer private rooms, but fact is that they have too many  patients and too few hospitals for this to be possible.  The big contrasts affect patients’ everyday life, the physical therapy-treatment and the patients goal-settings, which could be very different from what we are used to in Norway. In Norway we often speak of differences like if the patient has or doesn’t have stairs at home and small or big spaces inside the house, whilst here questions are about whether the patient has space for a wheelchair or stand, power to charge an electric wheelchair or enough money to buy his/her kid a ball or toy to train with. The inhabitants of Cape Town have different kinds of cooking and heating, from coal and fire outside over gas ovens to electrical systems. Often the electrical supplies are unprofessional installed at the townships. We registered that physiotherapists are working more with many severe burn patients in SA than in Norway, maybe due to this different kind of cooking and heating. In the rehabilitation center we saw training facilities adapted to these different kinds of cooking so that the patient could work more specifically towards their goal.

It was interesting to see the different types of mobility aids that were suited for different types of surfaces depending on the environment the patient is living in. For example a three-wheeled wheelchair that was specially adapted to uneven surfaces and areas without asphalt. The purpose of the three wheels was a chair that was stable and more difficult to tip over. In the rehabilitation institution we visited they did more of the adaptations of the aids themselves. They had both a seamstress and a carpenter and the wheelchairs were already available at the institution. The therapist would probably prefer to have the budget to buy the equipment they need, rather than adapt to whatever happens to be available. In our perspective this more artisanal approach to wheelchair production nevertheless seems to be more than only a virtue of necessity, it seems to be a more sustainable production, compared to buying new chairs because one part has been worn out. 

 Writing all patient records by hand, on the other hand, seems more resource-intensive, more time consuming, less specific and less focused on interdisciplinary communication. One therapist stated that it was impossible to read what the doctors wrote and that the notes were so short and unspecific because of lack of time. 

Another reflection was connected to the local distributions of resources electricity and water. In the university and the hospitals we found strange posters about Load-shedding of electricity. It showed different districts in town where at special times during the day there was no electricity. At our apartment we realized that we were on the lucky side of the town, where the lack of electricity did not affect everyday life that much as the shut down was during the night. In other less privileged districts the electricity stopped during the middle of the day and affected everyday life probably very much. 

The water restrictions we were not affected by so much, even though we heard about the empty reservoirs during last summer and autumn from the news. We experienced that at some hospital’s staff toilets we were encouraged not to flush down if not necessary: “If it’s yellow let it mellow. If it’s brown, flush it down.“ That makes sense when you know about the shortage of water, but still felt strange. 

The lack of two resources which we take for granted in Norway influenced the everyday life of many million people every day in SA. That puts a lot in perspective.  All in all we are really grateful for all the different experiences we made during our stay in Cape Town.

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