Medicine on the edge of the Kalahari
Dr Tim Pickering discusses his experience working in a clinic for the Namibian San and training local healthcare workers to handle the challenges of poverty and violence. Also see a slideshow of photos.
It is always helpful to see a new perspective on healthcare, and I have certainly had plenty of exposure to experiences not usually encountered as a GP in North Yorkshire. I have always been interested in the Bushman of the Kalahari – known now as the San. Laurens van der Post has written extensively about the tribe that he considers to be a direct genetic link back to earliest man.
Created with flickr slideshow.
In 2010 I was winding down from full time work as a partner in a practice in North Yorkshire. I took a course on Desert Medicine in Namibia and during my studies heard of a clinic looking for volunteers. The N/a'an ku sê Foundation runs the clinic to provide primary care for the San, a group who have not made the transition from hunter and gatherer to urban dwelling very successfully.
Like other groups who have lost their traditional hunting grounds when Europeans and others take over, they become the poor neighbours without the culture to thrive in a commercially driven world. They have a rich history and many unique skills and abilities as well as a love for stories, singing and dance. They have a slight physique in a country where big is good. They are usually quiet and much less assertive than their neighbours.
They end up marginalised and suffering from the conditions of poverty – alcohol abuse, TB, HIV and AIDS, malnutrition and high maternal and infant mortality. There is considerable unnecessary illness and mortality and the clinic goes some way to addressing these problems.
When I volunteered for two months early last year, I learned about the large animal sanctuary near the airport at Windhoek. The profits raised from the lodge, volunteer programme and other forms of fundraising are ploughed back into all the work the foundation does and helps to fund the clinic with its permanent doctor and nurse.
The living in Epukiro is surprisingly good, in a purpose built clinic and adjoining house. The San people are very friendly although speaking their language is not going to happen quickly – their four distinct clicks make it an attractive language but very hard for a European to get their tongue around. The children at the schools are eager to show off their singing and dancing and it feels a very safe place to visit.
My enthusiasm grew to attempt to set up a network of village health workers to work at a very local level, preventing illness, ensuring immunisations happened, spotting TB and pneumonia earlier than currently happens and pointing them to the clinic or hospital. To ensure the correct issues were to be addressed a health needs assessment was performed.
It was important to lose my Western way of thinking, as the gulf between my academic background and the culture of the San was immense. What emerged was a rather sad experience of their meagre diet, which had little variation beyond maize and water. I was also surprised at the number of violent episodes in the community – murder, suicide, assault and RTA's being more common than in rural North Yorkshire. Home births conducted by mother or a neighbour were the rule, so infant and maternal mortality were high.
I returned in September to start the project and was able to use the clinic car to drive the hour needed to reach most centres of population – small family groupings or a collection of huts. A translator was often needed to help with the village meeting and then recruitment of usually a mother with children who volunteered to be trained as a healthcare worker. It was great fun to do my one-to-one teaching under a tree but usually it became an attraction for the entire village to gather to hear what we were talking about.
Teaching sessions were kept focussed and brief but the San are quick learners and are very retentive so that when it came time for the‘end of term exam' they all scored very well averaging 80% in an oral test. It remains to be seen how they will have maintained momentum and engagement in my absence. Will they have been able to put the knowledge into action and understand how they can help their families by helping the community? Will they have translated knowledge into activity? I will discover when I return at the end of March to extend the teaching and the area of intervention.
In a remote area access to hospitals is poor and the service the San receive is very mixed. Many illnesses can be dealt with at minimal cost using local volunteers. This process provides a way around the thinly populated rural areas with minimal transport, poverty and a lack of enthusiasm for western medicine.
The clinic is an excellent place to experience rural Africa in reasonable comfort and in safety. Pre-medical students, student nurses and medics as well as older health workers looking for a different perspective of health care have all enjoyed their visits.
Dr Tim Thornton is a retired GP from Pickering, North Yorkshire, who is currently working as a locus and visiting Namibia as a volunteer.
If you would like to learn more about the work of the N/a'an ku sê Foundation, or volunteer please contact firstname.lastname@example.org