Paradigm Shift in Khayelitsha
It’s a busy Monday morning at the Doctors without Borders (MSF) office. We are in Khayelitsha, the “other side” of iconic Cape Town. While the city of Cape Town is postcard-perfect for the most part, the sprawling township of Khayelitsha tells another story. The origins of the township trace back to apartheid, when the government forcibly relocated its black and “coloured” (the South African term for mixed race) population to “townships” — urban settlements outside the city — and to remote rural areas, formerly called “homelands.”
While racial segregation is no longer government policy, the spatial realities of apartheid remain. As a result, the townships continue to be racially segregated, and dramatically poorer than the city. The bus I take to work slowly chugs and lurches through Khayelitsha, showing me a whirlwind of everything from shopping malls and childcare centers filled with uniform-clad children, to lines of public toilets and sprawling shacks built so close together they seem like they will fall into each other in heaps of corrugated iron.
I am overwhelmed by the immensity of Khayelitsha and the complexity of township life. How did I manage to previously live in Cape Town and hardly come here? Already, I am grateful for the opportunity to work in this setting, and see this reality that South Africa has to offer, so different from the “official” Cape Town that glistens by the sea. As a public health researcher and advocate, I feel like I have already learned more about the social determinants of health in South Africa on one bus ride than I had by reading innumerable scholarly articles.
My first week at MSF was filled with new names, faces, and new languages; primarily Xhosa, the most widely spoken language in Khayelitsha. If that wasn’t enough, there is an entire alphabet soup of global health acronyms, and heaps of new knowledge. This particular MSF office - or “project,” in MSF parlance - primarily focuses on operational research dedicated to HIV and tuberculosis (TB) prevention and treatment, and has close relationships with all the hospitals and clinics in Khayelitsha.
While I have a foundation of clinical knowledge as a nurse and public health researcher, I know there will be a steep learning curve when it comes to learning the nuances of HIV pathophysiology, treatment, and prevention. I have begun working with the Early Infant Diagnosis team to reduce mother-to-child transmission of HIV by identifying risk factors of mothers who default on HIV treatment, and pilot new technology aimed at preventing them from falling through the cracks. Once again, a paradigm shift: the diseases that are considered “rare” in the U.S. (such as TB and HIV) are the biggest battles here. It is an immense privilege to be a part of this effort to eliminate these diseases with the dedicated team at MSF, even as a new intern still learning acronyms.
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