“Let him first be shaved!” – C.S. Lewis: The Lion, the Witch, and the Wardrobe
The Ministry of Health has to convince grown men to go for circumcision. No easy task. If we Namibians, (it is my new home after all), circumcised men as babies they wouldn’t even remember, and voilà! In case you did not know, circumcision makes a man 62% less likely to get HIV. (The inner foreskin is very susceptible to the virus … too much information?). Circumcision is a norm in the Herero tribe, but not in others. Let them first be shaved, and we will have one less thing to worry about.
Recently the group of trainees had a tour of the moderately sized Okahandja hospital and the smaller Nau-Aib clinic to get a sense of the primary health care system in Namibia. The resources in Okahandja are not many, but way more than one would find in rural areas. The TB ward here does not have negative pressure air ducts, but at least it is a separate room with many windows and sunlight shining in. Did you know that TB is killed more quickly in sunlight? Oshili! (‘It’s the truth’ in Oshiwambo).
Here is a tour of the new clinic!
The primary healthcare system in Okahandja made a good first impression. (But I did not see it from a patients perspective, more on that to come after working in the hospital for a while). Seems like the research and the knowledge is all there, but widespread behavior change is yet to come. Maybe it’s because the mantra “health is wealth” is inevitably true. Even the most meticulously planned health system would feel the ball and chain of wealth inequality that is Namibia.
See, for example, the resort we went to one Saturday. A mere twenty-minute drive from a small house of 16 people with no electricity or running water.
In twenty minutes I can walk from a castle-like home with dove statues, green lawns and tall cacti to a small house made of zinc panels in the sand. This extreme inequality in income is yet another residual effect of apartheid. (Unsurprisingly South Africa is even worse).
The connection between health and wealth is not always the obvious inability to pay for care. Tuhafi’s parents couldn’t afford her school uniform, so she never learned about HIV testing in school. Bernard works on a farm in a rural area (Namibia is vast), and so delayed going to the clinic or hospital for care because he doesn’t have a car, and the farmer didn’t feel like taking him. Andani, eight years old, goes to bed hungry most nights as a child, so her immune system has trouble fighting off communicable disease. With over a third of the population living below the poverty line, these are some of the realities I’ve seen in my few short weeks in Namibia. The clinic can only do so much.
Too long; didn’t read (tl;dr) The health system is in place, but widespread poverty means people are not as healthy as they could be.
Ok but I have to end with hope! There is so much. One success story is Noreen, an amazing social worker in Okahandja who gave the most passionate speech on changing cultural norms at a community meeting on Saturday. Another is the national news, which is flooded with public health reminders: to exercise, get circumcised, and be tested for HIV (whether people are watching this or soapies though is unclear). And finally, prevention services like condoms, immunizations, and circumcision are free of charge!
Shave your baby men and ladies, it’s free.