Second Post

Last week, I visited a clinic in Rehoboth, a city/township about 90km south of Windhoek. As with most of my ventures outside of the hotel, a fellow co-worker (a driver) drove me to and fro. The trip there bordered on lovely, scenic, despite all of the energy I had to conjure to remain awake---pick-up time was 7:20am---and interact with my colleagues.

The hospital that houses the antiretroviral (ARV) clinic was originally founded by German missionaries. But, in recent years, the Ministry of Health claimed ownership. It still remains heavily funded by an outside NGO, care of USAID, which explains, in part, its outstanding resources and services. Unfortunately, this situation isn't sustainable.

My colleague and I met with the resident social worker and community counselors. They contribute greatly to the well-oiled machine. A little Mayo clinic in a dust bowl populated by the descendants of Dutch-African unions (often the latter being the servant of the former)---officially referred to as Basters.

The meeting was very productive, even if this clinic isn't representative of the majority. I learned the following:

• alcoholism is prevalent in the community.
• sex workers don't use condoms because truck drivers (and others) pay more for raw sex.
• many clinic patients are farm workers, who don't have steady transportation to the clinic, which is why they slip into non-adherence.
• because many live in fear of being fired on account of their HIV status, they don't disclose to their employers, with whom they spend a lot of their time, further complicating the adherence piece.

In case you're wondering why I'm traipsing about health facilities in Namibia...I've been tasked with writing curriculum for a cadre of HIV/AIDS case managers---a new profession needed to support the growing availability of ARVs. The meetings with health workers will, hopefully, lead to a relevant product. (Please don't ask me why a Namibian health professional isn't writing the curriculum. I wouldn't have a satisfactory response.)

The ride back from the clinic was even more pleasant than the ride there. I slept.