Table Mountain Sunrise Farewell

So, this is it. Our last sinrise in Africa. At least for the time being. And, my last blog. At least for the time being. Lots more stories to tell, but they'll have to be face-to-face. Can't wait.

In the mean time, enjoy the sights and sounds of our last Table Mountain sunrise.

See you soon,

Seth./.

p.s. One last story for the road. When we meet, ask me about "passion gap."

"You're just so Not-American"

So, how do you wrap up a year like this, succinctly, with a nice little bow, with no lose ends, having drawn the most acute insights possible from the experience? You don’t really. But going through the goodbyes with colleagues at UWC and UCT, and friends in Cape Town has pushed me to try to capture some of the learning that has taken place over the past year.

It is amazing to me how this one theme kept emerging...

Saying Good-Bye at UCT

My last day at UCT was wonderful. All the work had been wrapped up earlier in the week. I had a great final meeting with Judy, Sonwabo and Frank, some of the leaders from the "Social Responsiveness Committee" that I've worked closely with over the past year. My “Facilitator Training” for the upcoming “students in/and community conference” happened on Tuesday, and went really well. This is a conference that a group of activist students at UCT are organizing, and I've been helping them a bit with the planning. And the community partner lunch with Marlese and the new law and social justice service learning course took place on Wednesday, and resulted in some wonderful exchange between the prof (Marlese) and some very dynamic community organizations. They had done their homework, had read the course outline Marlese had sent them, and were very interested in sharing their ideas about social justice, and the relationship of these theories and concepts to the reality of the work they do (women's rights; farworkers' rights; youth development; housing and homelessness). It was a great meeting of "theory meet practice!" Sweet.

Then on Thursday, I took the day off and we got some boxes shipped off through the US Embassy, and said our goodbyes to the folks there. All that was left was a noon-time party at UCT, with my colleagues from the Center for Higher Education Development, CHED, my home for the past year.

Janice organized a wonderful, groundbreaking lunch. Groundbreaking in so far as they served wine, which was a first for a noontime gathering at CHED! A number of people spoke, including the Dean, the Director of the department where I had been affiliated, a representative from the School of Health Sciences with whom I had worked a lot on the social responsiveness policy working group, a student, and my colleague Janice. They all had wonderful things to say, about the work I had been able to accomplish, and the contributions they felt I’ve made to UCT.

I’ll spare you the self-congratulatory details, but one theme stood out for me that I do want to share, that echoed a theme from the goodbye party at UWC a week earlier. That is: you are a very NOT-American American! Not mincing words, colleagues from both campuses talked about how they were not necessarily looking forward to another “know-it-all professor from the US” coming to share their wisdom, tell them all what is right and wrong, and without any knowledge of the local context, critique their work. Pretty shocking, huh? Now I surely knew about the image of the ugly American tourist. And, I have also had lots of intimate opportunities to get to know the arrogance that comes with academia. BUT, I had never put these two things together. What a powerfully ugly combination: the UGLY AMERICAN ACADEMI! The know-it-all of all know-it-alls! Arrogance supreme.

How Low the Bar!

So, with that as the expectation, it was absolutely wonderful to be complemented as being the NOT-American academic. People really appreciated that I listened, and that I struggled to understand their context and their history. They appreciated how I didn’t try to bring the CSUMB service-learning dogma to them, but was willing to rethink and rework the concepts, so that they made sense for their own context and experience!

I guess when the bar is set so low, it is easy to stand out. The incredibly depressing insight is the realization of how low the bar was actually set. I know we can’t blame it all on the Bush presidency, but the words “American” and “arrogance” sure seem to go together in many people’s minds. Throw the word “academic” on top of that, and you have the very un-holy trinity of the Triple A: ARROGANT AMERICAN ACADEMIC.

Hopefully, I have contributed a little toward replacing the adjective ARROGANT with the words RESPECTFUL, CURIOUS, and CONTEXTUALLY-SENSITIVE (need to come up with a better word for CONTEXTUALLY-SENSITIVE). Amazing the impact that the past eight years, and a couple of wars, has had. Get out there friends. We've got work to do.

Blog ya later,

Seth./.

Catalysing Change in Pharmacy

OK, so perhaps you would have to be a service learning person to truly get excited by this scene: a big long table in the University of the Western Cape School of Pharmacy "Pharmacy Practice Foyer," around which were seated 7 professors (including the new Dean), 7 hospital/Communty Healthcare Center pharmacists, and two Cape Town health department bureaucrats. Rock on! What a party!

This was the party we had pulled together for my grande finale at the UWC School of Pharmacy. It was our "winter" service learning reflection session, where we had invited the 10 partnering hospitals and Community Healthcare Center pharmacist to come and share their insights, talk to professors, and keep on building the "Service Learning in Pharmacy" (SLIP) program, which has been my home for the past year at UWC. The most special guest was the new "Dean" of the school, who had just come a few months ago, and was struggling somewhat to understand what this "service learning" and "social justice" thing was all about. (No offense to my scienctist friends, but he is a laboratory chemist, afterall!) So, this was to be the first time for him to meet the partners, and to hear their perspectives on this program. Another special guest was the Director of Pharmacy services for the Cape Town district of the Department of Health. In other words, the bossman of all the pharmacists sitting around the table, who has been a big supporter of the SLIP program and helping to advance the idea of "patient-centred care."

The REAL VALUE of Service Learning
The previous day I had gone out to lunch with the new Dean, and was trying to help him understand service-learning. Like many new to this work, his undersanding of service learning was pretty literal: students do work in pharmacies, provide help to the way over-stressed staff, and at the same time, strengthen their knowledge about pharmaceutics and pharmacology. He was happy that the program seemed to be doing all those things, but his worry was that the "block" approach (students coming for 2 weeks at a time, 3 times during the academic year), did not give the pharmacies the consistent support that they really needed. He proposed that we change the schedule to have students come 2 times/week, on a regular basis for the entire year. He thought that this kind of consistent "service," would be of greater value to the overstretched pharmacies. Afterall, isn't that what they really need? People to take some of the burden off their huge work load?

In the car on the way to and from lunch the previous day, I had tried to share my perspective on the "real value" of service learning. I had told him that from my experience at CSUMB, and from what I had heard from my interviews with the hospital and CHC pharmacists in my evaluation the previous semester, there was something much richer happening in service-learning partnerships. While the contribution that students can make to reducing the work load was valuable and a real help, the real worth of the program was the emerging conversation that was linking practitioners and academics around the deep issues that they are struggling with: trying to deliver quality healthcare in one of the most unequal societies in the world! Once again, it emerges that even though pratitioners ARE overwhelmed, and even though that supervising students IS extra work, it is all worth it when there is a sense that we are working together to find solutions to the real problems, the structural problems, that we are facing. For pharmacists, this means reconnecting with the original reason they entered the profession, to provide quality healthcare. Unfortunately, with the reality of HIV, TB, hypertension, and diabetes all endemic in the poor South African population that they serve , all pharmacists are able to do is hand-out pills. (80% of South Africans use pubilc healthcare; while 65% of doctors work in the private sector...the Mitchell's Plain Community Healthcare Center serves over 1 million people! That's right, the only hospital in a subur of 1 million people, with very high rates of HIV and TB infection.) Or as they say "pick (the drugs off the shelf), lick (the labels that tell the patient what to do), and stick (the labels on the container)."

So, the real value of service-learning is that we are providing a space where the practitioners can pull their heads above water for a moment, and ask the questions that they walk around with all day long:

• What is the pharmacist's role in primary healthcare delivery?
• In addition to their technical knowledge in pharmaceutics and pharmacology, what other knowledge, skills and values do pharmacists need to sensitvely and effectively help people use medicines wisely?
• How do we inspire the next generation of pharmacists to embrace the challenges affecting the field?

And guess what happened at this meeting? Even though I presented the new Dean's proposal for re-working the schedule, the partner pharmacists themselves said: "We like the intensity of the 2-week blocks. That allows us to really help the students get connected to the site, and get more depth from the experience. And anyway, if it was just to dispense drugs, we would hire part-timers to fill in the gaps."

My Parting Gift: "We Need to Meet More Often."

It was so cool that I didn't have to say it, but that the partners themselves so eloquently expressed this deeper value that has emerged through their work with the university over the past year. Their enthusiasm for this project was so powerful, that it almost scared the new Dean. What a shock: a roomfull of passionate and empowered public sector employees, not the overworked, apathetic healthcare drones that the stereotype leads one to expect! As we were wrapping up, the director of pharmacy services for Cape Town said: "This is great, but getting together 2 times/year is not enough. We need to meet more often to put real energy into this project. We can come up with some pilot efforts that can be implemented with students' support. And we will be able to demonstrate to the Department that there is another way to deliver pharmacy services that is more patient-centred." And everybody around the table nodded in agreement. I'm sure you can feel the energy, no?

What a fabulous good-bye present that was. I couldn't have asked for anything more (even though I did appreciate the pen and the UWC tie that the staff presented me at the end of the meeting). To have a room full of very busy people, from very different walks of life, with lots of paperwork and patients and students waiting for them, look at each other and say, "we need to meet more often," that is real proof that this work is valuable. And even though they said, "Seth, you can come to," the best gift for me as the "external catalyst," was that they were looking at each other, and making this commitment to each other, and not to me.

I usually use the metaphor of "planting seeds." But I think the chemical metaphor is much more appropriate in this pharmacy context. I think I have been a pretty effective catalyst here. The ingredients were here. Afterall, the project had existed and was running for 3 years. But, I definitely inserted some new concepts/ideas into the mix, about values and social justice and confronting inequality. And I also nurtured the partnership, creating space for a meaningful conversation, developing a common agenda. Some kind of chemical reaction definitely has taken place. That room was definitely bubbling and frothing like a magic social justice-oriented service learning potion! Let's hope that they have enough of the right ingredients to keep it cooking. Afterall, the health of millions of people depend on it.

Blog ya later.

Seth./.

Some Rainy Day Thoughts

A month from tomorrow and we'll be getting on the plane to California, saying goodbye to what has been an inspiring year for the Pollacks in Cape Town. It's full-on winter in Cape Town now, which means clouds and wind and rain, and short days and long nights. Good days for rooibus tea (our new favorite, with milk!), and a fire place. Or, a quiet day without any meetings at one's office (as is the case today).


Obama's Speech in Cairo
Yesterday Obama gave his long-awaited speech in Cairo. I've read the speech, and have been reading reactions to it this morning. I so appreciate what he said, putting Israelis and Palestinians on equal footing as human beings deserving of dignity and a home and a viable future. But even more importantly, I love HOW he said it. So many of the articles commented how he included quotes form the Koran. And the New York Times commented how exceptional it was for him to open his speech with "Salaam Aleikum." It seemed that this simple act of greeting people in their own language was a historic first step for an American president in the Arab world.


Wow! Are we that pompous? Are we that dis-connected? Are we that arrogant? I guess we can be. But if you've ever lived in a muslim country, you know how rich life is made by the blessings and prayers that are offered to both G_d and to each other throughout the day. "Bissimilayi" or "welcome," when you arrive somewhere; or sometimes in an animated discussion, it might mean "I can't believe it!" "Allah akbar" or "G_d is great!" or again, it can mean something like "Unbelievable!" "Wallaayi" or "Ain't that the truth!" Amazing that our leaders can be so disconnected, and that we Americans can be so insulated. It really shows us that for those of us who have lived in diverse settings, and come to know the human reality that connects all of us so deeply, we have a responsibility! We have to lead with our truth, and demonstrate our love and understanding in more bold ways. Yes, saying "Salaam aleikum" might just be a radical act of transformation! (By the way, I found Thomas Friedman's piece, though written before the speech was delivered, to be wonderful: http://www.nytimes.com/2009/06/03/opinion/03friedman.html?em)


A Bicycle Commute in the Rain
So, although I've been a pretty regular road rider on Satudays, and somewhat regular in spin classes in the gym during the week, I've not at all used my bike to commute to campus. Everyday, I sit in traffic for a good 30-45 minutes, taking the girls to school and then making my way to either UCT or UWC. Either way, I spend minutes creeping along at a snail's pace, in a line of cars that seems to go on forever. This is the first time in my life that I have EVER had to go with traffic in a commuting rush. In Monterey, I have a 10 minute drive (45 minute ride on bike paths) against traffic to CSUMB. In Palo Alto, I had a bike, and in Manhattan, it was either bicycle or subway. Now, for the first time, I am sitting with everyone else, listening to talk radio as I snail my way to work in the mornings.


Well, today was going to be my day. We had to bring our car into the shop for a service before we sell it, so I was completely excited to put my bike in the car, and then ride from the repair shop up the hill to UCT. This was going to be my moment of revenge. To go smoothly and quietly along the side, passing sitting motorists along the way, even on an uphill climb. (As you can see from the picture here, UCT is situated at the base of the backside of Table Mountain, just below "Devil's Peak," a nice climb up from the town of Newlands below.) This would be a sweet revenge, even momentary, for the months I had spent sitting in the traffic.


So, I dropped off Maya at school especially early (she had a final, and wanted to get there early anyway), and was at the dealership by 7:30, filling-out the paperwork, saying "see ya later" to our repair-person friend Leslie, putting on my bike shoes, tucking my pant legs into my socks, and then with the glee of a little boy riding his bike to school for the first time, I sped away. The weather was cooperating, as it was dark and grey, but no rain. To avoid the ugliest of the traffic, and the most dangerous of city streets, I snaked my way through the now familiar neighborhoods of Claremont and Newlands, up the hill to Newlands Avenue, which is one of my lest favorite congested stretches of my daily commute. But this time, I was able to fulfill my dream, and I got along the side of the line of cars, and with a silent smirk on my face, cruised by dozens of cars, up the hill to the M3, and then onto the UCT campus. 15 minutes later, I was in my office, sweaty but happy, feeling very fulfilled and proud of myself.


Then, I sat down at looked at my key chain --the car key was still on it! In my enthusiasm to get on my bike and fly by all the traffic jammed cars, I forgot to give Leslie the car key! So, after a searching call to Naomi, who had no interest in leaving the warm confines of our home and driving WITH TRAFFIC up to the shop with the other key, I got back on the bike, this time a little less joyously. Down the hill, past all those cars again, and to the dealership, where I gave a grinning Leslie the key!


My second trip up the hill to UCT was a bit less of a thrill, for two reasons. One is that it was now 8:30, so the worst of the rush hour congestion was over. I only got to speed by a dozen or so cars this time. Secondly, about half way up the hill, the skies opened up, and the rain started. So, by the time I got to campus, I was drenched. Nothing that a cup of rooibus tea can't cure. But at least I can now say that I've cycled to campus, twice!


Blog ya later.

Seth./.

"Our Clinics are Over-Researched. I'm ready to lock the doors!"

I've not written much about my work with the two Universities in service learning. Curriculum development, course evaluations and faculty workshops are not always the most exciting thing to read about. I guess I was waiting for some inspiring gems of wisdom to share. There have been some great moments, some real goose-bumpy, light-bulb illuminating, insight-rich moments. But now that there is only six weeks to go on our year here, I better start sharing a few. Let me start with yesterday, Friday.

4th Year Pharmacy Students and Day Hospitals
I went with two colleagues from the UWC School of Pharmacy to meet a community partner and continue the planning of a new 3rd year service learning program for the School of Pharmacy. I've done a lot of work with their 4th year program, helping it more clearly address issues of social responsibility and social justice, and providing a richer framework for reflection and learning. In their 4th year program, the students spend 6 weeks in pharmacies in both tertiary teaching hospitals and local "day hospitals." The "tertiary hospitals" include Groote Schuur Hospital, which is famous for being the place where Dr. Christian Barnard did the first heart transplant, and are generally modern and well-equipped. On the other hand, the "day hospitals" are the government hospitals that serve the majority of the population. Only 20% of the S.A. population have health care, and they use private hospitals. The other 80% get virtually free health care at these public facilities, and the "day hospitals," are the first point of access for many people. They have a reputation for being overcrowded and underserved, which is pretty true (fact: the Mitchell's Plain day hospital serves a catchment area of about 1 million people. It is the only hospital in that area!). These hospitals also have a reputation for having poorly trained doctors and nurses, which is VERY UN-TRUE! However, patients often wait for hours before seeing a doctor, and then additional hours in order to get their medicines from the pharmacy. You can imagine how crowded these hospitals and pharmacies are in the context of AIDS and TB, both of which are endemic in many of these communities. You now hae thousands of people coming in regularly for their anti-retral virals, and their TB medicines, which makes for even more stress on the pharmacies! Not a pretty picture.

New 3rd Year Service Learning Program
Working in the pharmacies in these "day hospitals," the pharmacy students get great insight into the pharmacy/drug side of health care, and the realities of the difficulties of the public health program in South Africa. BUT, given the workload, they get very little time to actually talk with patients, or to get to know the communities that their patients come from, and their social context. So for example, you give someone medicines which need to be refrigerated, and they have no electricity where they live. Or, if they have electricity, they don't have a fridge. What do you do? Or, you give someone a medicine that has to be taken 3 times/day with food, but in fact, the person only eats one meal per day. What do you do?

So, the 3rd year service learning program is designed to give the students more exposure to the patients and their communities by doing service in city health clinics which provide primary health care services to women and children. So, we went to meet with Mary (not her real name), who is the district manager for 10 clinics in the area surrounding UWC. Mary is amazing, and has been actively involved with service learning at UWC for 10 years. Ironically though, even though she has been at many meetings, she has yet to really get into a true service learning partnership with the university. Don't get me wrong, there are plenty of students who come to Mary's clinics to "serve," including many nursing students. But as Mary says, they just come with their sheets, with a number of boxes that need to be checked off: x number of babies to be weighed; y number of pre-natal consults to be observed; z number of vaccinations to witness. From Mary's perspective, this is far from service-learning. This is checking-off boxes.

Service Learning is Really about Finding Common Agendas
What truly made this conversation different was the starting point. Our initial question to Mary and her staff was, "What kinds of issues do your patients experience with regards to compliance to their medications?" Well, that question set of a flood of stories and examples and situtions which people experience every day with regards to medication. And from there, we asked, "so, how can the 3rd year pharmacy students get exposure to these struggles and issues?" Together, we then developed an idea which is both at the heart of what Merle is struggling with at her clinics with regard to medications, and which provides the pharmacy students with the real-world exposure to communities and primary health care, which they have been missing. It was wonderful to see both the 2 academics from the UWC school of pharmacy, and the two health care administrators becoming so animated and excited, as the project began to come alive, and its scope and significance became more and more evident.

By the time the meeting ended, there was a wonderful sense that the beginning of a truly meaningful and reciprocal program had been created. Then, unprompted, Mary started to talk about her frustration with all the requests for research that she receives. As her clinics are right in the middle of neighborhoods hard hit by TB, by HIV, and by the "methamphetamine" scurge, they are prime targets for research. And yet, Mary's sense was that none of this research really had any impact on her capacity to delivery health care to the population. She recognized that there were undoubtedly some important insights that had been generated by the research, and that perhaps they did lead to some new laboratory-based innovation. But, none of this helped her deliver health care. Her issues continue to go un-met. It was then that she said, "I should just shut the door and say, 'No More.' Our clinics are so over-researched. We need some real research.

Hopefully, some "real research" will be one of the fruits that grow from the seeds of collaboration that were planted the other day.

Blog ya later.

Seth./.

Thunder Storm in Cape Town

We were woken up the other day to incredible thunder. This was unusual, because like our hometown of Monterey, CA, thunder and lightning rarely happens in the Cape. It felt as if the storm was right over our heads, as the lighting flashes were followed immediately by thunderous booms. It made for some pretty wild morning commuting, as the lightning was still going strong, and the rain was coming down in buckets.

Later that day, we receiveds some incredible photos from friends. I like this one, because you can see the incredible mountains which form part of downtown Cape Town, and which we have come to love so dearly over the past year. On the right, is Lion's Head. In the center is Table Mountain, and on the left Devil's Peak. This picture was taken from the North, looking across the harbor to downtown Cape Town. We've been living on the back side of Devil's Peak and Table Mountain, around to the left.

Blog ya later,
Seth./.

San Rock Art in the Cederberg

We have made some amazing trips during our year in South Africa, but one of the most stunning was our weekend in the Cederberg looking at incredible examples of San rock art. The Cederberg is a mountainous area about 200 miles from Cape Town. It is incredibly stark and barren, with few trees, and some amazing sandstone formations and rock outcroppings. And for perhaps 20,000 years, the San (arguably the oldest of all ancient peoples) lived in the caves of the region, doing their "hunting and gathering" thing, while using the regions many caves and overhangs as both shelter and canvas for their "rock art." As a result, the Cederberg is just a treasure chest of pictures, painted on these rocks thousands of years ago. This was definitely the coolest art gallery that I've ever seen.

For Naomi's birthday, I wanted to splurge and take us to a really high end resort called "Bushman's Kloof" (check out their website: http://www.bushmanskloof.co.za/), which is in the area, and is famous for its rock art (and luxury accommodations). But, being the ever practical realist, Naomi didn't want to spend the big bucks, so we went with a down-market option called "Traveler's Rest." We went up with our friends the Boraines, and rented two cute cottages, each with a fireplace and braai (BBQ) area. Right down the road from the cottages was a 4 km trail that took you through the cliffs and to 10 different rock art sites. The paintings were amazing, between 6,000 and 500 years old! It was so cool, as you wandered through these beautiful cliffs and hills and then would come across these amazingly beautiful cave paintings. One more beautiful than the next. At first, you didn't see much. But the more you looked, and the more trained your eye became, you started to notice that there were pictures everywhere you turned. You just couldn't help but feel the centuries and centuries that have past since these pictures were made, and wonder, "what would we leave behind, 6,000 years from now? Would it be as simple and beautiful and expressive?."

I've included a couple of pictures here, but for more, check-out the slideshow as well. Originally, the pictures had multiple colors --so they say-- but some of the colors didn't last as long as others. So, some of the figures are without heads, etc. But what is amazing to me is how delicate and descriptive the pictures are. (OK, the one I included to the right is not so delicate, but it is very descriptive!).

Last South African Adventure?

Anyway, this might have been our last adventure in South Africa --sad but true. We have one more trip planned, to Grahamstown for the National Arts Festival for 3 days before we catch our plan. So, I guess there is still more adventures to come. But nonetheless, this trip was very poingnant, as we all reflected on the amazing beauty and incredible history that we've seen and learned about during the past year. Quite astounding.

Blog ya later.

Seth./.