Clinic

Yesterday afternoon, I visited one of the three clinics where the Council conducts its Phase III study of Carraguard, our microbicide. The clinic was open only for administrative work on the day that I visited, and was not seeing any clients. This was disappointing, but made it easy for me and my colleagues to walk through the clinic and ask lots of questions.

I was struck by how bare and plain it seemed. There were public health posters on many, but not all, walls, and it seemed like not a particularly cheerful place. But I learned a lot --- when I asked a colleague of mine for her impressions, she said how nice it was relative to most public health clinics in South Africa. "It's clean, it's well-lit, and there's a place for children to play."**

Indeed, the clinic seems to be a small oasis in a fairly rough area. Another colleague told me that on a previous trip, his driver had overshot the driveway for the clinic by about 25 yards. Backing up was awkward, so my colleague moved to walk the distance. The driver wouldn't let him, saying that it was too dangerous to walk that distance, even in the daylight. This is, of course, a depressing commentary on conditions for the poor in this country.

The site has a generator, but I noted that the generator operates only for the benefit of the laboratory (so the samples do not get ruined). Therefore, when the electricity goes out (as it does frequently), this often means that the clients can't be seen, because of the reliance on computers to check clients in, record data, etc. (not to mention see in the dark).

An even more sobering commentary came from a story another colleague told me from her visit to the clinic earlier in the week. She sat in the waiting room, talking and listening to the clients. One client said how much she liked the product -- because she could put the gel in her vagina in the morning, and then she wouldn't worry as much about being raped as she went to work in the afternoon.

A lot of the Council's work focuses on the dynamic between men and women, and in particular empowering women and giving them choices. This is a good example of the connection between gender dynamics and health outcomes.

** After other colleagues read this blog, they told me quite clearly that the clinic we run is on the very high end of public health facilities in Africa. Other facilities are cramped, dirty, and entirely disagreeable places to visit.