The Storm After the Calm: South Africa Moves to a Primary Healthcare Model

Valerie A. Douglas-Sweet, BSN, RN


Topics in Advanced Practice Nursing eJournal 

In This Article

Journey to Cape Town

After a 26-hour trip, my colleagues and I fall silent under the twinkling lights on the western hillside of the city of Cape Town. The beauty of this country, even at night, haunts us. Here, far from home, 50 nursing students and RNs from all over the United States gather to get an education of the kind that can only be gleaned from study abroad. On the east side of the bus, there are no twinkling lights, only shiny tin roofs so close together that they flow almost seamlessly along the road and as far into the night as we can see. There are no lights on this side of the road because there is no electricity. No sanitation, either (Figure 1). The highway divides the privileged from the unprivileged, the haves from the have-nots, and the wealthy, educated, and employed from the poor, transient, and unschooled.

Figure 1.

Informal dwellings or "shanty town."

The world has acknowledged the struggle and subjugation of the nonwhite peoples of South Africa. The wealthy were the beneficiaries of apartheid; the unprivileged poor, its legacy. Families were torn from their homes and properties and forcefully bused into racially divided districts and townships. Robbed of opportunity by virtue of inferior education, they were stripped of their culture when compelled to learn Afrikaans, the white man's language. Eighty percent of the population of South Africa practices in the trades or works in jobs that require only informal training. Many South Africans are illiterate, and in some areas unemployment soars to 40%. Some of the poor here fled for their lives from neighboring countries. Others moved here from rural villages, and some have simply given up on the idea of equality and fallen into a desperate state of drug and alcohol abuse.


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