Sala Kahle

Bear with me, but I'm deviating from my normal blog format to write about something I feel incredibly strongly about. This is in no way an indictment of any of the clinics I have been working with. These thoughts are my own and not those of anyone I'm affiliated with in South Africa.

Whilst in clinic we were asked if we minded having some students sit with us and, of course, said yes. It transpired these were third year homeopathy students from a 6 year course at Durban University of Technology (DUT). Those of you who have ever had the pleasure of being on the receiving end of one of my sceptical rants will know how I feel about homeopathy, and I wanted to put down in writing why it has provoked such a response.

Homeopathy was thought up in the 1790s by Samuel Hahnemman, a German who constructed the concept of treating like with like, as opposed to conventional 'allopathic' medicine. There are good summaries of this system and how it purports to work here and here, but, in short, infinitesimally small quantities of compounds that would normally induce the symptoms you are trying to treat are given in sugar pills. Along the way there is some very important hitting of vials against special pieces of leather, which apparently aids the water in gaining the memory of the original substance.

There is absolutely no good evidence to suggest that homeopathy works in any way other than as a placebo. Contrary to what proponents will try and tell you, there have been plenty of randomised control trials and meta-analyses, all of which have failed to show any efficacy (see the House of Commons 2010 Select Committee report here and for those with less time www.howdoeshomeopathywork.com is very readable). Indeed, it is argued that carrying out any more research would not only be a waste of time and money but also unethical, as we already have plenty of robust evidence it doesn't work. This is hardly surprising given that homeopathy is based on nothing that even vaguely resembles modern science.

I'm illustrating my story with that much beloved device of the alternative practitioner, the anecdote. A lady came to the clinic and told us a few weeks before she had been treated for a fungal skin condition with a topical anti-fungal, anti-fungal tablets and a homeopathic preparation 'prescribed' by one of the students. Her rash had cleared up beautifully and she had returned to the clinic to get some more of the homeopathic remedy, believing this to be the one that had worked. She now thinks that homeopathy is an effective, safe way to treat medical conditions. This is a concerning development given she is on (rigorously tested and evidence-based) anti-retroviral therapy for HIV.

Those who say 'but what's the harm?' would do well to look at this website, which compiles cases where homeopathy, other alternative therapies and misinformation have been implicated in illness and even death. This question is even more important in a country desperately in need of qualified medical professionals and access to quality medications. South Africa (and KwaZulu Natal in particular) is still gripped by the HIV pandemic, and tuberculosis (TB) is widespread amongst the poorest members of the population. Defaulting on treatment is a huge problem, which contributed to the rise of Multi-drug resistant (MDR) TB and now Extensively drug resistant (XDR) TB. To suggest that one of the answers to these problems lies with homeopathy, a claim made by Durban University of Technology in their course brochure, is outrageous, and has the potential to make already serious problems very much worse.

I'm angry enough that there are still homeopathy services offered by the NHS (although encouragingly the NHS Choices website has recently been updated to state that there is no evidence it works). But to train young people to dispense sugar pills to a poor, desperate population with health problems of such a devastating nature makes me livid. The students I met were bright, friendly and compassionate and had been taught the basics of anatomy and physiology well. They just want to help those in need, but have been taken in by a very expensive lie (the course costs nearly R100000, about £6000). If these resources were put to use training them as nurses and doctors then you'd begin to solve one of the biggest problems facing South African healthcare.

I'm not deluded enough to think my blog post is going to change South African health policy or make a university rethink its course, but if a few people have learnt something about the myth of homeopathy and why it's not a benign force, then that's a good start.

The train pulled in at Park Station in the centre of Johannesburg. I was picked up by my hostel, Lebo's Backpackers in Orlando West, Soweto. The South Western Townships have existed in some form since the early 1900s and now comprise 34 sections and an estimated 3.5-5 million inhabitants (vague because of the numbers of unregistered residents). Previously notorious for the violent protests of the 80s and 90s, Soweto has become a thriving community and is the richest township in South Africa, but still contains slum housing and serious deprivation. When I was looking for accommodation in Joburg, most places prided themselves on being secure compounds away from anything even vaguely interesting. Lebo's brings the world to Soweto, giving you a chance to experience the reality of life for many South Africans and see the optimism that exudes from the place.

Lebo made his name taking bicycle tours through Soweto and I joined an outing the next morning (on a pink bike, obviously). It was a great way to experience parts of the township usually unseen by tourists. We tried the local delicacy of cow cheek and unfiltered beer in a shebeen (beer house) and visited the Hector Pieterson Memorial before seeing Nelson Mandela and Desmond Tutu's homes on the same street.

The musical heritage of Soweto is incredibly strong, from Solomon Linda (whose Mubube was infamously rewritten as The Lion Sleeps Tonight) to new artists and the fabulous Soweto Gospel Choir.

After learning some of the language in KwaZulu Natal where (the clue is in the name) all you need is Zulu, it was rendered pretty useless as every street in Soweto is home to a different language (SA has 11 official languages and countless dialects) and most of the young people speak a blended street slang that takes bits from all of them.

In the afternoon I visited the Apartheid Museum with Claire, originally from Australia but now living in Windhoek, Namibia and touring South Africa to get ideas for the backpackers and safari company she works for, Chameleon [http://www.chameleonbackpackers.com/bps_home.asp] (you're welcome Claire). The museum is very impressive and sensitively presents the last hundred years of South African social history, highlighting the problems without preaching and celebrating the successes of the Rainbow Nation without ignoring the shortcomings.

Next morning I braved the metro and central Joburg and appreciated the view from the tallest building in Africa.

The Arts on Main centre is an old warehouse converted to studio space, shops and a restaurant; something of an island of hipsters surrounded by the slightly intimidating former CBD. Main Street Life up the road has a similar vibe.

I made the most of the Transvaal autumn sunshine on my last morning and ended up being interviewed for Austrian TV about why I had chosen to stay in Soweto, before heading to the airport for the flight home. South Africa is a fascinating country and I'm glad I got a chance to see a little of it before leaving. But leave I must, as it is time for my little brother, who I swear just yesterday had Ryan Giggs on his duvet cover, to get married and the last part of my year out to begin.

I'd opted for the Premier Classe from Cape Town to Johannesburg, which combined my love of trains with a constant supply of food. I took a cab to the disappointingly concrete Cape Town station where we had tea and croissants in the lounge whilst our luggage was taken on board.

As we departed, snacks and champagne were served in the dining car (yes, I was a good 20 years younger than the rest of the passengers) and once we were out of the industrial fringes of Cape Town, the scenery quickly got interesting. The train passed through wine country before entering valleys with cloud-topped hills.

A three course lunch came next (vegetable terrine, orange chicken with rice and vegetables, strawberry cheesecake) after which I did some more staring out the window.

After afternoon tea and carrot cake I watched the sun go down somewhere in the Karoo semi-desert before heading for dinner. Five courses this time and yes I'm going to list them all- vegetable soup, fried fish, leg of lamb with potatoes, butternut, cauliflower and broccoli cheese, the traditional South African sponge malva pudding, biscuits and cheese. I rolled back to my compartment and slept as soundly as I always do on a moving train.

I woke to early sun over the flat expanse of the Transvaal, with corn and just-finished sunflower fields rolling by as I ate a huge cooked breakfast. The scenery became increasingly populated as we reached the outskirts of Johannesburg, arriving at Park Station over two hours late, but given my only purpose was the journey itself, that was nothing to complain about.

I navigated the impressive bus system to Greenpoint, where I was staying at the wonderful B.I.G backpackers. Within 10 minutes I'd been invited by my German roommate Monic to First Thursday, a monthly event where shops and galleries stay open late and serve wine. Ideal. We braved the rain and ended up in a higgledy piggledy antiques shop with a whole room dedicated to vintage bridal gowns, which somehow I was persuaded to try on. Make the most of this picture, it's unlikely to be repeated...

We moved on to a bar where one of the girls, Daragh, sustained a disco injury which I suspected had fractured her wrist, so we ended our night in the emergency department. I just can't keep away.

On Friday a few of us joined a very informative free walking tour around the city centre, taking in the old parliament building, high court and City Hall, from where Nelson Mandela gave gave his first speech as a free man when he was released on 11th February 1990. The realities of segregation and subsequent apartheid are all around, including a bench where I would have been required to sit.

The Slave Lodge was where the Dutch East India Trading Company used to house their slaves and now serves as a museum. Behind is the square where slaves were auctioned, now marked by stone plinths inscribed with their names.

We walked to the lively Victoria and Alfred Waterfront (named for the queen and her son) and perused the shops before returning to B.I.G where the staff had cooked industrial quantities of bunny chow and chocolate cake.

On Saturday we took a cab out to the Old Biscuit Mill, where a local food market is held weekly. What with the drizzle, the accents and the vintage feel this could easily have been Spitalfields and is a firm favourite of the local hipsters. I met our Felbridge neighbours' delightful nephews, Blake and Evan, for lunch at the Waterfront and tried Springbok. In the afternoon the weather scuppered our plans so we watched crap films in the cosy living room (apparently a temperature of 16C is all it takes for Capetonians to deem a wood fire necessary) before margaritas and Mexican with Jill, an American who was heading to Bangkok.

Sunday was glorious and some of us ventured up the cable car to the top of Table Mountain, where the table cloth was only half obscuring the view. The little dassies scuttled around; bizarrely their nearest relative is the elephant.

In the afternoon Ella and Meg, two Australian girls, and I took the ferry to Robben Island, the infamous prison island where some of the most notorious political prisoners of the struggle against apartheid were held, including Nelson Mandela for 18 of his 27 years of captivity. The tour was excellent and the museum has decided only ex-political prisoners can show visitors around the maximum security compound. Our guide was just out of high school when he was sent there in the early 80s and would often borrow the kitchen workers uniforms to sneak his way in to see Mandela and other ANC leaders.

On Monday I took the local metrorail south to picturesque Kalk Bay where Rosemary, who I was in the Brighton Festival Chorus with, now lives. As always it was wonderful to see a familiar face and we had a lovely day walking in the sunshine and eating calamari and chips on the harbour wall as seals looked on.

In the evening a group from the hostel went for dinner as it was the last night for three of us. Cape Town has instantly become one of my favourite cities, no doubt helped by the lovely guests and staff at B.I.G, which I would recommend to anyone.

I could have stayed forever but it was time to move on. Most of you know by now that if there's a train, I'll take it and for the next leg I'd gone upmarket- the 26 hour Premier Classe Cape Town to Johannesburg service.

Sarah (an American who is volunteering at Makaphutu) and I had an early start on Monday to drive up to iSamangaliso wetlands park. We stopped off at the excellent Crocodile Centre where they breed and rehabilitate crocs. Here's a pile of babies trying to get close to the heat lamp.

We had a guided walk on the outskirts of the park which gave us a chance to see some of the things you just can't appreciate from a car- stag beetles, ant nests, exotic fruits and tiny birds.

The planned boat trip was cancelled due to the high winds but we drove through the park instead, seeing all sorts of wildlife before stumbling upon Cape Vidal and the Indian Ocean.

In the evening we walked out to the estuary to see (and hear!) hippos. Next morning we hopped aboard a huge 4x4 for a game drive at Hluhluwe (pronounced with several invisible S's) Game Reserve, the oldest in South Africa. After more giraffes, rhinos and zebras we hit the jackpot when two lionesses and their cubs walked out in front of us. They seemed pretty peeved with us and we even got roared at.

After a picnic lunch and on the way out of the park we finally spotted elephants- three bulls happily munching their way through the bush. Near the gate were two more in the dry river bed. Sadly we didn't spot any leopards, but four of the 'Big 5' (lions, elephants, rhino, buffalo) isn't too shabby.

After returning to Durban, Chris and Dario came to collect Sarah and we all went for Indian food- Durban has the highest proportion of Indians outside India and so the curries are pretty authentic, even if they do stuff them in to loaves of breads to make local specialty 'bunny chow'.

And so I was on my own again. I had a day left in city so I headed to the beach, as had everyone else as it was yet another public holiday. This one was because of the elections, the first in which people born since the end of apartheid could vote.

On Thursday I headed for the airport for my flight to the Mother City, Cape Town.