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De Nile ain't just a river...

It is my first day back on the TB ward. After several months of relatively high levels of staffing the exodus has begun. The Norwegian doctor left to work in the Antarctic last week. In 6 weeks the 5 community service doctors (the South Africans who have to work for a year after their internship in a hospital lacking doctors if they are to be registered) will begin to leave. So I have moved to TB ward to cover the gap.

I had forgotten what it was like. A few people are well and improving on TB treatment. They are there simply to receive their medication as it is too far for them to get to their local clinic. But most are there because they are too sick to be managed by relatives at home. They are on TB treatment but continue to waste away, either because they have advanced HIV, or because they have resistant TB that we haven’t been able to identify. One man lies in bed near paralysed by TB of his spine. Another lies moribund and semi-conscious with TB meningitis.

We enter the side-room. One man, with the unlikely name of Bruce* enagages the nurse in animated conversation. The nurse replies and an extended debate ensues.

She turns to me apologetically. “I am sorry Dr. I am explaining about his HIV test. He does not believe it.”

“Why not?” She asks him. He explains with great animation, expansive arm gestures and widened eyes. He gestures at times towards his finger tips. Finally the nurse turns back.

“He does not believe that a tiny drop of blood from the finger can tell you he has HIV. He believes the sputum can tell you he has TB because that is from the lung, but how can a spot of blood from the finger tell you he has HIV? What has the finger to do with HIV?”

We start a rather tortuous conversation. HIV is partly a disease of your blood, I explain. That is why it does not matter where the blood comes from. He looks at me doubtfully.

“Sister, how about if I take the blood from a big vein in the arm? We can test that. Will he believe that?” She asks him.

“Yes Dr. He would like you to take blood from the big vein. The big vein is from the body – he says he will believe that.” I write the form as the nurse takes the blood - but rather doubt that he will be converted to belief.

*Not his real name but a pseudonym chosen for its broad anaculturistic similarity – a term I have invented to describe something that is out of place culturally aka. anachronism for time. There is probably a proper word for it. Answers on a postcard.

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