Skip to main content

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.

Comments

Post a Comment

Popular posts from this blog

Wherever you go...

I pull the sterile gloves over my gown sleeves and look at the nurse. “Please could you…?” I ask shrugging my shoulders in the universal “my-sterile-gown-is-about-to-fall-off” gesture. She grins and slips around the bed to fumble for the poppers at the back. I eye her name badge. Startled – I glance at her. “Your name is Ndlovu?” “Yes.” “But that is a Zulu name!” “Yes!” Her face lights up. “You have been to South Africa ?” “I was working there last year.” “Oh! Where were you working?” “Hlabisa.” She claps her hands for joy, an enormous grin crossing her face. “But I live near there. If you take the road from Mtuba to the hospital I live in a village on the right.” I laugh at the incongruity of it. Here, in the dark at 2am, on a medical ward in an Oxford hospital, working with a Zulu nurse just I did for the last year. We talk animatedly about her home. “Did you train at Hlabisa?” “No. I trained at Bethesda . Do you know it?” “Oh yes – I visi...
4 comments
Read more

Otherwordly isolation

I lean across the reception desk and catch the attendant’s eye. “Sawubona,” I say, dusting off my rusty Zulu. I see you. “Sawubona, ninjani?” she replies. I see you, are you well? “Ngiyapela.” I’m fine. She grins at me. “You must be a doctor.” “I am! How did you know?” “It is only the doctors around here who use Zulu. Even if it is only the greetings.” She arches an eyebrow. “I used to work here, at Hlabisa hospital up the road. I have a few other Zulu words, you know like ‘Does it hurt?’ and ‘Take a deep breath’.” She laughs. And then launches into an excellent impression of an elderly Zulu lady rattling off a series of complaints, waddling across the reception area clutching her back in mock agony. She gets it exactly right. I have come up to KwaZulu-Natal for a few days. Tonight I am staying in the Hluhluwhe-iMfolozi game park, 20 minutes or so from where I used to work. Awarded my entry ticket, I drive into the park. The sun is low in the sky, the kills bathed in amber light. I ta...
3 comments
Read more

10 years on

The door flies open. Lele peers in. "You must come out here and see. They are doing a play!" I finish up my case file annotation and come to the doorway. The waiting area is in chaos. A gang of school children are manhandling a couple of marimba's to the space in front of the consulting rooms, a team of nurses and counsellors are creating a stage area. Patients look on mutely. Some with interest, others - presumably feeling proportionately less well - without. "What is going on?" I ask. "It is 10 years since the clinic started. 10 years since MSF first started the HIV treatment programme and proved that it could be done in Africa. So the staff are celebrating. They are doing a show or something." The sister in charge of the clinic has moved to the front of the crowd of patients. She calls for silence and then gives a short introduction. Lele translates for me. "She is saying that this is a very important day. 10 years ago people were dying. And 10...
3 comments
Read more