To Stand With and Advocate

Last Friday, some men rushed into the clinic and – in a rapid stream of Xhosa – told us Fumanekile, an HIV/TB patient who has been rapidly deteriorating lately, was very sick. When we went to check on him – in his tiny, cramped, run-down, but clean and well-maintained, shack – he was unconscious, with depressed vital signs and shallow, irregular respirations. We loaded him on to our stretcher and put him in the back of our truck, where I climbed in the back, ready for another Mthatha ambulance run.

There wasn’t much I could do on the ride to the hospital. We don’t have any portable oxygen canisters in the clinic; the ride is so bumpy and stop-n-go I can barely take a pulse; and I couldn’t keep up an encouraging conversation as he was unconscious. About all I could do was hold his head to ensure it didn’t hit the seats in the back of the truck.

The hospital was what you might conjure up if asked to describe a stereotypical African hospital scene – patients on beds in hallways, patients in wheelchairs outside, loads of patients waiting on benches, nurses everywhere but no one apparently in charge. It was chaotic and it was distressing. I asked Fumanekile’s sister, who had come with us, to find an empty bed (fortunately her English is not bad) while I went and made sure we parked the truck as close to the door as possible.

But when I returned, his sister had not found a bed – when there’s no one clearly in charge, it’s hard to know whom to ask. I had long since decided the best response to the chaos was to act confident, in control, and knowledgeable (though I felt none of the three) so I barged into the actual ward where they were seeing patients (as opposed to letting them languish in the hallways). As I was barging in, I saw two somber-looking men wheeling a coffin out. I thought first, “Will that be Fumanekile in a couple hours?” Then I thought, “There must be a free bed here somewhere!” There was but I had to wrangle the nurse for it, explaining Fumanekile’s condition – basically making up vital signs and using the words I remembered from my ambulance department days that sounded most sophisticated and indicative of the worst possible condition.

In any event, we got him on to a bed and into the ward – jumping two other people who were waiting on beds outside the door to get in – where the nurses began to examine him. I had to hold back, because from my Nome ambulance department days I was used to seeing patients get oxygen, have blood drawn, and so on and so forth. One nurse took a blood pressure (surprisingly high, given the circumstances) and then another began to take an oral history from his sister.

His sister is a very capable and competent woman whom I respect a great deal. But I figured this wasn’t an easy situation for her and she might have to be in the hospital for a while so I figured she deserved a chair. The only one I could find, though, was behind an official-looking desk, scattered with official-looking papers. But since there were no official-looking people there, I thought the chair could be put to better use and carried it over to his sister, pantomiming the secrecy of the operation. We both laughed.

And that was about all I could do. I gave his sister my phone number (on the package of an alcohol wipe), not expecting her to use it – her English is alright but I doubt we could communicate very well on the phone because there would be hand motions – and some money, to get back to Itipini if need be and to call her family.

During mission training in June, one of our presenters asked us to introduce ourselves by picking a verb that would describe the work we were hoping to do abroad. I picked something basic like to “serve and learn” but two of my colleagues were a bit more creative and their verbs have stayed with me. Harry, who is in Jerusalem, said he was going to “stand with” and Kate, who is in the Dominican Republic, said she was going to “advocate.”

It occurred to me as we were driving away that I had been standing with Fumanekile during the trip. It wasn’t much but it was something. And when we got to the hospital, I became his advocate and ensured he was seen immediately. (I don’t even want to think about the racial implications of my advocacy. Did the nurses see him first because he was the most acute patient or because there was a tall white guy insisting they do so? Why could I find a bed so easily when his sister could not? Why should I be his advocate and not everyone else’s?) I like how expanding my vocabulary makes me think I’ve actually done something useful.

I learned on Monday Fumanekile is still alive; he can’t speak but has regained consciousness. His mother came to town from a village and his siblings have been to visit him.

Also on Monday, I visited a patient in his shack. He cannot walk, is distressingly thin and emaciated, and has a worryingly low CD4 count. It never ends.