December 22, 2007

Just when you think you’ve seen it all…

…you realize things can get a lot worse.

There’s a patient who’s been occupying a lot of our time lately in Itipini. She’s three weeks younger than me (what different paths our lives have taken since August 1982), she’s HIV-positive (that almost goes without saying), she’s weak, and very thin. Last week, her 3-month old baby died in the clinic and she has no family nearby to help her out. I’ll call her Nosipho, which means gift, though that’s not her real name.

I took Nosipho to the hospital last week but they discharged her over the weekend so she’s stayed in the sick bay at Itipini for a few days and was looked after and fed. I took her back to the hospital for an appointment on Thursday, she stayed the night, and got the results of a blood test that showed her CD4 count is 54. (Below 200 is clinical AIDS in South Africa.) This qualifies her for free anti-retroviral drugs. Sounds like great news, right? (The great news is the potential for drugs, not the CD4 count.) It is great news, provided she can live long enough and has enough energy to navigate the health-care maze to get ARVs. (I have a long post inside me about the ARV bureaucracy but it’ll have to wait until the new year.) I got an indication on Friday she might not.

We had managed to convince a friend of Nosipho’s to accompany her to the hospital to advocate for her. On Friday, the friend came back to the clinic alone. She said Nosipho wasn’t strong enough to make it back herself and so was waiting at the nearest place a taxi would drop her off, about a 10-minute healthy-person walk away. I drove down to the gas station where Nosipho was waiting.

I don’t know what I was expecting but it certainly wasn’t what I got. Nosipho was lying behind the gas station, in the midst of a pile of garbage (they are everywhere in Mthatha), on a piece of cardboard, and covered with a thick blanket, even though it was one of the hottest days I’ve experienced so far here. The gas station is right next to a shopping mall and a liquor store so there were loads of people around but no one was interested in her. It’s been worn down in my time here, but this set my outrage meter off. It’s one thing to see a person suffering in the midst of everyday life; it’s another thing when you know her. Nosipho was too weak to walk very far so I picked her up, bride-crossing-the-threshold-style, and took her through the gas station and to the car. (I think all the time about race her – another future post – and I wondered what it looked like to have the only white person in the whole parking lot carrying a black woman.)

We got back to the clinic, loaded her up with nutritional supplements, food, clothes, vitamins, and so on. Then I carried her back to her shack and that was about all I could do. (She is so thin that it was relatively easy for me to carry her but her hip bone was jabbing me the whole way.) We are closing for two weeks for Christmas and New Year’s and there are some very good reasons for doing that but I wonder if Nosipho will be around when we return. She and her friend know the clinic they need to go to get started on ARVs and seem willing to do it but if she can’t walk, how are they going to make it there for the several necessary trips?

Post-script: I checked the medical file of the friend and she is 18 years old and has a child of her own and is still going to high school. I don’t know if I could have handled all that when I was 18 but she seemed to be doing it with a smiling face and willing heart. I wish more people here were like her.