March 13, 2008

A Bit of an Uplift

I was preparing yet another tale of life in Itipini – yes, it involved HIV, TB, and suffering children, how’d you guess? – when I thought, “wait a second, how I have made it all this way without once telling the story of Mbongeni?”

Mbongeni is a South African success story. About a year and a half ago, he was weak and thin and dying. He’s HIV-positive and had been diagnosed with multi-drug resistant TB. He is the quintessential sub-Saharan African suffering patient.

But before I arrived in Itipini, he got his act together. He got on anti-retroviral drugs and his CD4 count is rising. He started going to his doctor’s appointments and consistently taking the drug cocktail that fights MDR. He’s been taking a big pile of pills every day for the last year at least and will for the rest of his life.

But the benefits are enormous. He is much stronger now, so strong in fact that every morning he takes his pushcart (a heavily modified grocery cart) into town and makes money by helping people with their groceries. In fact, he is so business-like that he only comes into the clinic once a week to get his MDR pills, as opposed to daily, because he wants to head into town before we open. One time I had forgot to prepare his drugs for him and as I rushed to do it I felt so guilty that I was making him miss valuable work time. Unusually for Itipini, he is married (well, I’m not sure if it’s actually marriage but he lives with only one woman) and the two of them are obviously in love. In a place where sexual violence and single mothers are too common, this is unspeakably touching. He is now helping her get on ARVs, no doubt buoyed by his own success.

All this would make for a good story all by itself. But what makes Mbongeni stand out for me is his unique and wonderful combination of character traits. First, he speaks not a word of English but when he makes his once-a-week trip to the clinic he is clear and direct about what he wants and does not waste any time. In addition to the pills, at various times throughout the month he’ll need the multi-vitamin cocktail we give to HIV patients, the prophylactic antibiotic we give to HIV patients with TB, an ointment for sore joints, and, for reasons that defy my explanation, mouthwash. He and I have developed over time a series of signals and shared vocabulary for what he needs. My favourite is the mouthwash. He just squeezes his eyes shut, puffs out his cheeks, and starts miming swishing. Some day I’ll figure out how to take a picture of it. I love it.

Second, in keeping with his business-like attitude towards his health, Mbongeni does not generally miss a doctor’s appointment. Often when he has one, he dresses up in his one suit coat and tie that, truth be told, is pretty ratty and limp. But he wears it with pride and heads off to each appointment with his head held high. On days when he’s not headed to the doctor, he wears this broad-brimmed straw hat that, I must admit, I find myself coveting some days.

On the way to the doctor with his wife – I call this one “Itipini Gothic”

I see more of Mbongeni around town than I do in Itipini. Sometimes he is pushing something around in his cart but more often he is sitting with other men, all of them looking for work. Whenever I see him, I shout his name and wave and he always gives me a gigantic smile and a huge thumbs-up that often involves his entire arm, which I can’t seem to capture on the camera. But I’ve got the memory of it and that’ll do for now.

Right. Now back to work on the other stories.