July 20, 2008

Coming Off That Mountain… Again

You might recall a post from January in which I compared the experience of returning to Itipini from a vacation to coming down from the mountaintop. While I had had a great time in Uganda, a couple people in Itipini had died and news of those deaths had been disheartening to hear after such a great experience.

I had a similar experience this week as we re-opened the clinic after two weeks away, two weeks in which I had a great trip to Lesotho. On Monday morning, news of a few deaths over the break filtered into the clinic.

The first was a young man named Fezile, who always had a great smile and insisted on calling me “Mr. Jesse.” He was Pakama’s brother and also had HIV and TB. I must admit that despite my guarded optimism in that last post about Pakama, part of me was prepared for the fact that we might return to Itipini to find she had died. Fezile always seemed the stronger one in that family and I had little indication he was nearing death. So it was shocking to find he had died on Saturday, just two days before we re-opened.

(It was a bit awkward this week when I went to Pakama’s house to make sure she made it to a few crucial doctor’s appointments on consecutive days. Everyone is sitting around mourning Fezile and I did my best to pay my respects in Xhosa. But then I turned business-like and made sure she knew when we had to leave and why we had to go. Pakama and Fezile’s mother is remarkable, not only devoting herself entirely to the care of her sick children but also now making funeral arrangements for one of them.)

The second was an older man named Bushman, also an HIV and TB patient. He was pretty gruff and could be demanding at times but he had worked a special place in our hearts. The last time I saw him, there were no obvious indications that he was about to die. He was regular with his medication and seemed to be doing as well as could be expected. His death was a completely out-of-the-blue piece of news.

I doubt there would have been anything we could have done to save either of them had we been open and I don’t regret the vacation. But it is always a sobering reminder to realize that while I was gallivanting around Lesotho, people in Itipini did not get the same vacation and carried on their lives as usual or, in this case, ended those lives.

In some good news, Nobathembu, the woman I wrote about a while back with a low CD4 count and several obstacles to getting on ARVs, came into the clinic on Friday to show off the ARVs she had just picked up from the dispensary that morning. It took a while to sort things out for her but once she got going, she moved through the system pretty quickly and took the process very seriously. Her health is still greatly compromised but she has overcome a major hurdle to improving it. We were celebrating in the clinic and Jenny said, “well, you did pester her about it a lot, Jesse.” I prefer “remind frequently” but if it’s what it takes...