February 22, 2009

Dramatis Personae

After a while in Itipini, I’ve come to know so many people and parts of so many stories, I can’t possibly begin to tell even a fraction of them on this blog. They just come fast and furiously, overwhelmingly at times, and each requiring a tremendous amount of energy. Here’s a snapshot of a few ongoing stories I regularly encounter.

Thobeka needs anti-retrovirals. She’s had a low CD4 count for a while and made slow and sporadic progress through the ARV prep process. But she just can’t seal the deal and go for the necessary appointment to get the drugs. There are definitely some psychological problems at work in this situation but at the root the problem is that she just doesn’t take the ARVs seriously enough. We’ve had to hand-hold her to get her this far but she needs to take the final steps herself.

Phelokazi gave birth last June at age 15 or 16. This week she tested positive for HIV. Since she’s been breast-feeding her baby all this time, that raises health complications for him (though the transmission rate is lower than you’d think in the early months). She also doesn’t seem to have much if any family around to support her, the child’s father is now in jail, and she’s not in school.

Mvuso has a series of unknown health problems - all exacerbated by his alcoholism - that have left him unable to walk or care for himself. He is skin and bones now and has been to a never-ending series of appointments with doctors over the last several months but to no avail. He might need surgery but he’s not a candidate for it because he’s so weak. But his weakness is brought about by his illness. It’s a catch-22 and impossible to figure out how to break it.

Tunyesa is a 17-year old HIV-positive mother who randomly walked out on her child last week, leaving her with the neighbours. The neighbours didn’t want the child and came to us to protest. We were about to call the social worker when Tunyesa nonchalantly returned to Itipini. She’s also not regular about CD4 counts and might be pregnant again.

Ali was high after sniffing glue in November (hence the burn marks under his nose) and so spilled boiling water on himself, resulting in partial thickness burns over 20% of his body surface area. He was in the hospital for 97 days, preparing for and recovering from skin-graft surgery. Now he’s back in Itipini, hasn’t been in school in ages, lives, apparently, only with his 15-year old sister (who is also a mother), and needs to have his wounds frequently bandaged, which takes an immense amount of time. Fortunately, they are healing quite well.

Patricia has needed bilateral hip replacements for year. Since that is highly unlikely here - the hospital is too overwhelmed to be able to do elective surgeries - it would be great if she could get into an old-age home. But that requires all kinds of referrals and paperwork and hurdles that take concentrated effort to surmount.

Those are just the patients I have pictures of. There’s also the woman with elephantiasis in her feet and a grossly swollen hand that just will not get better; the young mother who needs to be checked out by the eye doctor but never seems to go; the child who had meningitis when he was a baby that has left him with mental damage but whose mother can’t seem to get her act together long enough to go to the doctor; and many more “frequent fliers” in the clinic. There’s also the non-medical cases, people (mostly children) who need a lot of help just to get into school or to get enough to eat at home.

Not all of these should be our “problems.” There are, in fact, organs of government that should step in. But they don’t or aren’t capable of providing effective and timely help. So people look to us for help and it is hard to turn down a suffering person. Beyond all the obvious reasons why these situations could be complicated, there’s the small matter of the language barrier. You’ve read these brief summations in just a few minutes but you are likely read English as a first language. To get to the point where I could summarize a history in a few sentences, we first had to battle through endless complexities in Xhosa.

It’s overwhelming.


Patrick Knapp said...

It does sound overwhelming. Though I'm excited to be coming to Umtata as a volunteer anesthesia instructor, I am sometimes afraid that I will be overwhelmed and discouraged. But sitting home and just watching would be worse.