May 27, 2009

Surprised by Gratitude

Many of you have asked after my recent monthly e-mail about the health of my cleaning lady, Hilda, who I recently found out is HIV-positive. She is doing much better, thanks to the drugs I was able to secure for her that took care of her oral thrush. Her CD4 count has dropped dramatically in the past few months but I sat with her and explained about ARVs and she is now busily engaged in the preparation process.
Hilda’s situation has prompted a number of thoughts for me.

It’s made me think about access to care again. Like the woman I mentioned in this recent post, Hilda lives in a relatively new housing development and so has to take a taxi to get to the clinic for her counseling. It’s fortunate that her health is still good and she can do this unaided. And it’s fortunate she has a job and only has to go to the clinic once a week and so can pay the taxi fare and combine it with her regular weekly shopping anyway.

It’s also made me give thanks for all the activism in the early part of this decade that brought down the price of drugs so much. The drug that alleviated her thrush is called Flucanazole. (I think I have the spelling correct.) She got it for free from the public health system. Five or seven years ago, that drug cost a whole lot more and the government didn’t provide it. It took unnecessary deaths and a whole lot of public pressure on drug companies and the South African government to make it available. I’ve just finished reading Edwin Cameron’s Witness to AIDS and he tells the story of Flucanazole in detail. Literally the day after I finished reading that, I found out Hilda was sick.

I’ve been thinking about just how much patients know. When I tried to talk to Hilda about ARVs, I was kind of stumped. How do you explain to someone that the thrush took hold because her immune system is weakened when she doesn’t know what an immune system is or does? If you can’t explain what the virus does to your body, how do you explain how to address it? I resorted mainly to saying that ARVs would give her strength (the all-purpose Xhosa word amandla, well-known from anti-apartheid activism), confident that the preparatory process for ARVs would teach her much more.

(Similarly, the other day I took a patient to admit him to tuberculosis treatment at the Ngangalizwe Health Centre. I explained on the way up where we were going and why. It looked like he understood so I left him alone. When I came back, the TB nurse told me the patient had said he was already taking TB treatment. It took me a while to figure out that the patient was taking a vitamin cocktail everyday that we give to HIV patients and he thought it was working on his TB. I had just assumed he realized all the different illness at work on him.)

Mostly, though, what I’ve been thinking about is gratitude. I don’t get a lot of it in Itipini. Basically, I think people there are so used to having white people help them, they come to take it for granted. Hilda is used to waiting on white people, not vice versa. As a result, her gratitude for my help has been overwhelming and overwhelmingly genuine. Last week I dropped her off for an ARV appointment and showed her where to go, the same thing I do for scores of other patients. She was effusive in her thanks. That same day I dropped a patient from Itipini off at the hospital. The only thing she could say as she got out of the car was to grumble that I wasn’t coming to pick her up later. The difference was striking.

My goal was for Hilda to be on ARVs before I leave but health care moves slowly here and it doesn’t look like that will be possible anymore. I’ll just try to get her as far along in the system as I can.