June 5, 2009

Not my finest hour

About every month since January, a young man named Samkelo, not much older than me, has come into the clinic. He is HIV-positive with a low CD4 count and has tuberculosis. Each time he visited, he assured us he was in the preparation process for anti-retroviral drugs and taking his TB treatment daily at the nearby government clinic.

On Tuesday afternoon he came in and looked worse than he ever has before.
He had a miserable and hangdog expression. Just looking at him, I could tell he has not been taking TB treatment.

It turns out that Samkelo no longer lives in Itipini but in a newer settlement somewhat close to where I live. Like many of the other newer settlements around Mthatha, it doesn’t have a clinic so he was coming to us for help. I assumed he had taken a taxi across town. But even if he had done that he still would have had to walk at least a mile from the nearest taxi rank to the clinic.

I asked what time he had left that morning. He had left home at 5am. (It is winter here and it is very cold and dark at that hour.) “And you took a taxi?” I asked.

“No,” he said. “I don’t have the money.”

I clocked the distance later that afternoon. It had taken him eight hours to walk eight kilometers to the clinic, stopping for frequent breaks along the way.

His financial situation implicates his health. The clinic where he needs to go for ARV prep and TB treatment is a 20-rand (about $2.50) round-trip fare from his home. (There’s a closer clinic that is a 10-rand round-trip fare but that would require a bureaucratic hassle to change the location of treatment.) Clearly, if he doesn’t have the money for a taxi to get to Itipini one day a month, he’s not going to be able to afford to get his treatment every day of the week. If there was a clinic within walking distance of his home (a settlement that is home to tens of thousands of people), perhaps he wouldn’t have ended up in such poor health. But there’s not.

Since his home is on my way home, I offered him a lift. I drove him almost to his door because I wanted to know where he lives so I could come back and check on him. Here’s what we saw.
In the time he had been gone, his roof had collapsed! He looked at it and sighed. I was at a loss as to what to do. I didn’t want to leave an obviously sick patient to endure a cold night in a tumbled-down shack. But I had only expected my commitment to him to last until we got to his house. I was hungry and tired and wanted to get home myself. And where else could I take him?

What followed was not exactly my finest hour. I smiled, said something like, “Great!”, made a vague promise to come check on him soon, and took off. I didn’t look over my shoulder.

I was wracked with guilt the rest of the afternoon before I suddenly realized there actually was a place I could take him in town that would be able to help him with his TB treatment and ARV counseling. I resolved to visit him again on Wednesday.

When I returned, he was nowhere to be found. I asked the neighbours - all of whom live in much nicer places - if they had seen him and they said he had gone back into town, to a place down near the river where other homeless people hang out. I drove down there and searched all over for him and asked everyone I saw if they had seen him. No luck.

So now I’m in this horrible in-between zone of knowing that I can do something but not being able to do it. My only thought is that Samkelo took a taxi back to his rural village where is mother is. Sick people often do that here. They give up hope of living and return home to die where they were born. It is frustrating whenever it happens because I don’t want to give up hope like that, particularly not in this situation where it is clear - to me - what kind of help is needed. The tricky part is providing that help.

Thinking about all this, I find myself worried at the situation we might have created. Samkelo had figured out a way to get himself out of Itipini. That’s great. No one should live on a dump. But when he struggled so much to make it back to Itipini, the thought in my mind was, “It would be a lot easier for him if he just lived here.” And that’s an awful thought. But is it possible that the presence of our clinic is an inducement for people to live on a dump? Is it such an incentive that perhaps people never even consider leaving, even if they have the opportunity?

On Wednesday, as I was driving around looking for Samkelo, I heard the new minister of human settlement (i.e. housing) say in a radio interview that he wanted to take a broad look at the question of housing. He said something like, “It doesn’t make any sense to build a new settlement if there isn’t a clinic there.” It was tragically appropriate for the situation I found myself in. I just worried it was too late for Samkelo.


SpiritLightMyFire-Colombia said...

When is your departure date?