June 20, 2009

Trying to pull back

There’s these two brothers in Itipini I’ve mentioned in a previous monthly e-mail.
On the left is Zanethemba; on the right is his older brother Lizwi. They aren’t always so dour (well, Lizwi is). Here’s Zanethemba in a lighter moment.
Zanethemba came across my radar first back in March when he tested positive for tuberculosis and also had a low CD4 count. He was pretty sick. A few months later, Lizwi came in with the same set of symptoms more or less. He tested positive for TB as well, which is not surprising given that they both share this shack, which is about seven feet on a side.
That was where the story ended until a little while ago. It is nothing unusual in Itipini - people have HIV, people get TB. In this case, they just happen to be brothers and live together.

It turns out, however, that Lizwi has a few children, at least three, in fact, none older than 10. One of them is Siphisihle, the young girl who had TB when I first arrived and whom I invested a lot of energy in then. They had been living with their mother but she dumped them on Lizwi a few weeks back because she figured Lizwi was about to die and she was going to move on to a man who could earn some money. In addition, Lizwi’s wife’s oldest daughter dumped her young baby with Lizwi and took off. That daughter happens to be Tunyeswa, whom just a few weeks ago shocked me with the sharp deterioration in her condition.

Here are all four children.
At one point, the youngest of the three siblings had a very bad lip infection and couldn’t eat or even really open her mouth until the antibiotics went to work. But the children look after each other and care for one another. Here’s Siphisihle and her younger brother Siphamandla.
So now there are four children and two adult men living in a tiny little shack with only two beds just a few feet apart. Neither man apparently knows how to be a father and Zanethemba can’t always remember all the names of his nieces and nephews, mainly because I don’t think he’s taken the time to learn them. Lizwi would like nothing more than for us to figure out a way to get them into a home someplace that could look after them.

There’s all kinds of reasons to be concerned but one I think about often is the potential spread of TB in that shack, especially as Siphisihle has already had it. The TB guidelines call for us to test the people a patient lives with but children need a Mantoux test and in order to get that we have to get them all to a certain clinic on one day of the week. Given how hard it was to get the one child with the lip infection to take his pills, it is easy to get exhausted simply thinking about the logistics of organizing those tests.

We’ve repeatedly called the social worker for help and guidance. Nothing. (Remember how I said the government has an informal relationship with Itipini?) Siphisihle and her older sister go to school. The younger children hang around the shack all day. It is cold this time of year and they don’t always have a lot, or even any, clothes. Lizwi and Zanethemba get food because they have TB and it is easy to include the children in that and check on them every day. The greatest source of hope in this situation is that the children actually do a reasonably good job caring for each other and are in good spirits.

But there are no easy solutions and I want to scream at the complexity of the situation. Tunyeswa has disappeared since she last came in looking so sick. I’m concerned about her health but also about her siblings and child. If I ask her about her children when I see her, will that make her less willing to listen to my advice about her health? I want Zanethemba and Lizwi to get better (and they are, especially Zanethemba, who has improved in leaps and bounds) but I don’t want to absolve them of all responsibility because they’re sick.

And in all of this, I know I need to hold back and not get too involved because I’ll be gone before the situation begins to improve, if, in fact, it ever does.

This is what incarnational ministry gets you. You learn all about the contours of a situation, which is a blessing of sorts, to begin to realize the true complexity of life. But you don’t necessarily get any closer to a solution. You just have to hope that knowledge of the situation is good enough. It feels particularly unsatisfactory.


Michael Lavery said...

I'll prayer about this situation for you Brother.

Michael Lavery
St. Mark's Episcopal Church
E. Longmeadow, MA