Friday, October 29, 2010

The Clinic

I'm running an hour late. Four months and I'm already functioning on APT (African People's Time). I get out of the khombi after taking a roundabout way back from visiting a friend in a nearby town and run/walk to my hut. Roughly ten minutes later I'm sweating. It is not yet 10 in the morning. Awesome.

I find my host bobhuti (brothers) and our carpenter friend, essentially an uncle, planting mango and orange trees behind my hut. Make (Mother) is sweeping the yard. I come bolting through the gate and yell a rushed greeting. They humor my hurried and broken siSwati with knowing smiles and return to their tasks.

As I hastily change, throw my notebook into my book bag, grab my last, lonely orange - taking a mental note that soon all I’ll have to eat are a few slices of bread and soy sauce - I run through my head all the questions I need to be prepared to ask. I’m going to my community’s clinic today and as the most non-medical human being on the planet, I’m obviously well-versed in the correct comments to make in such an establishment. Great, I’m screwed.

When I arrive to the clinic, already I’m getting the same feeling I did on previous visits: they are busy and incredulous at my seemingly constant presence asking inane questions about staff size, their services and how many people on average they see. But today I persevere and stand my ground; I made this appointment weeks ago and I intend on staying the entire day to observe, shadow and learn.

One of the nurses reluctantly shuffles me into the first examining room, bringing me a chair. This is the family planning room and today the head nurse, a midwife, is in charge of consultations. Patients are seen according to the numbered slip they paid 2 rand for at the booth down the road at the inkhudla (government offices). Since today is a Friday, the wait isn’t terribly long and the clinic will probably see 30 or so people. Unlike Tuesdays when the patient load can be upwards of a 100 or more.

Woman after baby-clad woman enters the small, cramped space, each here for a variety of prenatal, postnatal and birth control needs. The majority are here for the injection to prevent pregnancy. The first patient, a young woman seemingly no older than myself, is pregnant with her fourth child and is HIV positive. The nurse explains the procedure for PMTCT (Prevention of Mother to Child Transmission), examines her and gives her a follow up appointment. Most sessions last only ten minutes and in about two hours time we’ve seen a dozen women.

They completely avoid my gaze, which I can only surmise must appear cold and clinical as I sit in the background taking occasional notes. No matter how hard I try to catch their eyes to offer an encouraging word or inquire about their child, they ignore all my attempts. They are painfully shy, speaking barely above a whisper. I feel the colonizer and they the colonized, only instead of land, I’m occupying the most private area of their lives. It’s a strange new feeling and at this moment, I’ve never been more aware of my skin color and the privileges it has afforded me.

I’m moved to the curative room where the nurse practitioner is stationed. This is the catch-all room and gets everything from STI’s, some admitted and others posed as bath water burns, to a 29-year old woman who has symptoms of stroke. I ask the nurse how common this is; she remarks that due to the high rate of HIV they see this more often than would be normal. As I sit, I notice an ostentatious sticker on the filing cabinet: US AID: From the American People. It’s bizarre to see it here in this cramped room; I feel disconnected from something that could easily be stuck on any undergrads Mac Book. And yet here I am, with both this sticker and a never-ending stream of ill, poverty-stricken people who are barely kept afloat by the mounds of outside aid this country receives.

I’m still trying to conceptualize this apparent contradiction when a woman in her 50’s walks in. She has a sculpted face, no wrinkles and kind yet scared eyes. She is waiting on the results of her HIV test. As the nurse talks to her, the lab technician comes in carrying a slip of paper ripped out of a notebook. I see a name written and the word “positive.” Apparently the woman had tested before, but in denial had “clinic shopped,” a common enough practice the nurse tells me where those who are positive take multiple tests in hopes that there was a mix up in the lab or a badly administered test. Mostly, they are not ready to come to terms with their status.

Normally the woman would be counseled, but as the expert client (an HIV-positive individual who works at the clinic and helps the newly positive cope with a their changed existence) is out that day, she is merely told to come back Tuesday to get her CD4 count taken. As she gets up to leave, the nurse reminds her to bring her partner with her so he can be tested. By the look on her face, that’s highly unlikely.

It only took a few moments, but I had just witnessed someone’s life change in a way I can hardly understand. Yet it was all so normal, so routine. I feel numb, unable to understand how it could get to this point. This is the beginning of my real education, my real exposure to a pandemic that has up until this point been articles in news magazines and the topic of conferences in far-off, well-lit, air conditioned auditoriums.

I’ve never been so close to the reality, and there is nothing dramatic or momentous about it. Only another victim added, disappearing into the nameless mob of those who just happened to be born in a country and continent where the combination of colonialism, poverty, gender inequality, corruption and a whole host of factors contributed to their likelihood of infection.

I could have easily been her, but instead I’m sitting on this side of history, disgustingly healthy, obscenely well-educated and most importantly, transient. In two years I can escape this, I can get on a plane and fly back to the safety of suburban comforts, away from constant strain of heat, poverty and disease. It’s a strange knowledge to have, well-understood by the patients: they look at me and see only a voyeur, someone who has come to get a “life experience” and then return to tell of my valiant trials and tribulations in this strange African land.

I would have left dejected, defeated and useless had it not been for the nurses. I’ve heard much about the lack of training, professionalism and humanity of nurses and other medical staff in this country. Perhaps I’m no judge of how to run a clinic, but the women I met that day instilled in me a shred of hope for this community, for this country. They were well-spoken, compassionate and thoughtful about a disease whose collateral damage they are barely able to stem.

Perched on a stool in the back room, eating a shared lunch of Pap, beef and curry, I listen intently as they impart their war stories to me. They are not blind to the odds, yet they keep showing up every day. I’m told that I am welcome anytime and my help is greatly appreciated. That help will most likely be pill counting with other volunteers. But I relish the thought of even such a menial task as that.

As the afternoon winds down, I walk home, in deep thought about my day. I cross the main road and start down my gravel one. I hear the familiar cries of my Swazi name from neighbors. The women at the grinding mill are still there – and they shout their usual greeting my way. I enter my homestead and see my family bustling around: Make is feeding the chickens, the kids are preparing dinner over the open fire and the goats are wandering back from their daily adventures.

I fetch my book and take a seat on my front stoop. It is by far my favorite place to sit – I can watch the dying light and feel the forgiving breeze. The nearby Lubombo plateau frames a picture of budding acacia trees and Swazi women with bundles on their heads on their way to their respective homesteads. Often, one of my host sisters brings over a mat for me to sit on so I don’t get my skirt dirty.

It is in this place that I find solace, that I can make sense of what I’ve seen each day. Sometimes I don’t even read, just gaze around at my surroundings. In effect, just exist in this strange, new environment. I must look bizarre to passerby and my host family, but I chuckle to myself upon realizing this, since I’m sure my pale complexion among other strange habits already elicits such thoughts. Can’t get much weirder when you are already plenty weird.

I stand up and enter my hut, noticing the huge spider web around my door. Looks like I will have some visitors tonight. I start dinner, only to discover the power is out. Looks like it’s a bread supper and bath-by-candlelight kind of evening. 

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