When Starvation was sexy and other woes in times of excess

For all her claims of post-colonial independence, Africa's poster child is once again the gaunt toddler with skin kissing his ribs. I don't know exactly why this weeks media coverage has left me with a drought-dry feeling on my palate - it's almost, almost as if 'the wires' and big media houses have caught on to something new and starvation is sexy again. The pictures coming out of East Africa, and those from Kenya and the Dedaab refugee camp are voyeristically spectacular - tall women swathed in fabric with dust lingering in the air , against the backdrop of tattered tents - poignant in its African-ness. Perhaps less artistic and more gut-wrenching are the images of the children - sucked dry of nutrients.

Why am I spitting such venom when media coverage and a deliberate focus on the situation is sure to rake in some of the money that’s needed by relief agencies? Maybe it’s because I feel like Africa is being used - again. To give the first-world ‘a cause’ , a chance to polish our rusty consciences, for a while … until we ‘drop it like it’s hot.’

So while East Africa may trend on twitter and tumblr may be adding #Somalia to its featured tags, will the interest last long enough to affect any real change? While seriously doubting that it will, I also deeply hope that I’m wrong.

Because if we can’t invest in long term interest, in sustained, painful and protracted contribution, then our humanity lies in the balance. The situation around the Horn of Africa is ‘The Perfect Storm’ : an other worldy combination of climate’s ability to oppress, man’s ability to haunt other men and the collation of the mankind’s weakest of the weak in a concentrated area.

To outline immediate solutions would be to try and profess a cause and in my mind the situation seems so entangled, so complex , that for now urgent and unflinching relief seems like the best way forward - let’s talk about development a little later. Just some relief - a bit of reprieve … some metaphorical water for parched hearts.

Tired

I want to write something about good company, settled souls, settling souls, people who have drive without vaulting ambition. A post about sanctity of true scripture and resonance of true scholars. About the piercing nature of language that makes your heart nod in recognition. I want to talk about 'home' and the concepts around it, but I'm tired and feel like I will write sentimentally because I have a tendency to 'gush'.

(to be continued... or not)

Diffusion

I will hold you

contain you

diffuse you

and not let go

till our strengths

have leveled

Stick it

There are very few moments in life where one can say with conviction , "you know I really didn't see that one coming", but that day God knows : I really didn't see it coming. Sometimes there's a less than supernatural premonition about which way a story will go and which angle a confession from a friend will take. Mostly, it just takes an articulation to tie the subconscious facts together. You've noticed her tardiness at work, the dark rings under her eyes, the strained conversations over the phone and you know that during your next hear-to-heart she's going to tell you about the boyfriend-turned-cheater.This was something altogether different. Even now, it seems so far from reality, so far from how the world should work.

During my stint as a Medical Officer I was sitting in my consulting room during a generous tea break. I had my own problems : I was preparing for a diploma against the backdrop of my father lying comatosed in hospital after a hi-jacking. So when a good friend came into my room looking like she was ready to offload some news, I wasn't sure that I was ready to handle it. But good friendships come with the caveat that you will be available in times of crisis. So I put my books aside and listened.

I held a clicker of a black-pen in my hand and wore a tie-die pink dress. It's strange the details that you remember so intimately when you recall hearing big news. Like how I remembered the red scarf that I wore and the CD that we were listening to when we received the call that my dad was shot. I pulled my chair back watching her sip on tea - it had to be ginger tea because the scent of fresh ginger waded to my side of the room. I had noticed her looking really run down over the past week - physically drained. I knew that she was having some domestic troubles. I also noticed that her eyes had lost some of that luster that I usually associated her with. Her eyes were tinged with ... yellow?

"Ah ginger tea, " she said ,"good for immunity"

"You have a flu?" I asked.

"The strange story gets even more interesting," she said, "I have HIV actually - from a needle-stick injury"

I measured my reaction , instantly toning down the shock and obviously modulating my tone. But those tell-tale tears building up over my bottom eyelid must have been a give away. If she noticed them, she showed no signs of letting them unsettle her. "Don't be patronizing," I told myself, "play it cool".

She went on to explain how this all happened during her pregnancy when she was an intern. Her shift was over and she could have handed over any outstanding work to the next doctor on shift. She noticed that one of her patient's intravenous lines were out, so being the thoughtful doctor that she is, instead of handing over the work, she decided to insert the line. This was a very sick patient she tells me, he had AIDS - a very advanced stage of the disease, he hadn't even moved for days. As she was inserting the needle, he moved tossing the needle into the air and then it landed puncturing her skin - I can't remember whether it was her hand or foot. But the damage was done.

Most of the doctors that I've worked with are flippant about taking antiretrovirals after an injury - we have so many near encounters with infected fluids that we would be spending a large amount of time on drugs with some serious side-effects, if we took treatment with every suspected HIV encounter. Occupational health Specialists tell us that the risks of contracting HIV from a needle-stick injury are low, with the statistics being something close to 0.03%. We also carry a measure of bravado believing that we are healers and altruism won't go rewarded with a life threatening illness. But here was a clear injury - and a very ill patient. My friend started the therapy - but she was pregnant and reacting very badly to the medication, so she stopped taking them altogether.

Later on in her pregnancy she was admitted to hospital with a strange illness.Doctors wrote it down to a vague pregnancy related illness, but she never fully recovered. Eventually a specialist encouraged her to get tested for HIV, and the results spelled out the diagnosis that she would carry with her for all her years.

She talked without scathing, hatred of her situation or self-pity but with a determination that was admirable and a conscience that was alive. The reality of it all still hits me every-so-often. It could just as easily have been any of us. I've had two needle-stick injuries in my three years of practice. I was so sick form the side-effects that I even considered stopping the treatment. My friend's story finds an echo with other similar stories lurking in doctor's tea rooms and over shared gossip in the operating theater. It terrifies us, because it brings home the reality of mortality - the concept that 'Doctor' is not infallible and that this job that brings with it (often undue) respect and good money, carries risks, big risks ... life-changing risks.

(I have received permission to mention my friend's story - anonymously)

Archives: Strike Three - Personal Perspectives (20 August 2010)

We're in the midst of the second large scale Public Service strike that I can remember. Pundits say that it's the third since 1997. Things are really heating up down on the ground. I come to work, bypassing groups singing, “ my father was a garden boy, my mother was a kitchen girl, that's why I'm a socialist, I'm a socialist ...”.

The floors are dirty, a few days away from being filthy and the toilet paper is running out – fast. Dietitians say that the food stores are just enough to last over the weekend. Protesting groups are blocking patients from entering the hospital, and that's why I can write this note while sitting at work – the casualty is empty. We do see emergencies ... but don't spread the word. Protesting mobs may track us down calling us 'magundwaan' or 'rats'.

Back to 2007. It was my first year of working as an intern and the strike hit us something awful at Chris Hani Baragwanath hospital. Working in a setting with no porters, cleaners or nursing staff was frustrating. It took about fives times longer to get work done. So while there might have been a lower patient load, the work day was just as long and infinitely more frustrating. This highlights the absolute necessity of every 'link in the chain'. It pointed out the importance of the so-called-menial-worker. The work needed to go on ... and it did. The army came in and were more grand-looking than effective. When the strike finally abated, we knew that we would have to deal with a severe backlog ... and we did.

The 2009 Doctor's strike lacked the pizazz of strikes lead by more militant (and effective) unions. What we saw here were 'wealthier faces' of varying colours asking for better wages. The public were divided in opinion. So was I. We had a 'live-able' salary.

My opinion changed when I heard an ICU doctor state her case. It was a time when the strike was really gaining momentum. We were running 'essential services' alone. The question of a 'complete shut down' arose. We were debating closing ICU facilities – and perhaps letting the private sector absorb our current patients – at the state's expense.

This doctor had dedicated her life to public service. She could have been earning at least four times her salary in the private sector, but she believed in providing a service to the less fortunate. She was calling for an ICU shut-down. She said that she didn't need the extra money as hers was a supplementary income in the household. She wanted doctors to be paid more so that more doctors would remain in the public sector.

We are experiencing an exodus of skills to private hospitals and abroad. The result is a public service that is understaffed, under-skilled and collapsing. Young doctors are looking at their working hours, working conditions and salary and comparing it to their corporate counterparts. For many of these skilled professionals, the reward of being altruistic just doesn't cut it. Does the ends justify the means ? An ethical dilemma.

A huge ethical dilemma is what we are faced with. In this setting, it's definitely not fair to write deaths off as collateral damage. The results in a strike situation are more acute and evident. However, the results of nurses and specialists leaving the country en mass to seek better pay are far more chronic and debilitating – but the issue is not as sexy as a large-scale strike which grabs media attention.

So here we are , at the beginning of our third large-scale Public Service strike. Workers have expressed a commitment to engage in protracted strike action. Government is digging its heels deeper into the ground. Both sides are posturing – a familiar series of events. It all seems quite reactionary .

Policy analyst Ebrahim Khalil Hassen offers alternatives to the present methodology of negotiating .http://sacsis.org.za/site/article/535.1

In the meanwhile the poor guy who gets the bad end of it all is – the poor guy. Yet again the have-nots are at the mercy of the privileged (or somewhat privileged).

Regarding strike tactics – South Africa has a strong protest history which I believe to be a positive thing. Our apartheid legacy , though, leaves us with heavy-handed tactics like intimidating non-strikers, coercing people to join and turning violent on those seen as not completely sympathetic to the cause. Ideally and theoretically a more 'democratic' mode of engagement is needed. In reality – people are angry and on the brink of tipping over to the violent side.

The casualty staff on duty tonight are in support of the strike but have come to work – they are afraid.

Just a few minutes ago an elderly lady somehow made her way through the gates into casualty. She was short of breath. Even though we don't see adult medical patients in our casualty generally,we were ethically obliged to see her as it was an emergency. We did primary management, but she needed admission to a tertiary facility. The best that I could do was write a referral letter to our referral hospital, knowing that the gates of the Helen Joseph hospital were shut. Does the ends ever justify the means?

Archive: Selling Pipe Dreams to the Poor (14/sept/2010)

As I drove in to work last night I was listening to a news report about fifty shacks burning down in an informal settlement somewhere in Johannesburg. I fleetingly wondered about who would be providing relief to these people.

Later on that evening, paramedics brought in a heavily pregnant woman. She was stable but gave a story about inhaling smoke ten hours earlier. Her shack had been burned down from the same fire in the news report.

The nursing staff gave her a rough time, accusing her of just wanting a place to sleep. I think that they may have been right - she probably came in for a warm bed and some food to nourish her pregnant body. All her documents had burned. Fire has a way of devouring paper. She had no pregnancy records and no identity papers.

I've become a bit hard and mechanical about my job, which is partly why I need to take a breather for a bit. In a moment of recently-uncharacteristic concern, I asked her, " So where will you be staying now?"

"by the pipelines," she repeated about four times before I finally understood what she was saying.

"you mean by the pipelines, on the streets? " I asked.

"Yes," she replied.

It hit me.

Like that unexpected blow to the conscience - the one that makes you almost nauseous for a few seconds.

The problem with this feeling is that it often catches you offguard - just when you think that you are least capable of feeling anything.

I gave her big instructions about getting an antenatal card from her old clinic, then sorting out her identity documents as soon as possible.

These were all just formalities for me. I could tell that I was just wasting my breath to appease my conscience as she probably wouldn't have the resources to drive around and sort out paperwork.

She would fall back into the world of the 'unknowns' - the people who are shunted between jobs, places and instability.

I looked at the T-shirt that she wore. "Vote Cope" it said.

With a sense of irony I realised that she was sporting a banner for some of the leaders who had let her down. This was a political party created out of the egos of Power Politics and it's now disintegrating for that same reason. Maybe she really supported 'Cope' or maybe she just needed the free T-shirt.

In the corridors of post-revolutionary leadership, champaign flows freely as 'crony capitalism' enshrines the spoils of war in the hands of a select few. Somebody , somewhere has failed my now-homeless-soon-to-be-living-alongside-some-pipeline patient ... and I don't think that it's God that's failed her.

I wonder where her baby will be born...

TIK AND TOOTHLESSNESS

(part diary , part reflection, part searching)

TIK AND TOOTHLESSNESS

The community service year took my husband and I to Tygerberg hospital on the Cape Flats.The other side of Cape Town- the side that isn't featured on inflight magazine articles. The Cape Flats refers to that flat part of land on the side of Table Mountain opposite to the ocean. This is the anti-Longstreet, the un-Gardens, allocated to Coloureds and Indians during the apartheid days. It was everything that the Cape Town suburbs weren't: sparse , dry ,sandy and interrupted by industrial plants. Gangsterism reigned proudly, low-grade drugs were rife and teenage pregnancy was common. A suburb in the Flats , Cravenby, has the dubious honour of having the highest incidence of TB - in the the world. It was a place that could suck theadventure out of relocating to Cape Town. If it wasn't for the view of the Table Mountain that I savoured walking to work each morning, I would have sworn that we were living in a run-downsuburb back in Gauteng.The Table Mountain - a living, breathing character she was. Her temperament fluctuated like a pregnant lady. On some days she was warm and receptive as the sun reflected her in a welcoming light and on other days she was broody, melancholic and harsh as the clouds embraced her, subduing her.

To my husband and I the Tygerburg deal sounded like an all-round decent package: a family sized hospital quarters apartment for R700 a month was probably less than the rent charged for a home in the housing projects, and with an opportunity to explore white Cape Town on the weekends - we were sold on the idea.

Tygerburg hospital was at the junction of Coloured Cape Town and Afrikaner Cape Town. It was on the line of the 'Boerewors Curtain'. In Cape Town these racial demarcations seemed very distinct with a cordial but well delineated interaction between races (at most times). If I haven't mentioned Black people, it's because they were clumped together in overcrowded settlementslike Gugulethu and Khayaletsha. Coming from working in the heart of Soweto where informal settlements were a mainstay, I was surprisingly appalled and poured unfettered scorn and self-righteous piety on the concept that was the settlement of Khayaletsha : shacks were stacked on top of each other - something like a mini-version of the Brazilian favellas. The settlement extended for kilometers blocked off from the mainroad by a porous concrete fence - with just enough space to voyeuristically peek inside and just enough security to feel separated from it.

The Tygerburg Hospital building stood as a testament to apartheid's clinical (yet morally depraved) practicality. The hospital stands as two interconnected buildings which are mirror images of each other. Legend has it that during apartheid days one side was used for white patients and the other side was used for the 'others'. But those were just memories now in this post-apartheid South Africa where we are all brothers (as long as everyone knows their place).Racial tensions were more evident to me in Cape Town than in Gauteng. The Afrikaner Specialist dominated : he ( occasionally she) worked with efficiency and commanded the respect of his juniors. Most of the nursing staff were Cape Coloured and rallied around the doctors with reverence that I've never witnessed- before and since. Many of these nurses were harsh in their disrepect towards the Black staff who were often treated as incompetent and bullied. And if thereis anyone that you don't want bullying you, it is a Registered nurse.

I value working in a community different from my own. As a doctor you have the privilege of being let into that private space of an individual - physically and emotionally. Such insight into people and their condition is invaluable. The pulse that I picked up from the community around the Tygerburg hospital was a fatigued resilience. It was truly a tough life. Unemployment was rife and a survivable poverty existed. Working in paediatrics, I found that many of the mothers were young and often single. A fair amount of the babies were born to drug addicted mothers -posing the challenge of drug withdrawal for the newborn. In light of all this, births continued,young boyfriends occasionally came to support their girlfriends who had just delivered their baby and mothers loved their newborns - intensely - almost all of the time.

(more to follow - depending on time and inclination)