COMPASSION FATIGUE IN THE TIME OF HIV

COMPASSION FATIGUE IN THE DAYS OF HIV

Some mornings I would go to the death register secretly hoping that a patient or two had died overnight.  Are you shocked, horrified maybe? I was too when my friend who had passed through the Medicine rotation before me told me that this would happen - I didn't believe her. But here I was , coming into work early to care for some patients while holding a subconscious wish that the universe had shortened my patient list while I was asleep. I didn't secretly wish death on just any patient , it was usually the ones who came in looking as though death was already dancing with them. Like they just needed some excuse for departure. These were usually AIDS infected holding onto life's last moments being rolled in by families who I knew had the same secret hope as me. 

With patient loads into the forties per intern , could you blame us for compassion fatigue? Anticipating a patient intake sometimes made me  physically ill. Psychosomatic? Perhaps. A rotation of night duty every five nights then four days catching up from the last shift managing the patients from that intake then another night intake then patients come and go and more names are added onto your list than are scratched off.
It was a game of numbers, a tally of scores.
Kamlia , the other intern, would ask me something like" so how many are you sitting on?" 
I'd give her my number of patients .
"I've got a lung ca and pneumonia that may be leaving, " I might have added on hopefully, trying to deflate the load of patients that I was already carrying. 
She'd say something like 'shit, that's a lot - and this is before intake tomorrow'
Thanks, I knew that. With a barrage of A-type personalities, there was often a subtle ( sometimes overt ) tone of competition.

Every single patient (less) counted.  The good intern was the one who worked the fastest and cleared out the most patients to free up bedspace. Beds were a big issue at Bara. That list of forty patients were usually scattered around the hospital , dispersed in a ward where a free bed was available. A morning ward round could be as much about a good cardiovascular workout around the hospital, as it was about logistics. Sometimes , only sometimes, a patient who had been sitting in the same bed for almost a week unattended, would be pointed out by the nursing staff. 
'doctor, what's the instructions for this patient. There's no notes since last wednesday'
The patient was lost in the system - to the system. He had probably fallen off an overworked intern's patient list and lay scattered in some ward with every passing doctor thinking that he belonged to someone else.

If it sounds like I didn't care , I'm not sure that I could honestly tell you that I  did. I worked mechanically, wanting ,so desperately wanting to care - like the doctors on TV, like I did when I was a medical student asking about a patient's family history and whether he had running water and a flushing toilet in his home, sincerely asking about every fart and bowel movement. It's just the situation we kept on telling ourselves. The sheer workload just to give each patient basic care left no time for niceties. I still wanted to be nice.

It's strange that at times when I thought that I was the most callous, the most hardened a patient being rolled in on a rickety overused stretcher would knock the compassionate breath out of me. Like that feeling of unexpectedly passing by a long lost love , only its the exact reverse. It was usually the patients with Aids who came to came to take their last breaths at the hospital. I remember an intake night when a skeleton lady in a red polka dotted dress was rolled in. Her skin clung to her bones like a tight fitting leotard. Her eyes bulged out of sockets which looked too small and her cheeks caved into the grooves of her facial bones. It wasn't an extraordinary picture but my reaction was far from normal.At least, I had a reaction. A bolt of guilt-laden pity slammed hard into my conscience. It was revelatory : I was still able to care. It passed as quickly as it arrived- that feeling. But it gave hope that there was still hope, some inkling of humanity in me to be salvaged.

AIDS was (and still is) like that creepy uncle that everybody hates but still has to tolerate. It was so much a part of all that we ever knew. We knew no pre-Aids days when wards weren't a pit stop (to heaven) for the terminally ill. Most of our patients would not really recover. I often think that this must have beaten down on us quite badly in a very slow degrading type of way without us realising it. Yes, AIDS . Our government had missed the boat you see. 
At the time when HIV was gaining ground and governments internationally were putting measures in place to cope with the emerging disease, our country was going through the great transition from apartheid to democracy. We seemed to have more pressing priorities at the time. After Mandela and democracy came the aloof technocrat President Thabo Mbeki. A brilliant man by many standards, his messages didn't translate well to people on the ground. Often criticized as inaccessible, Mbeki adopted what was dubbed a 'denialist' approach to HIV. He told the aching nation that HIV did not cause AIDS. In reality, his message was not as simplistic as that - he apparently meant to say that the HIV virus exclusively does not cause AIDS, focusing on poverty as a major causative factor. He was pretty straight on the mark, but the message that reached the general public was that 'HIV does not cause AIDS' . A confusing message at a time when clarity and decisive action was needed. His administration resisted providing widespread antiretroviral medication to patients but later caved into legal pressure from the Treatment Action Campaign - a persistent and powerful NGO. President Mbeki was recalled by his party, the ANC in 2008 amidst a coup-like leadership battle. 
His successor President Jacob Zuma had none of the intelligence of Mbeki but much of the charm that Mbeki was lacking. President Zuma's infamous blow to HIV/AIDS education in South Africa was pre-presidency , during a trial where he stood accused of rape. Yes, he admitted, he did have consensual sex with the unnamed lady whom he knew had HIV, but... a very big but ... he thought that he would not get HIV because he took a shower straight afterwards. AIDS activists buried their heads in their hands. It was another few steps backward at a time when HIV statistics were reaching epidemic proportions. So yes, our government definitely did miss the leadership boat when it came to tackling HIV/AIDS head on.

thumb top :)

Thumb-top sized
with 'fingernails'
and fuzzy hair
moving and swallowing
weird looking human
being , been waiting a while
to feel you,
and then I won't be able to wait
to see you.
thumb-top sized cute-ness
with Juno-like 'FINGER-nails'

Borders

At the junction of courage and fear
are borders that segregate the mind.
Aching poverty that didn't know how to dream,
Oppressive opulence that didn't know what to dream.
Gunmen at checkpoints stopping the fetus of dreams.
Countries that tighten and loosen their borders
like the inspiration and expiration of vile utility:
taking in when they need and tightening up when chips are down.
Borders that suffocate mobility, motility -
with pores so small that humanity's side-lined must squeeze through,
but large enough to be tossed back to the other side with ease.
Borders to exclude not to include-
Borders along which to build walls and fences,
motes and trenches.

Rise and Fall

rise-and-fall

a small story friend

Let me tell you about a man who never had his obituary written in a newspaper.
He spoke to each man as if the man had so much importance in the world. He won hearts without wanting to .He walked with humility, because he probably felt that he had nothing to be proud of. But striving never to hurt another man, sacrificing your needs for those of others, lending an astute ear and keen eye to the nuanced likes and dislikes of your loved ones and strangers, friend - such a man has reason to be proud (although he will never know it). This man walked a gentle walk, talked a gentle talk and held integrity above all else. Take his money, take his possessions, but please friend , don't falsely taint his name. And he died with a few shirts in his wardrobe, having crossed the sea only once, on pilgrimage. He left us comfort but so much else: a wealth of morality that would serve us good to tap into. This self-less hero, this grandfather-would-be...

BUDRUS - Movie Review

Behind the political rhetoric and media distortion, is a story about a people, their right to use their land to survive and their intrinsic connection to this land. Budrus tells this story while steering away from directly conveying the political narrative.The movie is gripping in a way that appeals to fundamental human emotions of compassion, empathy and justice.

Directed by the award winning filmmaker Julia Bacha,the documentary follows Ayyed Morrar in his attempt to lead a non-violent resistance against the construction of the separation barrier through his Palestinian village of Budrus. Bacha says that a decision was taken to focus on the villagers and their story, avoiding the broader political context. This is perhaps where the authenticity of the story lies. Through interviews with villagers and footage of their protracted resistance towards the construction of the wall, a personal connection with the audience is formed. The civilian statistics become real and the actual impact of the construction of the wall is contextualised.

A focal point is 'The Olive Tree' - the Palestinian people's connection to it, the life-source that it represents and the impunity with which the Israeli Defence Force uproots these. I recalled scenes from Avatar, where the Na'vi people feel like they have lost a family member when their precious trees are uprooted. The tragedy in the Palestinian scenario, though, is that it is real, not fiction and that it is ongoing. After the olive trees have been uprooted to make way for the wall, a farmer with innocent disbelief and morbid concern tries to explain to an Israeli soldier that he does not know what to do as his trees will now die. Never before was the simple yet intense relationship between the Palestinian people and their land been conveyed to me as powerfully.

While Budrus does not promise to tell 'both sides of the story', it gives a voice to Yasmine Levy, the IDF squad commander in the border police sent to Budrus.
A spokesperson for the Israeli army Doron Spielman gives the Israeli justification for constructing the wall.The interaction between the military and civilians is poignant when viewed through live footage.

The issue of non-violent resistance was a deliberate choice by Bacha (who is also a historian). She says that her studies have shown that violent resistance movements in history had always transformed into dictatorships.

The movie had been well received by international audiences, winning numerous awards at a various film festivals. Budrus is scheduled for screening around the United states and The United Kingdom over the next few months.

Spare (the) change - a penny for my thoughts

At my high school reunion a couple of weeks ago, an old classmate asked me what I planned to do. I mentioned that I wasn't sure as we were moving to Doha. "You're immigrating?"he asked.
I stopped... thought... and realised : well, I guess I am.

My boss gave a farewell pseudo-speech sometime last week. It was slightly strange hearing those words because I never felt that I was ever really a part of that space. Was it a deliberate disinvestment on my part, knowing that my future was on 'screensaver' moode and would be chnaging soon? Perhaps. I was there for nine months - it's crazy how a month turns into four turns into nine.

These farewell things are a bit of a formality. I realise that as much as I bemoan formalities, I'm suckered into creating and maintaining them out of politeness. Bah - politeness - my achilles heel. I'll take passion or courage any day, but what d I get stuck with? sterile politeness.

Then the visa comes and I need to book a ticket.

Staying in Cape Town for some months last year, I came to realise that the grass on the other side is not always as green as it seems. Change is change is change and contexts may enhance or detract from the overall experience, but the true constant and decisive factor is 'the self'. And grudgingly I admit that , yes... the universe does lie within.

It's always 'the people' and relationships that tear me apart. I know that the world is small and ever-shrinking but the thought of leaving behind rock-solid support-structures leaves me hollow. I often feel that I hold relationships in too much esteem. That perhaps my strong feelings of love aren't always reciprocated - but it doesn't really bother me much.
Don't be a baby I tell myself. Man-up ...
But 'myslef' really knows that's it's for a good reason that I'm being so clingy, so nostalgic and so sentimental - I've met and fallen in love with so many real people ofver the past years. Selfless people, spiritual people, ambitious people, intelligent people. People who have been strength when all that I could do was collapse. God knows that I have reason to feel nostalgic...