Tuesday, November 25, 2008

My last Monday at GSH

Mondays in any medical setting are notoriously busy. I always start Mondays here with a sense of dread. Who died over the weekend and what new admissions await me?
Yesterday was by far the worst Monday I have experienced so far. Rather ironic that it just so happens to be my last. I had 16 new admissions over the weekend and this was in addition to the 20 or so that I already had on the ward. All the new patients had HIV, all were critically unwell and all required complex management plans that took me hours to organise. For the first time ever, I started to get really cranky at my nurses- something I have always prided myself on not doing. During the ward round, two of my patients died. One was 20 years old, had AIDS and presumably died of meningitis. Her neck was so stiff that when I went to lift her head off the bed, the rest of her body came up with her. The medical term for this is nuchal rigidity and I have never seen it quite as profoundly as what we see here. The second patient, also in her 20s also died from an AIDS related illness. I wish I could eloquently describe the feelings that emerge inside of me when I face days like this, but I am unable to put into words the series of emotions that leave me with an utter sense of despair.

Last night, as I lay on my bed, just staring at the ceiling, I started to think about what constitutes a “disaster”. When a bus crashes and people are killed, the news headlines read “Disaster”. When kids in China are poisoned with melamine, we call this a “disaster”. When the economy crashes and people have to tighten their belts a bit, we call this a “disaster”. I don’t want to trivialise these issues, because to the individual, these are important- but what do I call what’s happening here?
I’m working in a hospital where 100% of my patients have AIDS. They are suffering shocking conditions that we don’t always have the resources to adequately investigate or treat. We are now overcrowded and have to turn sick people away because we have run out of beds and floor space. We’ve even run out of sheets to put on the beds. Now most of my patients are between 20 and 30 years old. Most have children that will be left without a mother when my patient dies. Even if I manage to improve my patients’ condition, they are discharged home where they struggle daily to access food and water. They often can’t afford the medications that I prescribe them to keep them well. They can’t afford to pay for transport to come back for a review visit so that I can try and keep them well.
So I ask you, why then is this not on the front page of the newspaper and quoted to be a “disaster”? What needs to happen further before we realise that the lives lost here are just as important as the lives lost anywhere else in the world? I don’t understand why the world is not screaming out about the injustices that allow almost 50% of a population to be afflicted with the one disease.

Then I am faced with my own sense of guilt, because I am abandoning what I consider a disaster. Does this not make me as guilty as the rest of the world that chooses to turn the other way instead of facing the reality of this disaster here in Swaziland? But the reality is, I cannot face the pervasive smell of death any more. I’m not sure when the time will come when I can close my eyes at night and not see the bodies of my patients, emaciated, covered in fungal skin conditions and languishing in their own excretement. I don’t know when I will not be able to hear their cries and their desperate pleas to me to ease their suffering. I don’t know when I will ever truly state that I have any sense of hope for Swaziland.

I usually spend Monday evenings with the Pons’. I called them and told them that I wasn’t able to make it last night. I felt so completely depleted. At Helen’s insistence, I ended up going and I am pleased that I did so, because I felt a lot better afterwards. The Pons’ have been incredibly kind and generous towards me during my stay in Swaziland. Helen has become a particularly valued friend and she has provided me with a great deal of compassion and comfort that I will always be grateful for. At the end of the evening I brought home a companion called Ginger. He’s the kitten that belongs to the youngest Pons- Ruth. They are going away for a few days and they asked me to care for the tiny animal. He’s ginger (duh!) and has the most magnificent blue eyes. He is about 5 weeks old and no bigger than the size of my hand. I am completely in love with him and I think he feels the same way about me. I really like cats, but I have resisted the temptation to get my own as I have always felt that this would cement my future as a spinster. It seems that in my experience, all spinsters tend to have a cat and I am determined not to follow a similar fate. I do, however, feel that this is only a temporary arrangement and therefore unlikely to have a negative impact on my marriage prospects. However, I went back to check on him after my ward round and I was rather disturbed to find him playing with the strap of my bra that I had left out to dry. Whilst you may not find this anything to be disturbed about, this actual event is not the first time that an animal has taken a liking to my unmentionables. Last year, I looked after a dog, called Patrick, when his owners went overseas for a holiday. Patrick had the rather disturbing habit of going into my wash basket, selecting out my underwear and distributing it throughout the house. I believe he actually buried one of my particularly expensive bras, because I searched everywhere for that item and it was never to be found. So, it is with this new piece of animal evidence that I have concluded that the reason I can’t attract men is the fact that I must be secreting a pheromone that attracts animals only. Now I thought Africa was the only thing that had problems……