Western Medicine in Northeast South Africa

              My host family in the village of Phoshiri has a daughter named Vivian and since I am an honorary member of the family while I am living here, Vivian is one of my “host” sisters.  ‘Vivian’ is her given English name and in her case it is unique that her given English name is far more commonly used than her native Sotho name.  In fact, I cannot even recall her Sotho name come to think of it.  The South Africans call her Vivian and so I do as well.
              Vivian is 29 years old and she has a 7 year old son who, also uniquely, has only an English name: Desmond.  Vivian stays with my host family about a quarter of the year.  The rest of the time she is in Gauteng Province (where Pretoria and Johannesburg are located) studying at UNISA (University of South Africa).  This fact is unique among my host family, the Madigoes, as she is the first child to attend the university.  Although Vivian is away from the home three quarters of the year, Desmond stays with my host family (his grandparents, uncles, aunts, cousins, and me) year round.  Aside from attending the University, Vivian is unique from the rest of the Madigoes for her English skills.  By no means is she fluent but I do find myself communicating with her an equal amount in Sepedi as English which does not occur with any of the other family members.  When she lives in Gauteng and is attending school, she has some kind of regular employment.  The details of this employment are unclear to me, but I know that she has some sort of income when she is away from Phoshiri.  In Gauteng, Vivian stays in a “room” there with running hot water which is unheard of in this village of Phoshiri.

              On the Monday week before last, I returned home from school and found Vivian outside.  She had been away for several months and I was not aware that she was returning on that particular day so it was a pleasant surprise when I rounded the corner to my room and heard a soprano-registered “Burneeece!”  (My host family members have all adopted my host father’s unusual persistence in referring to me only by my surname which is pronounced “Burneese” here).  I smiled and exchanged pleasantries with Vivian.  I came to find that she would be staying until the end of the first week in September and she was upset to hear she had missed my Mother who had visited in May from the states.  As I was walking to my room, I heard static-filled music and voices. 
              Could it be?  No….
              Wow, it was!  As I gazed through the door into the family’s living room, I saw a TV flickering on the table.
              “Whoa!”  I reared back and asked Vivian with a smile, “Did you get that?
              “Yes, Burneece.  I bring the television to here.”
              I walked into the living room and found both my host parents, Desmond, and host siblings Thuso and Mihtee sitting in silence around the static-laced set.  We all exchanged the customary greetings and as I smiled, my host father said “I don’t, uh, understand the language.  I just like to watch the pictures.  It’s alright.”  He laughed rather heartily.  In fact, it was easy to see the entire family really digging this television which was broadcasting some crappy sitcom in English.  Through only minor struggle, Vivian was able to communicate with me that she wanted to program the remote’s “favorite” function for her 2 favorite stations.  After adjusting the antenna stand and wand (which involved resting a metal key on it for better reception) and finding the fine tuning adjustment, I had the TV displaying a slightly clearer picture.  Only 4 channels could be received so the point of her desiring to have a “favorite” channel was a bit odd, but I didn’t want to quell any of the family’s enviable enthusiasm.

              As I walked out of the main house to my room located behind the main house, Vivian followed me out and told me that she was worried her son Desmond was sick.  I didn’t get the impression she was overly worried or he was too sick, but she found it important enough to tell me so I asked some simple questions.  Mainly, he had a bad cough and didn’t seem to be eating very much.  She asked if I had any “juice” and so I gave her two things which have been so graciously shipped from the states: Crystal Light powder packs and a couple of Airborne tablets.  She was pleased with this and I retired to my room.
              Later that week, it was Wednesday and as I was pouring water from the large container jug into my medieval-looking chalice pot called a Stulutulu (Stew-lou-two-lou – one of my favorite Sotho words), Vivian came out from the house.  I asked about Desmond as I hadn’t seen him since Monday and she said that “he’s better but still sick.”  I inquired further and found out that she had taken him to the next village over to a traditional doctor.  I asked why she hadn’t taken him to the hospital which is about an hour’s bus ride away.  With a bit of a shrug and in broken English, she explained that her parents always went to this village doctor and the hospital was too far.  She said that the doctor gave her some kind of medicine which I took to be some herbal concoction and she ended by saying that he (Desmond) “is coming better now.  I think so.”

              That week ended and the following week, as was custom, I stayed in my second village of Seleteng in order to work at my second school.  I was also away in Pretoria for the latter portion of that week for a Peace Corps meeting.  I returned to Phoshiri Tuesday evening of this current week.  Wednesday was one of those days here where the frustration arising from life at a different pace gets the best of you and I just wanted to retreat to my room after school for some anonymity and solitude.   So that is what I did.  Didn’t see Vivian that day.
              Upon my return from school Thursday, I found the family once again circled around the television.  This day, feeling much peppier than the previous day, I bounded into their living room to greet, talk about the day, and ask how that cherished TV set blasting foreign English was working.  To the latter, there was a request from Thuso to add E TV as a favorite channel to the menu since she clearly was a fan of the channel.  After obliging Thuso, I said “go lokile” (all is good) in a questioning format and my host mother replied in quick Sepedi something about Desmond.  I looked around but Desmond was not there.  My host mother then rose from her seat on the ground and sauntered out into a back room.  Vivian told me that she was going to get Desmond.  I was a bit confused so I just stood in place sensing “all was not good.”

              Now I must mention that Desmond is one of the cutest boys I have seen here.  I am biased because I live with him and I am fond of him because he is polite, friendly, and very well behaved.  I also am not a person who routinely (or perhaps even scarcely) proclaims children to be “adorable” but Desmond is just that.  He has slightly poofed, soft, furry hair.  He has sad eyes which belie his near-constant shy smile and distinctively large protruding ears.  As he came from the back room this Thursday with his grandmother, he was looking weak.  It is scary when someone, especially a young boy, is visibly weak.  He didn’t look to be in pain; rather he just appeared comprehensively spent.  With his left hand clasped in his grandmother’s right hand, he slowly raised his right hand to shake mine and looked at me tiredly.  His hand was limp and I told Vivian right there in front of everyone that he looked weak and ill and should go to the hospital.  (The hospital is free here!).  I had no idea what kind of turmoil my recommendation would start.
              “Aowa (no)” my host mother replied and shook her head.
              “Ahh Burneece” Vivian said in an exhausted voice.
              My host father grabbed the ubiquitous plastic chairs and our apparent meeting was to move to the rear outside of the house.  This impromptu meeting was only to include my host mother and father, Vivian, and myself.  Voice volumes quickly elevated and Sepedi instantly reached the rapid conversational pace; that pace that native speakers use when they are, well, among natives.  I could only make out individual words here and there.  Vivian got up from the chair and walked past me and I could tell she was doing everything she could not to unload a storm of tears.  My host mother looked angry.  I was clearly confused.  I tried to converse with my host father but I was not getting any direct answers.  From him, I gathered that Desmond had seen a “special” doctor (which I finally realized was the traditional village doctor) and had taken some kind of medicine from the chemist (pharmacy) and would get better.  I was very skeptical.  I went to talk to Vivian.  I told Vivian that I would be riding the bus the next day to deposit money earned from the community poultry project.  I suggested that we could ride together to the hospital.  By this point, she was crying though still holding back the deluge that was obviously on the brink.  She told me she was scared of the hospital which I initially attributed to a break in communicative translation.  However, upon rephrasing the statement several times in English and Sepedi, I became convinced that yes, she was scared of the hospital.  When I told her that I would go with her, she seemed to warm up to the idea but only slightly.  She talked in circles about “her parents” and I could easily tell that she was in disagreement with her parents but I could not pinpoint from what this disagreement was stemming.  I tried to assuage her by telling her that all of the doctors would be speaking Sepedi (the hospital is in the small town of Lebowakgomo which services a rural area dominated by native Sepedi speakers).  She surprised me by giving a small laugh through tears and said “I know its Sepedi Burneece.”
             “Then what?”  I was truly baffled by her fright and very perplexed over the mixed emotions coming from her and her parents. 
               There was a family disagreement occurring.  It was palpable. 

               It is truly an odd feeling being in the middle of a tense disagreement when you don’t know what the specific topic of the argument is and the people arguing aren’t speaking your language.  You feel the tension but are only left to your senses for sorting out its impending release.  It is bewildering and frustrating.  Yet you can’t turn away.

              Finally I resolved to phone my supervisor who is the school principal, Mr. Magoro.  I hate to rely on Mr. Magoro for translation purposes (Mr. Magoro is my English-speaking link to Phoshiri but he only stays in the village during school weeks), but I felt I was in need of both a cultural translation as well as a linguistic translation.
              Mr. Magoro is very well known to the Madigoe family as he arranged for my living at their house after he applied for a Peace Corps Volunteer.  They are all friends though I sometimes sense it is more of a “business” friendship than a ‘kick-back, you-can-tell-me-anything’ friendship.  But whatever, I needed some clarification.
              Over the phone, I explained to Mr. Magoro that Desmond appeared very sick and I thought he needed care and I had told this to Vivian and some sort of disagreement had ensued.  Vivian was in tears and I was not sure if I should accompany her to the hospital with Desmond the next day or not.  He agreed to speak with Vivian over the phone so I handed her the phone only then realizing that I had not explained to her what I was doing.  She looked at me questioningly as she took the phone clearly surprised but not resisting. 
              After Mr. Magoro talked with both Vivian and my host father, I took the phone back.  Mr. Magoro explained to me that Desmond should go to the hospital “right away.”  Apparently, Mr. Magoro had been aware that Desmond was sick for over a week and had told the Madigoes to take him to a clinic, “not the sanguna (traditional doctor)” but clearly they had not heeded his recommendation.  I was right that Vivian was scared of the hospital.  However, despite her fears, she was also well aware that Desmond needed to go there.  She was crying because she was scared for her son and, as Mr. Magoro explained to me, Vivian’s parents do not believe in going to the hospital.  Obviously, Vivian was conflicted.  Mr. Magoro said that they “are not aware that those are places of help” and are skeptical of services.  They always use the traditional doctors.
              Regardless of the familial conflict, Mr. Magoro felt that there was no time for debate.  He told me that he had informed Vivian that he was calling the ambulance and to get ready to go to the hospital.  To this, I was a bit surprised. 
              For starters, I did not even know there was an ambulance servicing any village anywhere near Phoshiri.  In twelve months here, I have only seen about a dozen different motorized vehicles pass through the dirt roads of Phoshiri and nothing resembling anything close to my mental image of an ambulance. 
              Secondly, I was surprised at the exigency with which Mr. Magoro was acting.  Nothing seems to happen with anything remotely resembling urgent in rural South Africa so this was a shock to me. 
              It also solidified concerns over Desmond’s condition.
              As Vivian got her things together and briefly talked to her parents (who now seemed resigned to the fact that Desmond would be going to the hospital), I went to my room still a bit miffed by the whole turn of events. 

              However, the ambulance did not come.  At first, I wasn’t too surprised.  If an ambulance showed up in 30 minutes, that would still seem “urgent” to me in this area.  As 30 minutes came and went and the evening fell to dark, I still fought suspicion.  I mean, c’mon – was I really expecting a siren-blaring loud van thing to barrel down the dirt path to whisk Desmond away?
              Finally, as I washed my dishes outside of my room with the family nearby, Mr. Magoro drove up to the house.  He got out smiling and, of course first things first, we all exchanged greetings.  He explained to the family in Sepedi (and subsequently me in English) that the ambulance would not be coming as it was tied up with “an accident” and so he would be taking Vivian and Desmond to a clinic in a neighboring village where the ambulance could pick him up later that evening after a nurse had assessed his condition.  He instructed me to ride along and off we went.

              The village where we took Desmond is still very rural but is considerably larger than Phoshiri.  The clinic closes shortly after dark, but the nurses live in the village and can be called if they have left for the day.  Fortunately, we arrived just before 6pm and they were still at the clinic but were closing the doors as we drove in.  They were agreeable to see Desmond and Mr. Magoro and I waited in the make-shift waiting room.  Posters adorned the walls that looked straight out of my elementary school Health classes in the 80’s.  Anti-drug posters, anti-smoking posters, and the 4 food groups were all prominently displayed.  Mr. Magoro was in good spirits and as we waited we discussed a range of topics comprising healthcare in South Africa Vs. America, women’s rights, gays’ rights, safety in Botswana, the Peace Corps program, other Peace Corps Volunteers, wine, my visiting his home some weekend in the future, strikes by the public sectors in South Africa (including the current maddening Postal Workers Strike), the upcoming World Cup, and even a few comments on rugby.
              After about 2 hours, Vivian and Desmond came out of the treatment room and Vivian was crying.  She had a bag of medications and as she sat next to me, I looked through the bag.  There were multivitamins, a bottle of some kind of generic antibiotic, cough syrup, and some tissues.  She said that “they are doing tests and will tell us next week.”  After some back and forth, I verified that these tests were for TB.
              She then smiled and said “He is negative for HIV.”
              “Oh.”  I said and smiled. 
                In a country with one of the very highest rates of HIV in the world and where rates are easily above 25% in rural areas, I should not have been surprised that they would routinely test for HIV in a 7 year old boy.  But I was.
              “Even myself.  We both tested negative” Vivian said pointing to the area on her finger where they took blood.
               As we got up to leave Mr. Magoro and I stopped by the nurse’s room to give her thanks and verify that they would be following up with Vivian in the next week.  Vivian and Desmond proceeded outside to the car.  I asked the nurse if she really thought Desmond had TB and she said she did.  “That boy is very sick.  I am just waiting for the sputum to confirm it but yes he shows the signs.”  As I had noticed and Vivian had told me, Desmond was coughing near constantly and was not eating much of anything.  I left Mr. Magoro with the nurse and followed Vivian and Desmond to Mr. Magoro’s car outside.  When we got inside, I sensed that Vivian was still quite upset.  I asked her what she thought and she said “he is now vomiting.”
              In the dark, I turned back to them in the backseat and saw that she was holding Desmond in her lap as she was trying to get him to take the antibiotic.  She was wiping his chin as the medicine was not going down but rather coming right back up.
              I told her to go back into the clinic but she said “No.  Burneece.  Its okay.”
              I got out of the car and went back into the clinic.  I told the nurse and Mr. Magoro that Desmond was vomiting.  They immediately went outside and to the car and collected the small boy.  As Mr. Magoro and I returned to the make-shift waiting room, we were told that the ambulance (which I now had discovered was just a van with the words “medical clinic” painted on the side) was being called and Vivian and Desmond would be going to the hospital for the night.  They were no longer waiting for the sputum test to confirm TB.  If the boy couldn’t swallow anything, he needed to be in the hospital immediately.  As the van pulled up and Mr. Magoro and I prepared to go back home, I asked Vivian if she was going to be alright.  She looked rather frightened.  But she was going to the hospital now without questioning any other option. 
              “I am okay Burneece.”  She said as she packed up some cloths and the bag of medicines.  “We go to the hospital.”
                I realized that without her parents present, the only conflict about going to the hospital was originating from her own fears.  And I also realized that as a mother, she simply had to face her fears with this.  There was no other option.
               The nurse said that Desmond “would be okay” and smiled.

               And he will.  There are treatments for TB. 
               But they don’t exist in the rural traditional clinics and they certainly don’t exist in the home of my host family.  As Mr. Magoro and I drove back that evening, I asked what would have happened if I hadn’t called him or if he didn’t have a car.  He simply said that I did the right thing.  I told him that I had no idea when I phoned him that we would end up in a clinic that night.  I had just needed some help with cultural and linguistic translations and was not sure what should be done.  I also told him that I thought at some point, Vivian would certainly have sought professional help.  He agreed that she likely would have but added that he knew Desmond was sick and “you can’t wait for a situation like that.”  He expressed his gratitude for my calling and I expressed my gratitude to him for being so adamant about helping. 
              And I pondered the differing attitudes towards medical treatment existing in this insanely beautiful but frustrating country. 

              When we returned to the house, we updated my host parents about the situation.  Thankfully, they were nothing but thankful.  It seemed that our concern had been verified to them and Mr. Magoro told me that they were pleased with me for calling him.  They were smiling and all of the palpable tension from earlier in the evening had vanished.

              That was Thursday night.  As I write this on Sunday afternoon, Vivian and Desmond are still in the hospital.  Vivian phoned Friday night to say that Desmond was going to be okay but they would need to stay a few more nights for treatment.
              She finally sounded relieved.

~ by Andrew Bernish on August 30, 2009.