Misizi

“You must not see.” Says Tondo, my host sister, who quickly leans over the paper she is writing on, so that I don’t see what she is writing. There is a funny mix of a British sounding properness, along with the thick accent of native Zulu clicks and long vowels, that cannot be hidden behind the articulate English skills of my host family.

It feels as though every moment I am away from the computer days go by. Each say is so long and jam-packed it feels like a day at Tawonga, where each one day feels like it contained the activities of five. I have just finished dinner, and this meat laden diet is unusual for me. I feel like I’ve eaten more meat in the last six days than I have had in my mostly vegetarian lifetime. Ok, perhaps that is a slight exaggeration, but often I feel that words can hardly to justice to the emotions and rich feelings of everything new around me. It’s unconveyable.

On Friday, we finished up at King George V hospital, and already my life has been more touched than the patients I met could ever know. The miracle baby has certainly earned a spot in my heart, that will not ever be replaced by any experience. I think the first ten minutes in the Pede’s ward pretty much pointed me in exactly the direction I want to go. I’m sure as you all read this you may experience heartbreak, but I feel that the worst is yet to come for me on this journey. As I held (frieduian type there, initially I struck the a key in the middle of my word: HEALD) Misizi, I half expected him to take his last breaths in my arms. He is 25 months old, and has massive tuberculomas in his brain from meningeal tuberculosis. The Doctor in Pede’s said he had never seen anything like it , and that frankly he was surprised the child was alive. Upon gentle rocking and “baby dance” Misizi quickly fell asleep in my arms, tiny fingers clutching my white coat. My heart melted like butter, and I unsuccessfully tried to resist attachment. Hating myself for every moment of bonding, I tried to gather the feasible memories of Misizi putting his tiny knuckles against mine when I reached through the slats in his crib to offer him a thumbs up. He offered his back with the biggest smile I have ever seen in my life.

As I grow here, and become more worldly in my views of disease and the things in life that are really worth fighting for, I think of Chantal. Always in my heart she comes through brighter in my love of medicine and compassion for pediatric care.

I find myself more willing and able than I was even a week ago to speak and ask questions about spread of disease, particularly with HIV and its prevalence here. Yesterday at a party for our host mother’s sister, who was married three months ago, I got and incredible view into the way traditional Zulu culture meets modern society and development. And as my cousin Molly says, there are always reality checks. I was standing talking to a group of men whom, I was not clear on weather they were friends of family. In the time we were talking they were both brought plates of food.

*NOTE: At the party yesterday there must have been close to 200 people. Every one had a porcelain plate, glass cups, and real metal silverware. Not that I expected them to bust out the Chinet or anything, but being able to feel your guests well, and on nice plates seems to be a symbol of wealth.*

Back to my reality check- One of the men asked me what was my favorite thing, and after several minutes of discussion and deliberation, I understood that he was asking about my dreams and aspirations in life. So I said what I was most focused on at the moment, finding a cure for AIDS. I think this blew them out of the water. They knew I didn’t mean single handedly, but I think it was shocking to them that someone from another country was so acutely aware of the problems going on in their country. One of the men told me that he had finally gotten tested and was negative, much to his relief. So this led me to start talking about my concern of people’s fears of getting tested, and how prolonging a diagnosis because of shame in a positive result was detrimental to living successfully with the disease because of the delay in ARV (Anti-retrovirals) drugs.

*Wednesday, while I was observing surgery in the operating theater, my colleagues went to the CVT ward. (center viral treatment?) The woman who was showing them around talked about how hard it is to convince people to get tested, and even more difficult to convince them to share positive status with family members. Often they throw away their ARVs because they don’t want their families to know they are sick. The woman offered to test come of the CFHI students. Three of them got tested, all negative. The woman had been working there for 6 years. It was the first time she had ever had three negatives in a row.

Anyways the profundity of my conversation with the men at the family gathering was that one of them inquired about what to do if he did happen to test positive, “hypothetically.” And I talked to him about ARVs and how good the life expectancy is if the disease is caught early. Although, I don’t know whether ARVs here are the same one provided in the states. The information I gave him about the difference between HIV and AIDS, seemed to be completely novel, and it felt overwhelmingly good to be able to educate these men. Then he asked me a question that confirmed my notion that his example was not hypothetical. He said, “What if the hospital will not give me these drugs, because I have a CD4 count that is over 400?” I racked my brain for a clear recollection of the past weeks numerous conversations with doctors. What did they say? Was it a patient will not be admitted with a CD4 count over 400, or ARVs will not be administered with a CD4 count this high. CD4 cells are a special type of white blood cells. The cells have a receptor on the outside that allows HIV to bind with the CD4 cell and inject its genetic code. Think of a lock with a key: HIV then uses the machinery of the CD4 cell to make more HIV which ends up destroying the CD4 cell. The CD4 count is a test which measures the number of CD4 cells in a blood sample. Normal CD4 counts in adults range from 600-1500 cells. This number is a laboratory marker of the strength of a person's immune system. It helps to determine how advanced HIV disease has become. One of the criteria for an AIDS diagnosis is when the CD4 count drops below 200 cells. At this point there is a great risk for developing opportunistic infections like pneumocystis carinii pneumonia (PCP) or MDRTB.

In effort to end on a high note, I can only begin to paint a picture of my experience at the family party yesterday. Almost an hour drive out of town, we arrived by hired cabs(minibuses) to Emangamazini, the outskirts of a township. Durban is geographically larger than Chicago, and smaller than Los Angeles. The further you move from town it seems the more the rolling hillsides are covered with tiny huts and poverty stricken land, that is probably closer to a stereotypical American idea of South African life. No indoor plumbing, one light bulb inside an empty round hut for electricity. Although I notice an interesting cultural parallel, between the black communities in Oakland who live in West Oakland, and can barely afford food or shoes for their children, but drive brand new Lincoln Navigators. Outside the door of the cement floor, plaster wall, wooden stick huts, we sat in at the party,( mostly women inside while we ate) were brand new shining Toyota Camrys. Much of my observations feel like stereotypes, and I feel like I am placing a great deal of prejudice on a culture who’s iceberg, I can only see the tip of.
I had an incredibly rich experience soaking up culture during our 4 course meal, my roommate Sarah and I groaned at the bottles of pineapple Fanta and plates of cake and cornbread muffins, that followed the main meal. We decided that we would make an exception, to our full tummies, “When in Rome . . .” reminded Sarah, we both laughed. My camera spent part of the afternoon with a cousin, (I think) who feels like a sister to me. (Samke, comes over every morning and walks with Tondo to school.) And she is becoming an excellent photographer.

Post meal the women and children, and a few men engaged in clapping and singing in Zulu. There was a partial call and response form, and no photograph or video could to justice to the aliveness ringing off the walls of a tiny hut on a tiny map dot in South Africa. I felt more alive than I have, probably ever.

The last thing I forgot to mention was the dowry. Upon arrival at the party yesterday morning, We(the women, Sarah and I included) carried in endless bags of oranges, and onions, cornmeal, and sugar, beans and flower. It took 40 women three trips to carry it all into the kitchen hut. Ketokuhle, Tondo’s 4 year old chubby checked sister, who I didn’t meet until yesterday, watched the women file into the hut in a line carrying the food accompanied by their harmonious voices. Keto took it upon herself to help out, so she grabbed a tomato and placed it carefully atop her head, steadied with both hands. This sent everyone erupting into laughter. A goat was also brought into the hut where the women sat and presented to the husbands family, they examined it an approved. And I was thankful that it was taken outside to be slaughtered. And later our final course was goat meat and special bread boiled with the meat, called Dombolo. It was delicious, I’d never had goat before. Very tender, like lamb. The meat was cut on two separate wooden palates one for the men, one for the women. The meat was sprinkled with salt and followed by another round of cold cider-beer, or soda. And A final singing and dancing session. My Zulu dancing skills probably need improvement, but I obediently danced the steps I had been taught and the room erupted with cheers, followed by a celebrity feeling as a heard of children followed me outside at the conclusion of the dancing.

Hopefuly I’ll be able to post some pictures soon. The computer access has been slow and far between. Love to all, Sasha