-för en 'bättre värld'
So, today, December 1st, is the UN’s World AIDS Day. This day was first announced in 1988 when the disease still was relatively new as a means of perhaps first of all take away all the stigma. Today, it is a symbolic day for the fight against the disease that has killed 30+ million people and today infect 33 million and affect billions of people world-wide.
First of all, if you do not know what AIDS is, I have written an article on the disease in my Global Health series.
Secondly, I figured that so much is written about HIV and AIDS and that there is so much statistics, that you perhaps would enjoy a more personal story instead of the rambling of numbers and diagrams.
Well, I have actually had quite a few encounters with the disease, because I have volunteered in Africa twice. In the winter-Christmas-New Year of 2010-11, I visited Gweru, the third biggest city of Zimbabwe, and in the autumn of 2011 I worked in the Tanzanian capital Dar es-Salaam. I could tell you a couple of short stories, but two anecdotes are perhaps more special than the rest.
They are not special and I wrote them in one go, without a manuscript or without planning. I just hope they serve to show everyday meetings I have had with HIV/AIDS and how I perceived the disease.
The Performance Review
So, I had been at Mkoba Polyclinic, a rural health-care centre in the suburbs of Gweru (suburbs in Zimbabwe meant basically shacks, no electricity, and bad, if any, roads) for a week or so. I had in the beginning only been at the labour ward, where women gave birth, but I knew that there was a ward for Infectious Disease as well.
The first day I spent a few hours sorting different medicines, so called ARVs (anti-retroviral drugs, inhibiting the development of AIDS from HIV). I saw quite a lot of people pass by, but very few that actually came up to the cubicle where I and the drugs were. I sort of wondered what all the other people were doing at the clinic. Then one day I spoke to a short man, who wore a shirt that was at least two sizes too large, who I had seen run around the clinic with different patients. He told me he was an AIDS consultant, meaning he would sit down with patients who had been tested to give them their statuses. So, one afternoon I went with him to his office (literally the room next door to the cubicle).
In his office, we sat down and a nurse came in to show the equipment used to diagnose HIV (which was a stick very similar to the one used to detect pregnancy). Afterwards, the consultant told me we were meeting some patients. He went out to the waiting room, called a woman in and she came in and sat down, facing us. I cannot remember her looks wholly, but she looked very young and she had very short and curly hair. Perhaps she was five years older than me, at a maximum 30 years of age. She wore a red t-shirt or dress (I cannot remember that detail either) and had a serene look. She looked part nervous, part frightened.
The consultant took up a few papers and started to talk to her in a local language. I recognised a few English words, for instance ”positive”. That could not be good. In front of my eyes, she was told for the very first time that she had one of the worst diseases known to us. She did not move. She did not even blink. She did not cry or speak, apart from a confirming mumbling. There was no explosive panic and there was no dramatic gestures. I was all so very common, so mundane, and so very, very simple. I would figure that we back home would have made a big deal out of giving a patient the knowledge of his or her disease. Here, in rural Africa, there was little more than a shrug of the shoulders and a disappointed look. I could see no tears and hear no sigh nor sob. There were no real consolation from the consultant – and I myself was not even prepared to sit by to see this unfold – and there were no stir of emotions. She was very quiet, did not really ask much. After a couple of minutes, it was over. She went out, with a paper in her hand and a diagnosis of her health that without this health care centre would be a death sentence.
I have more or less consciously saved this image, this short-short video clip of her receiving that horrible news. And, in retrospect, I have thought that that very touching scene in reality really was nothing more than a cold performance interview. I would have compared it to a meeting where a boss fires an employee, but that meeting would have entailed more emotions, protest, and rage.
This, this was nothing more than a release of results. Not really a meeting between a physician and his patient. Just a mundane performance review. A meeting between the helpless and the authority.
Making the bed
I had been at Mwananyamala Hospital for a week or so, following the intern doctors on their rounds at the female ward. Rounds was the most interesting part of the day, where a senior doctor would go around, accompanied by interns and the non-senior physicians and assisting nurses (or, sisters, as they say in Tanzania). In one of the first beds, just at the right side of the aisle when entering the ward, was an 18 years old woman, diagnosed with HIV and an infection of the feet that had eaten away most of the skin on the ankles. She looked nice, but she also looked very young.
There were many other patients in the beds in the ward, but her case was very touching due to her low age. Also, her wounds were terrible, and the doctors I spoke to said that they would try to treat them for a couple of months but after that they would be forced to amputate. They cleaned her wounds every morning. I cannot exactly remember how, but I have a vague image of a bottle of hydrogen peroxide and a cut-off PET Cola bottle filled with liquid honey. The physicians first used gauze and hydrogen peroxide to clean the wound of old pus, skin tissue, and dead muscle tissue. The smell was not enchanting. There was a fizzing sound when the oxygen oxidised. And she cried. I could not imagine how much it had to hurt to clean those open wounds with a liquid that worked by turning into gas in a bubbling reaction. At times she screamed. I was frightened – there, open wounds with pus and blood containing HIV. Imagine how close I was to this virus that one reads about every day back home.
18 years. When I was 18 I also cried. But for so much less. I failed my driver’s license test drive and cried for an hour. I was such a spoiled brat. This brave young woman (or should one say ”girl”?) suffered from an infection that ate away part of her feet following the weakening of the immune system. How she even acquired the virus to begin with, I would rather not think more about.
The days went by with the same procedure each morning. None of the doctors or nurses really consoled her or spoke to her. She seemed awfully lonely. She must have been scared. The doctors spoke English to each other, and that must have added to the mystery and enigma of the whole situation. Add to that a couple of young-looking white and Asian youngsters in white robes lurking in the background, and there is a situation in which I myself would have panicked ten times over.
This one day, she was actually up. Limping, slowly, because the open wounds were not healing. One hand holding on to the bed, she tried to make her bed by readjusting the bed sheet on the mattress. The doctors and nurses were already treating the patient in the next and second following beds. Back home, in Sweden, the nurses would of course have helped her. So, despite all my fears – whatever I had read about how the virus is communicated – I decided to help her. But first, I put on gloves. Imagine that. I put on gloves. Such a mean thing to do – so symbolic of the stigma of the disease, that even a mzungu in a white robe would not even help her make the bed without putting on gloves. However, I think she understood that it was not meant personally, because all staff dealing with patients used gloves. At least I hope that was the case.
I helped her make the side of the bed that she could not fully reach. I did not really say anything and neither did she. It was such a simple thing to do. I was part angry at the nurses for not doing it to begin with and the other half of me felt a tingling of fear that I would get the virus (although I very well knew that there is no risk at all I would acquire it through helping her make the bed). The following exchanged smile between us served as a hearty ”thank you”.
I must admit, though, that the inner most hypochondriac and spoiled parts of me – the part of me that cried when I failed the driver’s licence test drive – was afraid of the virus until the other month when I was accepted as a blood donor at my local hospital. They test your blood for all sorts of diseases and I was clear and healthy.
Still, I cannot help to think what would have happened to me if I would have been her. I mean, had I been infected in Sweden I would have received life-long world-class healthcare and would probably not have noticed any real differences in my health. But, how the future for the young woman I helped make the bed for would turn out, I will never know.