29 August 2010

"You did a damn good job changing my nappie...you'll make a great nurse"

HIV/AIDS is a devastating disease and it scares me to think of number of young lives who are being infected and affected each day. I understand being young and wanting nothing more then to be in love. At the same time it terrifies me to see that one impulse action can have such a negative reaction. I'm not here to lecture anyone on the importance of making smart sexual decisions, that choice is up to you. I do wish however that people I know would be more realistic about the disease itself. Its not limited to Africa or to blacks or to gays. Thinking like that is ignorant and wrong.

I wish I could fully explain just how much havoc HIV/AIDS does on the body. The opportunistic infections (TB, STI's etc.) that coincide with AIDS are just as debilitating. I know everyone thinks 'it can't happen to me,' but each and every day I hear the echoes of "how could this happen to me?"

Friday at Don McKenzie I had the pleasure of sitting with a feisty young woman named Lauren. Her hair was matted and falling out and her frail body required oxygen numerous times throughout our conversation, but her spirit was spunky. August 20th - It was her 20th birthday; she was upset that she was so sick and in the hospital.

I spent a good hour listening to her talk about how she was lucky enough to make it out of the valley and attend a great local high school, Kloof High. With pride she explained how she was able to go onto University. We talked about the 15% matriculation (passing your high school final exams) rate. An alarming rate which includes both Zulus and white South Africans. Lauren chronicled her first two years of University with a gleam in her eye. She told me how she was a part of the debate team at school and how she was really quite clever. She told me that her and her teammates went to a match where she ended up meeting a guy. The two of them had unprotected sex and a few months later while joking around with friends on her University campus she got tested for HIV. She tested positive.

As she retold the story her eyes filled with tears and her pain filled the room. She quietly admitted that it took her almost six months and becoming very ill to acknowledge the results, tell her mother and start receiving treatment because she thought the test was wrong. "I didn't think it could happen to me" she said over and over and over.

It was heartbreaking to hear her story and to see someone with such a passion for life, wisdom beyond her years and a yearning for education be confined by such an illness. She told me that her goal in life was to graduate school with a degree in public relations and then to go onto Medical school. I told her I was toying with the idea of being a nurse and her sassy reply, "You did a damn good job changing my nappie, if you don't vomit after something like that and you can still talk to me like we friends you'll make a great nurse" made us both laugh.

I went to check on Lauren on Tuesday and was told that she ended up being discharged so she could pass away at home. I thanked the nurses and told them that I had had a great conversation with her the previous Friday. To which one of them replied: "You're Meggie? She kept talking about you and left you a note"

"Dear Meggie" it read...
"You listened to me and made my birthday very special. You are my new special friend and I can't thank you enough for making me smile on my hard day. I love you - love Lauren"

I can have the worst day here and then a second later something so profound happens. Lauren and people like her keep me going, but they also are a clear example of the devastation that one careless act can do to your body and the rest of your life. Her story is profound because she was a profound young woman.

What protects your heart?

What protects your heart? Is it stability in life, love and family? Is it confidence in the work place or the understanding that regardless of how bad your day may be, at the end there will always be a healthy dinner on your plate, a secure roof over your head and a warm bed calling your name? Is it the realization that healthy or sick an educated physician is merely a phone call away and medical attention accessible day or night? Or the knowledge that with the wealth of education you received options for employment and advancement are endless?

Take away stability. Remove confidence and understanding. Evaporate the table of food, well constructed roof and warm bed. Eliminate access to medical professionals, confiscate necessary medicine and delete the option for education.

Forget about viable transportation or a reliable income, for those never existed within your possession. Add a lifetime of suppression, depression and disappointment. Add a generation of death and disease pillaging your community, your neighbors, and your home. And to top it off add a current debilitating strike which closes the doors to all schools, clinics and hospitals.

Welcome to South Africa. Welcome to the recent harsh reality of the children my roommates want to be teaching, the patients I care for and want to aid in obtaining their necessary medicine. Welcome to the closed doors at hospitals, the locked gates at clinics and the vacant classrooms in both government and some private schools. Welcome to frustration, hindrance, and heartbreak.

South African public servants have been on official strike for a week and a half; unofficially striking for two plus. Teachers, nurses, janitors and orderlies have left their stations and headed outside to toy toy, dance and chant in hope of a higher pay raise. They have only re-entered to harass, intimidate and forcibly remove others from their posts.

The nationwide strike has paralyzed the world in which I live. The unions are demanding an 8.6 percent payment increase and a 1000 Rand – around $137 USD per month housing allowance increase. They are threatening a secondary strike including all taxi drivers and other public workers if demands are not met. I understand that the union members are using their working abilities as leverage because it is all they have, but it hurts me to see that those most affected by the strike are children and the sick.

My roommates whose classroom lays dark sit at home day after day unable to even privately tutor students for fear of attacks. The children who would be attending school sit at home, empty bellied because their largest and often times only meal is one that is provided on the school grounds at lunch. My clinic is still functioning which is a blessing for the 22 patients admitted. They have a bed and care, but my patients along with all of those who are sick at home are unable to go to clinics to receive pertinent treatment.

Patients are being discharged too early because there is not enough staff to care for them. Those with AIDS who depend on their regularly scheduled appointments at ARV (Anti Retro Viral – AIDS medicine) collection sites to obtain medicine imperative to their survival are being turned away. Individuals with Tuberculosis are being sent home. They are carrying with them the great risk of obtaining multi drug resistant strains of their disease, instead of the medicine that can restore them to health; effortlessly exposing countless others.

The strike infuriates me. I’m annoyed that day after day I can’t do my work as regularly scheduled. I’m troubled by the lack of responsibility on behalf of President Zuma. I am bitter, pissed, annoyed, stressed and sad. I hate that people will die because of this.

As the unrest and cacophony of the strike surround me I think about what protects my heart. Although the stability and confidence I have help, it’s not them. It’s not the food or shelter, the medicine or knowledge. It’s the unspoken love I am surrounded with even in times of annoyance. It’s the dedication and strength in the eyes of my patients even when their appointments are cancelled. Its being able to have faith in something bigger than myself and my feelings.
What protects your heart?

How do you continue?

South African Public Servants are on strike.

Last Friday I was asked to help work at Don McKenzie, a tuberculosis hospital I frequent with my patients to pick up medicine because the staff had not been there in days. The hospital whose normal 200 + capacity had to be cut in half with early discharges because there was not enough man power to staff the facility.

When my boss asked me if I would assist her husband, the head Doctor at Don McKenzie for the day I unhesitatingly agreed. It wasn’t until I closed the door to our car and started walking down the hill towards the picket line that I began to grasp to what I was agreeing to. Leaving Sinead sitting in the car and willingly walking towards the locked gate and strikers felt like walking into the lions den. I have never been so terrified. I was all alone and even though many of the strikers I recognize from bringing patients there for appointments I was beyond intimidated.

Chants and screams in Zulu, “Fuck you Umlungu (white person)” and other phrases I couldn’t quite understand surrounded me. Bodies encircled me and vuvuzelas were thrust forcefully in my direction. The exuberant symbol they once stood for just a month ago during the World Cup instantaneously shifted to one of terror.

Friday I joined Dr. Stephen Carpenter and three others in running a hospital. I performed every task: making meals, making beds, helping to administer meds, washing floors, changing adult diapers, doing bed baths for patients that couldn't bring themselves to the bathroom and everything and anything in between.

The day was a blur of chaos and frustration coupled with pride in my abilities. I felt good about being able to assist and I am proud of myself for being able to work under pressure and take charge, but I have also never been so scared.

I sat with a man for a solid hour during my time at Don McKenzie. I changed his diaper, bathed his frail body and cleaned the thrush out of his mouth. At 29 he was the most emaciated man I have ever seen. Frail is an understatement, his body was much smaller than many 10 year olds. I have dealt with death a lot this year at the Respite Center and I am comforted by the fact that I am able to be with the person in their last moments so they are not alone. I then pass the responsibilities of post mortem on to the nurses. Friday I was the only one.

As his breathing labored and then slowed and eventually ceased and his deep dark eyes became glassy and hallow I knew that it was the end. Dr. Carpenter was busy keeping everything else in line and the nurses were outside chanting. I did as I have seen my co-workers at the Respite Center do. I lifted his head off his pillows and lowered his body into a horizontal position. I pinched the skin around his eyes with one hand and with the other pressed his lips together tightly. As frustration and revulsion welled inside me, I swallowed down nausea and I held tight so as his body went into rigor mortis he would stiffen with both closed. I put name tags on the four parts of his body - head, shoulder, stomach and toe so the morgue could identify him.

As I rolled Bafana onto and then zipped up the white body bag I thought of the irony of his name – Bafana meaning “our boy” – the name of the SA World Cup team. I thought of the striking difference between what South Africa was experiencing a month ago with the World Cup hype and now... a world of striking.

Friday was quite possibly the longest hardest day of my life. I love South Africa, the people and cultures here have enriched my life. However I am frustrated – I am sad – I am overwhelmed. I have three months left here and day by day I am trying to make the best of it, but it is harder than I ever imagined. I know I won’t leave early, but I also won’t lie...I have entertained the thought on a fairly consistent basis. Emirates flights are quite expensive...I check too frequently for my own good.

There are days where I feel like I am so far beyond knowing what I am doing here. I knew this year would be hard. I knew it would challenge me and push me to my limits, but putting someone in a body bag was a harsh realization of the fragility of life. Plain and simple – it was terrible. How do you move beyond that?

Delisile Gwala, my dream come true

Not that I'm supposed to have favorites, but if I were to Delisile would be my number one. She’s a pint sized little thing that was admitted into the Respite Unit just after I arrived in South Africa. I spent many months by her bedside watching her regain her strength and listening to her stories.

She is a mother of two and has the most positive outlook of anyone I have ever seen. She is battling HIV and TB and remains positive. Her laugh and the love that emanates from her is contagious. She is the reason I push through each day. She calls me her “icecream” because I am “white and sweet” and I call her my brownie because she is brown and delicious. She is my inspiration and my strength. She is my best friend in South Africa and my family.

The Oprah magazine did a story on the Dreams for Africa chair that 160 beaders produced. I have written about the chair in a previous post. Deli sat in the chair and shared with us her dream. She was highlighted in Oprah and the magazine came out today- just in time for her to read it at home healthy and stable!! I have never been so proud of someone in my life.
Let her story inspire you. Let her courage motivate you. Let her love fill you.

Deli in the Oprah Magazine


Her beautiful lay out


The print of her that my brother bought me for my birthday!!! Cause he is the absolute best!!!


Deli signing the print for me!!!


"Delisile Gwala, 32, is a domesitc worker and mother of two. Whe she arrived at the Hillcrest Aids Centre Trust early this year, she was so ill she was admitted to the inpatient care unit. She was entranced by the chair, but too weak to even be lifted into it, so Claudia unhooked one of the wings for her to touch. Two months later, when the chair returned from the Design Indaba in Cape Town, Deli had recovered enough to sit in it -- and to dream again. 'I would like my daughters to have happy and healthy lives so they can be themselves. I want everyone to have their own happy ending!' "

Cheers to you Dad!

Being away from family and friends for a whole year is part of what makes the volunteer experience challenging. The distance keeps me from feeling like I am ever fully a part of anything that is going on in the lives of those I know and love. I have had to learn to rely on e-mails, pictures and phone calls chronicling life (thank god for facebook).

Finding a way to feel like I can comfort someone from miles away has tested not only my patience, but also my writing abilities. Learning to accept that for this year I will not be able to physically be a part of birthday celebrations and engagement parties (congrats Erin and Court!) or acknowledging that for the first time in eleven years I was not able to work at Camp Daybreak is something that has been beyond hard.

Just as I have learned to make accommodations to live life in South Africa in new and creative ways I am learning new ways to keep my sense of self alive back home.
Last week my Dad retired from being a Doctor. My family put together a big party celebrating his accomplishments and although the invitation to the extravaganza made its way to my doorstep in South Africa, the price of flying home for a quick weekend jaunt was too expensive to tick the “I’m attending” on the RSVP. More than anything I wanted to be there to commend him on being the best Doctor I know and thank him for sharing his gift for medicine with me.

While visiting me in Africa Colin helped conspire with me on how to make that happen. We spent hours writing a speech to be read at his party. Colin would read the beginning and then hit play and a video recording of me reading the second would play. A little rendition for those of you would also couldn’t be there...

Colin:

“Tonight is a night that is about celebrating the accomplishments of a man whose devotion has always been to the service of others. Through his consistent positive role modeling, Tim Cope has shown each of us what it means to be a devoted employee, husband and father. His work ethic is unbeatable, his tolerance is endless, his love for all that he cares about is immeasurable and his jokes are plentiful.
As a father, Pop has taught us many things, but the one that we both agree is most valuable would be the meaning of devotion. Devotion to one’s family, devotion to a life of education and devotion to a hard day’s work.

As a father, Pop has taught me many life lessons, but the most important has been devotion. I have been shown through his unconditional love and support that devotion to one’s family is invaluable. He has taught me that devotion to a life of education is important by always encouraging me and my abilities in the classroom. And through seeing the dedication he has for his job, he has taught me the meaning of devotion for a hard day’s work. His kindness and patience have enriched my life and have given me the confidence and support to become a proud member of our family, honest member of the working world and a respectable man.”

Enter video of me (I even got dressed up and had a glass of wine to celebrate!):
“As a father, Dad has taught me devotion to one’s family with his consistent love and support. He is always willing to provide me with advice. Whether it is advice for a broken heart or a potential broken bone or advice on how best to comfort a patient dying of AIDS, he always knows how to ease my pain. He has taught me the importance of devotion to a life of education through his unending support and encouragement of my educational advancements. And through watching his work ethic I have learned that devotion to a hard day’s work is one of the most important elements of a successful life. His unconditional love, support and friendship have exceeded all exceptions. He has enriched my life in countless ways and given me the tools to better myself in his image.

The commitment and affection he has shown each of his children has always been carried into his office and into the hearts of each and every one of his colleagues, interns and patients.

From all the way in South Africa it is with my great pleasure that I ask you to please join Colin and I in raising your glasses and commending the vast accomplishments of Timothy T. Cope, Doctor, co-worker, friend, husband and our loving father.”

I think I spend a lot of time thinking and processing what I see, feel and think about here. I do not give enough credit or thanks to each of you, who have supported me, encouraged me and loved me through this adventure. Dad, you have been one of my biggest fans, one of my most valued outlets and the person who has inspired me to fall in love with the medical field.



This ones for you!