April 26th, 2010: Case of the Mondays. It was hard to wake up as usual, but I was actually excited once I left the house. Today we were going to Malagazi Clinic in Umlazi, which is a township. This would be the most rural clinic thus far. We pulled into the clinic to see the usual long lines. We were greeted by Clementia, the head sister of the clinic. Overall, it was by far the warmest greeting I have received since being here. All of the staff was so happy to see us and said hello whenever they had the chance. We began by witnessing the family planning clinic, which consisted of a line of women sitting in a chair waiting to get injected with birth control. Like cows getting branded, when it was their turn they got up, dropped their dresses, got injected, pulled their pants up, got their stuff and left…all in front of each other. We injected about 20 women what seemed in like 5 minutes. Next we got to do the regular clinic and sit with a sister. I became extremely excited when she told us Hailey and I had to split up due to the small examination rooms. Finally, I got to be alone with a sister or a doctor for the first time. I went with Clementia and Hailey went with the other sister. The patients started pouring in with a variety of ailments. There were lots of cases with children and adults with sores all over their body. The main cause of this was their diet. Since this was a rural clinic, we got to see the repercussions of malnutrition and poor diet choices. Clementia was a 75 year old sister with a hard hitting attitude to come with it. She obviously has done this for a while, and she sternly lectured everybody about their diet choices and how they’re doing it all wrong. Everything she said was very harsh, but very true. This one baby came in with sores all over his mouth and she told me to listen carefully. She asked the dad (very rare to see a dad there) what the child ate and he responded, “Whatever he wants”. And there is your first problem. A lot of people in this community have no sense of proper balanced diet and give their children whatever they want. They also think that once breastfeeding is completed that milk consumption should be halted. In a community like this, it is close to impossible to compensate all of the vitamins and minerals that are lost with no milk consumption.
We had another patient come in; she was this very beautiful 18 year old girl. She was complaining of a headache amongst a load of other things. We found out she had multiple STI’s and needed an injection. She admitted to not using condoms with her sexual partners and when Clementia asked why not, she didn’t say anything. She just shrugged her shoulders or looked off into space. Clearly, she was impossible to get through. I assumed she would develop HIV in the next year or so.
The most interesting case was this 25 year old man who came in. He didn’t even need to explain himself since he just looked completely emaciated. The sister asked what wrong and he said he has been sick for a couple weeks. She also knew that he had not been eating. He said that he had not eaten in 3 days. I lifted up his shirt and noticed he also looked severely dehydrated. I pinched his abdomen and it felt like I pinched pizza dough. The skin just kind of stayed where I had pinched it, but slowly returned to normal. He tried to remove the rest of his shirt but he had so many aches and pains in his joints that he needed help. He had oral thrush (white coating of the tongue that bleeds when you touch it), which is a good indicator of HIV and a green discharge coming out of his eye. I took his heartbeat with my handy dandy stethoscope and it was beating so fast that I had to recount it a couple times. Sure enough he has tachycardia, or a fast heart beat. We asked him what he has done to help himself out during the few weeks. He replied that he drank a whole bottle of castor oil (not Castrol motor oil…don’t worry). Castor oil is this translucent, extremely viscous, unpleasant smelling oil that was banned in South Africa years ago but has come back due to the introduction of flavors (it still is to be avoided however). It basically acts as an extreme laxative and “cleanses” your body to the point of mass dehydration. The usual dose is a couple tablespoons. Traditional Zulu believe that you need to cleanse the body whenever something is abnormal, so they take a WHOLE bottle of Castor oil only when the sun is down to cleanse themselves. Hence, we see the dehydration. The sister recommended that we stop giving him care and him be referred to the next level of care. The clinic refunded his R40 (~$5.75, the price for all public clinics) since they couldn’t take of him. I asked Clementia how he would get to the hospital and she replied “well he might not, it’s all a matter of how much money he can get to get over there”. It was a pretty sad case to see a 25 year old so sick and only to send him off hoping he has enough money to get to the referred hospital before he dies.
At the end of that case, Goodness (yes that’s her name and she’s 100% awesome) came in and said something in Zulu to Clementia. Clementia turned to me and said that my tea was ready. Umm excuse me? MY tea? What about hers? I told them they didn’t have to that for me and when her tea was. She replied that she only gets tea if it’s not busy, only doctors get tea. Too bad I’m not quite the doctor you think I am… I felt completely undeserving for the tea but they insisted. Hailey and I walked to the back room of the clinic and were pretty touched with what they did. They set up a little table with teapot, teacups, tea, milk, and sugar for us with what little supplies they had. Granted we were having tea on the same table that the birth control medications were administered, I was really humbled by the gesture. To them though, it’s standard to serve the doctors tea. But since doctors rarely make appearances in this clinic, they really tried to make us happy. I busted out my severely bruised banana (my plum had exploded in my bag…sorry Jay) and began to eat it. Out comes Goodness with the biggest smile on her face and apologized for only providing powdered milk. We laughed and said it totally fine only to be greeted with tea cookies. The ones with the raspberry filling…mmm. Again, they really didn’t have to give us cookies.
After tea, we went back into our rooms and continued to see patients. I was sad when the clinic ended. I really enjoyed my day with a fiery 75 year old sister named Clementia. In fact, this became one of my favorite days here. I had the most patient interaction thus far and felt like I contributed to the clinic. I gave Clementia a big hug and told her how much I appreciated everything and headed home.
At home, GoGo continues to blow my mind when I see her hobbling around without her crutch. I don’t think she likes the crutch too much so she manages to get around slowly. A lot of family has been stopping by to check in on her. She continues to smile and also offer me a lot of food… so basically nothing has changed. That night Hailey and I took our brothers out to the arcade to hang out. I bought them some tokens and we all had a good time. On the way back, we had all of them screaming to some rap and even some Poker Face ☺.