Sizwe's Test: A Young Man's Journey Through Africa's AIDS Epidemic Page 13

“They nearly killed you last Monday!”

  The man slams his hand down on the table. “Yes, doctor! They nearly killed me! They nearly killed me last Monday!”

  His baritone is so deep, I look to the table to see if it is still. Sizwe and I glance at one another, wondering whether we too should feel angry.

  Hermann is as animated as I have ever seen him. He waves an arm in the air, rallying everyone in the room, the nurse too, who returned with some reluctance about half an hour ago.

  “Listen carefully,” he says. “Listen to what this man is about to tell us.”

  He turns to the large man. “What happened on Monday?”

  The patient clears his throat loudly and shifts in his chair. He is obviously pleased to be bearing testimony to his ordeal.

  “I came Monday to the clinic,” he says. “They gave me a bottle of pills. They said I must take the first one now, right here, in the clinic. They fetched me a glass of water. I drank the pill, and then I couldn’t breathe. And then I was lying on the floor. I looked at my arms and there were blisters, huge blisters.”

  “They gave you co-trimoxazole on Monday,” Hermann says. “It nearly killed you. You must learn the name of that medicine. Cotrimoxazole. You must never take it again. Also, I am going to write down the names of other medicines which have different names but are the same as co-trimoxazole. You must never take those medicines. I have written it all over your card in big letters.”

  He turns to the rest of his audience.

  “This man has Stevens-Johnson syndrome,” he says. “It is an allergic reaction to medicine, a very rare one. He is a gold miner. He went to a clinic on the mines last November. It says here in his notes that he had an allergic reaction to co-trimoxazole. The people here didn’t see that in the notes. They gave him co-trimoxazole and nearly killed him.”

  The big man nods in agreement.

  Hermann continues reading for a moment, then looks up at me.

  “He was a miner. He got sick. They retrenched him. Sent him back here. Next time you hear the mining houses speaking nice about HIV, remember this story.”

  “Which mining hou—”

  “They all do it,” he interrupts. “Even the ones that talk nice.”

  He turns to the miner. “Why don’t you get the union to fight for your job? HIV is treatable now. You can work.”

  “I don’t trust the union,” the patient bellows dismissively.

  “Why not?”

  “They are in it for themselves.”

  Hermann looks at the nurse. “Do you know what alternative medicine to give him?” he asks.

  “No,” she replies.

  A FEW MINUTES later, in the dying afternoon light, it is just Hermann, Sizwe, and me left in the examination room. My head is down. I am taking notes.

  “I don’t like what you’re writing,” Hermann says.

  “What am I writing?”

  “That it’s the nurse’s fault that man nearly died.”

  “Whose fault was it?”

  “Whoever treated him at the mine in November. Everybody knows that nurses might struggle to read clinical notes in abbreviations. Doctors understand clinical notes. Other people struggle. My colleague who treated him at the mine knew he was coming to a rural area. If he thought for longer than half a second, he would have known that the clinic in the rural area will give him co-trimoxazole. It is a general prophylactic. Everyone with HIV gets it. My colleague should have educated him. It didn’t dawn on my colleague that giving knowledge to the patient might save his life.”

  “WHAT IS THIS clinic’s mortality rate?” I ask Hermann as we make our way to the car. “Is it higher than clinics closer to town?”

  “Why do you ask?”

  “At Village Clinic in town, you have five experienced nurses. Here you have one temporary nurse who knows nothing about AIDS.”

  “The workload per nurse is worse at Village than here,” he replies. “Everyone goes to Village. It has a strong support group, I am there often, it is a hive of activity, so people go there. Measured in patient numbers it is the most understaffed clinic in Lusikisiki. Here is better.”

  “Still,” I say, “I have seen patients today who might have died if they had been diagnosed by the nurse instead of you.”

  “It does not take long to train a nurse,” he replies. “And besides, poor clinic nursing does not increase mortality rates. If a good nurse sees someone is very sick, she sends the patient to the hospital. If a bad nurse sees someone is too sick, she also sends the patient to the hospital. That is where people die: in the hospital.

  “The biggest consequence of having too few nurses is that fewer people start treatment. No nurses, no treatment. That is the problem.”

  It is Hermann’s mantra: Fighting the epidemic is a primary health-care project. It needs arms and feet, nurses and laypeople, to share the load, and that is all. Their competence will come later; the priority is numbers.

  I do not believe him. From the Kaposi patient to the big man with Stevens-Johnson syndrome, I have seen today before my eyes that an AIDS patient who visits this clinic and sees this nurse is far more likely to die than a patient who sees Hermann. And if the Lusikisiki district isn’t given the money to advertise its vacant posts, nurses experienced in AIDS medicine will keep leaving, and they will keep being replaced by nurses who know too little, like the one we saw today.

  Hermann ought to have answered my question more candidly. Yes, poor nursing can result in mortalities, he might have said, but if ARV treatment is confined to well-trained specialists in hospitals then almost everyone sick with AIDS will die waiting to be treated.

  DRIVING HOME IN the sunset, we pass a group of patients walking home. They wave to us.

  “Those people are lucky,” Sizwe says.

  “Why?” I ask.

  “Because they live in a place where a doctor, a white doctor, comes to spend the day.”

  For once, Sizwe’s answer does not come out of Hermann’s textbook. The doctor does not overhear our conversation. Had he done so, we would have received a mouthful about inherited prejudices against nurses and laypeople.

  In the coming months, I will often pause to remember Sizwe’s remark. The next time he speaks to me of a white doctor, his words will be far darker and far more complicated.

  The Fence Around AIDS

  On the Saturday morning following Sizwe’s visit to the clinic, his father, Buyisile, left Ithanga for the weekend. That night, Sizwe went to his mother’s place for dinner. He was joined by his sister, Lindiwe, and by his niece, Thandeka, who had a weekend off work and had come to stay. The four Magadlas who broke bread together that evening constituted a full quorum of the bearers of Thandeka’s secret. No other Magadla knew of her illness.

  What with the old man far away and the four enjoying a simple evening together, somebody plucked Thandeka’s illness from its silence and cast it into the discussion. There was an awkward moment in which no one said a word. Then Sizwe asked Thandeka whether she had been sharing her toothbrush. She had: she had left hers at home and had been using Lindiwe’s.

  Sizwe advised them to stop sharing. Even a healthy person, he pointed out, can break the skin on her gums when she brushes her teeth and leave blood on the toothbrush. Both women apologized. They had not been thinking; one is not accustomed to thinking of these things.

  MaMagadla, Sizwe’s mother, chipped in for the first time: those who are HIV-positive should also not share towels, she said. They rub it on their private parts when drying themselves, and the AIDS may have given them blisters that split open. And there is also the blood that comes from a woman when she has her period.

  Thandeka agreed that she would be careful not to share her towels.

  The family fell silent. They soon began speaking of other matters. Nobody had raised the question of what to do. Nor had anyone voiced the uncertainty all four of them felt inside: the question of timing. Next week, next month, next year, or ten years from now, Thandeka would
fall sick. It was impossible to say when.

  Yet the matter had been broached. Not furtively, in an unseen corner, but over a family meal in the homestead rondavel. Something had been shared, albeit something terribly fleeting and ethereal.

  BY THE TIME this family discussion took place I had left Lusikisiki. I next saw Sizwe about a month later. I asked him whether we would go to Mthatha to see the girl who can cure AIDS. He had told me that Thandeka should get medicine from her rather than go to the clinic, for a cure is far preferable to lifelong treatment.

  “I don’t think so,” he replied.

  We were in my car once again, driving from Ithanga to town.

  “Have you changed your mind about her?” I asked.

  “I attended a funeral in Port Saint Johns last Friday.” His voice seemed tired and reluctant. “There was a priest there, a priest the people respect. He mentioned the lady from Mthatha. He said she had failed in her promise to cure AIDS. He had watched people go off to see her. They came back and kept getting sicker and died.”

  He was silent for a long while. I was about to ask him about the priest.

  “In any case,” he finally continued, “there was a man from another village who has directions to the Mthatha lady’s place. I looked for him for two weeks. When he heard I wanted to talk to him he came to Ithanga especially to see me. But the paper with the directions on them was at his home. He hasn’t come back since then.”

  “Do you have another plan for your niece?”

  “No. I am sitting without a plan. Maybe I will urge Thandeka to go to the clinic.”

  “Do you know whether they have taken her CD4 count? It might tell her how far away she is from getting sick.”

  “I don’t think she has had that. I have no plan.”

  Although more than a month had passed, we had not spoken of our trip to the clinic with Hermann. Aside from his fleeting comment in the car at the end of that day, I did not know what he thought of what he had seen. It was on the tip of my tongue to ask him, but it appeared from his brittleness that now was not a good time.

  THERE ARE MANY things about which Sizwe likes to talk to me: his father’s life choices, his boyhood memories of herding and hunting, his business plans, his impending marriage. Sometimes, when we go walking together, all I need do is point at something, anything—a circle carved into the hillside by a bolt of lightning, an unusual tree, a hilltop—and a story will flow from him.

  About illness he is not comfortable sharing his thoughts. The tension pulls his head into his shoulders and he observes me warily. I am knocking on the door to a universe in which I do not belong—because I am not family, because I am white, because I am a writer, because there are matters about which one does not speak lightly, and others about which one does not speak at all.

  But I am here, after all, to write about illness. We are both aware of that: we must either speak of these things or part ways. He has in fact long ago decided to talk to me of the matters about which I want to know. It is a question of how, of the most respectable approach.

  I think that the first time was in connection with the twins.

  THE MOTHER OF the twins was a schoolgirl, fourteen or fifteen years old, and one of Sizwe’s nieces. News of her pregnancy had been greeted with much anger. The girl was sat down and interrogated, and the name that finally passed her lips elicited a frightened silence. Nobody knew the boy, but his name betrayed that he was of the same clan as Sizwe’s mother. If the two had indeed had sex, their union had violated a taboo.

  Sizwe was instructed to visit the family in question—they lived about twenty-five miles away—to demand compensation. At first he refused.

  “It is a very rude thing to say to your mother’s family,” he told me. “And I did not trust that the girl was telling the truth. These teenagers have sex with many people.”

  Reluctantly and with some bitterness, he did finally make the journey, and when he returned, it was with good news. The girl had been mistaken: the boy in question was just staying at that place; he belonged to another family and another clan.

  “In any case,” Sizwe said, “I doubt he was the father. I suspect that the father is from Ithanga. I have been watching. There is a young sangoma who lives near my niece. When she goes into the forest to collect wood, he always follows ten minutes later. Nobody notices because a sangoma does woman’s work; he is meant to go to the forest to collect wood.”

  Sizwe’s niece gave birth to twins at about eight o’clock on a January evening. She was attended to by Ithanga’s most experienced traditional midwife. The first twin was born healthy, the second gray and unhappy. When I arrived at Sizwe’s parents’ homestead early the following morning, there was a pallor of heaviness about the place. The second twin had died during the night; the family was preparing to bury her.

  Buyisile was in a mood I had not seen before. His face had frozen into a mask of extreme gravity, the corners of his lips pulling his broad mouth into his chin. He moved about relentlessly, first going into his field to untether and retether his goats, then pacing the circumference of his rondavel, then mooning around his workroom, his path trailed by the clattering of tools and implements. He was wearing his igqira’s vest, and his powerful, young-man’s frame cast a bolder shadow of violence than I had noticed before.

  The unexpected death in his family had placed him in a no-man’s land. He was, on the one hand, the oldest man in the family, and thus a leader on occasions such as this. Yet he was also an igqira, for whom the rituals of death are contaminating; his role here could at best be no more than peripheral.

  After much wandering and muttering under his breath, he chose a burial site at the edge of the family’s mealie garden, next to the graves of his three dead children. Sizwe and I and several other men began digging a grave. Within a few minutes, the men had put down their spades and were engaged in heated talk. The oldest among us, Buyisile’s younger brother, had remembered that a twin ought not to be buried outside the family homestead. It must be close to where people sit at night. Nobody was certain of the reason. It had something to do with the well-being of the surviving twin.

  Buyisile was called. There was a great deal of discussion. He walked off and we followed at a distance. He chose a new spot, this one directly behind his rondavel, and ordered us to dig.

  When our work was done, we put down our spades and went to sit on the benches outside the family rondavel. Buyisile watched us closely from some thirty paces away. He was sitting on his haunches outside his workroom crushing herbs with a mallet; the mixture he was preparing protects his medicines from the pollution of death rites.

  Without warning, Sizwe’s mother appeared holding the corpse out in front of her at eye level; it was bundled in a thin blanket. A procession of seven or eight women followed behind her. She started to sing so softly that her melody periodically disappeared, and the other women cast in their voices and began picking it up. By the time the procession had disappeared around the back of the rondavel, a full chorus of voices mingled with our hushed conversation.

  Sizwe’s eyes were fixed on a spot in the middle distance. I followed his gaze to find a woodpecker near the top of a tall tree, hammering at its trunk. I smiled at him.

  “My friends from Durban would come here for three weeks just to see that bird,” he whispered.

  After an interval that seemed to last no longer than three or four minutes, the singing ceased. Sizwe’s mother reappeared from the back of the rondavel and signaled for us to come. By the time we arrived at the gravesite, the women were gone. We picked up the spades we had used to dig the grave and began filling it in.

  Some time later, as I sat on a bench in his rondavel, Buyisile came to sit next to me.

  “You have found us on a bad day,” he said. “The child of my granddaughter is dead. It is a very dark day for us. When the family is scattered here and there we cannot protect them all. You know that death is coming, but you do not know precisely where. I have been seeing i
n my sleep for a while now that death is coming, but not once could I tell where it was going to strike.”

  “What do you see in your sleep that tells you death is coming?” I asked.

  He frowned and turned away from me. “When you are here during happier times,” he mumbled, “I will explain these things to you. But you are here during sad times, and I can’t say more.”

  He stood up and walked out.

  THAT AFTERNOON, I sat with Sizwe and his younger brother Mfundo on a hilltop overlooking their father’s homestead. Most of the people who had attended the funeral in the morning were still there. From this height, they looked like charcoal figurines moving in slow motion.

  As I recounted my conversation with Buyisile, Sizwe nodded.

  “I am also warned when there is going to be a death in the family,” he said. “I don’t remember any death that did not first come to me in a dream. There are certain visions that mean that death is coming. For instance, a span of oxen plowing a field. Or if it is winter and the land is barren and you dream of a healthy mealie field, that means death is coming. If you dream of shit, of human dung, that is also a sign of death. What else?”

  “Cultivated fields,” Mfundo added. “Even if it is not winter, a cultivated field could be a sign that death is coming.”

  “Were you warned of the twin’s death?” I asked.

  Sizwe and Mfundo exchanged glances. They had clearly discussed this matter in the last few hours, and they were not sure I should hear about it.

  “Yesterday,” Sizwe said, “I had a terrible headache. It was with me the whole day. It was still with me when I went to bed; I could not sleep. When I finally slept, I dreamt of eating raw chicken, and when I woke up, my stomach was burning, as it always does when I have dreamt of eating raw meat. I thought to myself that a demon must have gotten into my room during the night; they have sent a demon again to feed me raw chicken and attack my stomach.

  “Then I heard in the morning that one of my niece’s children was dead. I was confused. Maybe the dream was actually about death. Maybe it was not a demon, but my people telling me there had been a death in the family. Except that the visions in the dream were not the visions of death, so I don’t know. One does not dream of raw meat when there is a death.”