Sizwe's Test: A Young Man's Journey Through Africa's AIDS Epidemic Page 16

  “‘Don’t ask in front of the patient what is wrong with her,’ one of the nurses told me. ‘If she hears it is AIDS, she will die.’

  “When we came from our training to the villages we were sent to the hospital. We were given the patients the hospital could not treat. At that time, if you had AIDS the hospital sent you home to be cared for by us.

  “And so that was my work. We went to our home villages and we went door-to-door to help the patients to die with the love of their families. We touched the sick person. The family watched. We taught the people how to love the ones who were dying.”

  “That must have been very difficult,” I commented, “this work of changing nightmarish and lonely deaths into peaceful deaths. It must be very difficult to deal with so much death.”

  “It was difficult for the parents to know that their child was waiting for death,” she replied. “The parents did not want to know that.”

  I would soon learn that this was always how Kate Marrandi answered a question about her own emotions—by deflecting it onto someone else. I would come to see with time that this ostensible blankness was the secret to her work.

  “I would arrive one day,” she continued, “to find that the patient is not there. She had been taken by her parents to a prophet or an herbalist. And so the patient would die far from home among strangers because her people did not want to know that their child was waiting for death.

  “But then things changed. Then everything changed. In 2003, Dr. Hermann came. He started to tell us he has got help—ARVs. Nobody believed him. Some said this one has come to kill the people. Even the doctors didn’t believe him. People thought he had come to destroy the people with his needle and his blood test. They believed AIDS was caused by politics, by white people.”

  Sizwe translated these words slowly and carefully, and as he did so, he burrowed his eyes into mine. When he was finished he kept staring at me, and although he said nothing more, he told me plainly with his eyes that what MaMarrandi had said was what he had refrained from saying earlier in the car: that in Ithanga people had wondered aloud whether Hermann Reuter carried the virus in his needle. That is why, when I had mentioned Reuter’s name some months earlier, Sizwe jolted as if he had been struck.

  “We talked to Dr. Hermann,” she continued. “You see, here our nearest clinic is Ntafufu and our hospital is Bambisana. We fall under the Port Saint Johns district, and Dr. Hermann is working in the Lusikisiki district. We are not part of his ARV program.

  “We asked him how he can come to us in Ntafufu. He said he could help. We must gather him some volunteers, and he would teach us about the ARVs, and then we could take our patients to Lusikisiki.

  “So we stopped working for the hospice and were recruited by another organization that employs community health workers called Bambisanani. We had some workshops with Dr. Hermann about AIDS and ARVs. Me in this village, and others in other villages, we began to take the sick people to the clinic in Lusikisiki. We discovered that after these ARVs have been used by the people, they are not dying a lot now, they are not lying down and dying. But some are still dying: the ones who do not like to listen. If you don’t want to stop drinking or smoking you die.”

  “Tell me,” I said, “about the ones who die even though there are ARVs for them. What is it that causes them to die?”

  “It is mainly the young people,” she replied. “They are living for the present. They don’t know about the future. Someone who cares for their life will know that at point x I will be doing this and at point y I will be doing that. The young do not know these things.

  “I don’t know if you remember, but the first time I met you in Dr. Hermann’s room at the clinic in town I was with a young man. He was swollen here.” She ran her hands slowly down the sides of her throat. “He was so weak he could not walk. I went to his house and told him he must come with me to the clinic and we carried him to the taxi. At the clinic, I asked Dr. Hermann for ARVs for him. The man was so weak he couldn’t go to the support group. I said at the clinic they must give him ARVs. I will teach him at home.

  “Then I started to teach him. I told him he must stop drinking beer. He must stop smoking. I told him that his life depended on these ARVs: you are going to be using them for the rest of your life.

  “He said, ‘Auntie, I was born not smoking and drinking. All of these things I started when I was grown. I can stop.’

  “I told him to start with his ARVs, and he lasted two days. On the third day, he sent the little children to buy him cigarettes and beer. I see before my eyes that the young do not know what to do about their lives. I went home for Christmas. I came back on January 3. When I came to his place I saw he was near death. He had gotten so drunk on Christmas Day he did not find his way home. On his clinic card it was written PCP—pneumonia. The following day he died.”

  “The youth—” I began to say.

  “Sometimes I call the youth to the school and meet with them. They need to have sex at fourteen, fifteen. And they will not use condoms. I ask them why not. The boys say sometimes they are just sleeping at their homes and the girls knock on the doors. They hadn’t even invited the girls. You do not use condoms in such circumstances. I say, what about AIDS. They say, no, we don’t need condoms. I give them advice: be faithful to your partners. They say no. I say, well, then abstain. They say no. I say to them, ‘You are a generation of AIDS.’”

  “How many people in the village have you taken to be put on ARVs?” I asked.

  She rummaged through a rucksack that had been lying in front of her on the table. A pair of reading glasses and a hardcover ledger soon emerged from it. She put the glasses on the end of her nose, opened the ledger and began inspecting it carefully, moistening her fingertips each time she turned a page.

  “I cannot say for certain,” she pronounced finally. “I think I have about thirty people on ARVs.”

  “And how many have died?” I asked.

  “Only a few. If they listen, they live. Most of them listen.”

  As I imbibed her stories, it struck me that the position MaMarrandi occupied was quite extraordinary. Nomvalo was located beyond the last outpost of Hermann’s treatment program. None of the voluble young activists he had trained was here—no adherence counselors, no pharmacist assistants, no Treatment Action Campaign activists. The local clinic, Ntafufu, did not treat AIDS at all. This entire village’s relation to ARVs was mediated through one woman.

  An image of Kate Marrandi filled my mind. Her rucksack on her back, her nose keenly tuned to the scent of illness, she knocks on every second or third door in the village. She is invited in, and sits in the family living room speaking softly and paging through her ledger. She coaxes the sick into a taxi to visit Dr. Hermann. It struck me that in Nomvalo what she meant and what the drugs meant must have long become inseparable.

  I asked whether we could come back the following month and shadow her, and she agreed. Then I asked if we could visit the very sick young woman in the wheelchair and the pink tracksuit, and she said that when I was back the following month hers would be the first home we would visit.

  “How much does the government pay you to be a community health worker?” I asked.

  “Five hundred rand per month. So that we can buy soap to be clean when we visit the people.”

  It was the first hint of irony I had encountered since meeting her, although her face remained so deadpan it was impossible to tell what she thought of her remark.

  AIDS Needle

  We said nothing to each other as we made our way down the long concrete ramp that connects Nomvalo to the rest of the world. Only after we had rejoined the tar road and were heading for Lusikisiki did either of us speak.

  “I am relieved that Kate told you what the people were saying about Dr. Hermann,” Sizwe said. “I was worried that it was only Ithanga. When you laughed, I thought, Maybe I am telling Jonny some bullshit that only the people in Ithanga believe. But now we have both discovered that the story is e
verywhere, even as far away as Nomvalo.”

  Yet he had not in fact told me the story. Even while betraying the black people’s secret on the journey to Nomvalo, he had not been able to say it out loud. MaMarrandi had had to say the actual words—“they thought Dr. Hermann had come to destroy the people with his needle and his blood test.” Sizwe had told me with his eyes that this was his story too, that this is what he had been trying to convey to me in the car.

  For all our talk on the causes of AIDS, it had taken this trip to Nomvalo to out his strongest suspicion about the origin of the epidemic. It was brewed, not by witches and their demons, but in the vividly imagined laboratories of Western science.

  We had known each other four months. Both of us knew that the most significant afternoon of our acquaintance was drawing to a close. Yet there was strangely very little to say. I considered asking him what he thought of the heart of MaMarrandi’s story: for three years she had buried her patients one after the other; now they were getting up and walking. I wanted to ask him to take an imaginative flight with me and wonder what it was like to stand in MaMarrandi’s shoes: to know that people you greet in the street every day would probably be dead if you had not come into their lives.

  I listened to my internal voice saying these words, and even to me, they sounded relentless and insufferable, and so I said nothing.

  Instead, I began to think about Sizwe. It struck me that the trip he had embarked upon with me was radically experimental. Among the things he wanted to discover was whether Hermann Reuter was a villain or a friend.

  I believed that Sizwe was entirely open to either possibility, and was gathering empirical evidence. How does one gather such evidence? What is it one is looking out for?

  I was thinking of how to formulate the question when he spoke.

  “Ushayela kahle,” he said. “You are driving well.”

  I turned to look at him. His face was full of quiet playfulness.

  DURING THE FOLLOWING weeks and months, the tale of Hermann’s HIV-laced needles began emerging all over the place, always unsolicited. It was usually a Hermann acolyte who told the story.

  “Even before Hermann came to our village for the first time, people had heard the rumor that he was bringing AIDS,” a young woman called Doli Mapungu, whom Hermann had hired as a pharmacist assistant, told me. “When he arrived, there was a big crowd outside the clinic. Many were not sick; they had come to see Hermann. They said they had heard that here is the doctor who has come to inject AIDS into people. They came to see what he looks like. When he came out, they all stared at him, but no one said anything.

  “Then, in the next months, the community saw that dying people took ARVs and they got better. Now, on Tuesdays, the day Hermann comes to the clinic, it is full. If people come on a Tuesday and they find that Hermann did not come today, and only the sister is there, they go home. They want to see Hermann. They love him now. They know him as a healer.”

  Some weeks later, I interviewed a young man who comes to the clinic in town punctually at eight every morning to manage the lines. He was one of the first in Lusikisiki to begin ARV treatment.

  The day he came back from the clinic two years ago to tell his family he had tested positive for HIV, they scolded him.

  “They were very angry,” he told me. “Not just because I was HIV-positive, but because I had gone to Dr. Hermann.

  “‘You have been to the doctor and allowed him to put his needle in you. Do you understand now that you are already dead? Your eyes are open but you are dead.’

  “I have not seen my family in a long time,” he continued. “Sometimes I want to go to them just so that they can see my healthy body and then remember the words they said to me.”

  Treatment activists had claimed the AIDS needle story as their own and worked it into a sunny narrative. “The people used to be ignorant, but now everyone knows.” Each story they told was a simple variant of this theme.

  Yet their narrative was a little too sunny, a little too self-assured. I would soon get to see how much ground they themselves had been forced to give to the idea that Western medical technology embodies malicious intent. Indeed, they had given this ground so thoroughly and so long ago, they were no longer aware of having made the concession.

  THE FIRST TIME I asked Hermann about the story of the AIDS in his needle, he gave me a long, sardonic look.

  “What do you want to know about it?” he asked coldly.

  “Why and how you won that battle. It might have ended very badly.”

  “Clearly,” he replied, “those in favor of treatment prevailed over the others.”

  He looked at his watch and said he had to go.

  Only after this clipped conversation did I discover the ordeal Hermann had experienced. During his early days in Lusikisiki, he had on two occasions arrived to packed clinic waiting rooms; some of the people assembled there had not come to be tested but to ask him to explain what was in his needle. He had had to stand in front of his audience and convince them that he had not come there to kill them.

  The voices of dissent had grown quiet, and people had come to test for HIV in their thousands. Those involved in the treatment program assumed that the doubts had gone; they spoke of them only in the past tense. In truth, the doubts had retreated into a zone of deep privacy. They were now in the heads and the hushed conversations of people like Sizwe: neutral people, agnostic people, neither in one camp nor another, scouting the landscape for a remedy to bring home to stricken relatives.

  AFTER HEARING THE AIDS needle story, I began searching the literature on Pondoland for episodes in its medical history. I was seeking echoes of the fear of Hermann Reuter’s needle. I stumbled only upon my own ignorance; the echoes were almost everywhere, spanning the generations.

  In the wake of the great flu epidemic of 1918, for instance, of which Sizwe’s grandmother still speaks, the flu inoculation kits that public health officials distributed throughout the Transkei and Ciskei territories were greeted with suspicion and hostility. “They often incited whispers that the ‘long needle’ of the White man [had come] to inject more harm,” writes the historian Benedict Carton. The Christian Express, for example, a missionary-run Eastern Cape newspaper, “reported in late 1918 that Xhosa-speaking messengers kept one step ahead of vaccination efforts, warning of ‘a device of the Europeans to finish off the Native races of South Africa, and as it has not been quite successful, they were sending out men with poison to complete the work of extermination.’”

  Once I was looking out for it, the fear of white doctors’ needles seemed to crop up in everything I read. In the 1930s, for instance, the anthropologist Ellen Hellman and the psychiatrist Wulf Sachs conducted an extended period of fieldwork in Rooiyard, a shantytown in Doornfontein, Johannesburg. During the time they spent there, rumors swept through the shantytown, which soon proved to be true, that it had been targeted for demolition. Sachs had asked several Rooiyard residents whether he could take their blood and test it for syphilis. He promised to provide medication for those who tested positive.

  On a Saturday night in Rooiyard shortly before the place was destroyed, an angry and drunken crowd turned on Hellman and taunted her menacingly. Once she had been pulled away to safety and the crowd had dispersed, an enraged resident blamed Sachs’s blood test for the incident.

  “The women say [the doctor and the anthropologist] have used our blood against us, the blood they took from us,” he admonished. “They say our blood is not good, it shows a bad disease, and so they expel us from the yard.”

  Indeed, across colonial Africa, medicine was always understood as a vital ingredient in white political power. The needle that penetrates African skin to extract or inject substances into African blood has never been a neutral technology; it is an image that has always been hungry for meaning.

  Between the 1920s and the 1940s, for instance, it was widely believed throughout central and eastern Africa that whites and their agents killed Africans in order to stea
l their blood. The story varied from place to place. In the Kenyan city of Mombasa, it was believed that the fire department captured Africans, extracted their blood, and took it to the medical department for the treatment of Europeans with anemic diseases. At times the belief was a cause for public action. In June 1947, for instance, an angry mob gathered outside the city’s fire station to demand that it be searched for a woman whom eyewitnesses claimed had been kidnapped by firemen. And in Tanganyika in the 1950s it was believed that African blood was taken to city hospitals, converted into pills, and fed to whites, who needed them in order to stay alive in Africa.

  Indeed, the fear of needles is hardly confined to Africa; it seems to mark every colonial and imperial landscape, every borderline where power is unevenly dispersed and motives are obscure. In Joseph Roth’s novel Job, set in the early 1910s in a small town somewhere in the Pale of Settlement, smallpox breaks out.

  “The authorities ordered vaccination,” Roth writes, “and the doctors forced their way into the houses of the Jews…About [Dr. Soltysiuk] resounded the lamentations of women and the howls of children who had not been able to hide themselves. The policemen pulled women and children out of deep cellars and down from high attics, out of narrow closets and great straw baskets. The sun brooded, the doctor sweated. He had to vaccinate no less than one hundred and seventy-six Jews; for each who escaped and could not be reached, he thanked God in his heart.”

  Yet there have also been times when colonial subjects have literally lined up by the thousands for injections. In the Masisi district of Tanzania in the early 1920s, news spread that missionary doctors were successfully treating yaws, a horrific disease that begins with tumid sores all over the body and ends with the sufferer’s bones rotting away.