Home again

Its been almost a full week since I've come back home and after handing in my final assignments and realizing that this will probably be my last blog post I worry more and more that with every day I spend away from Rustenburg I will lose the feelings within myself that had been changed so much by this ISA. Coming home has been like going to a different world and even though I had left Rustenburg wanting to continue some sort of HIV related service work during my summer vacation, that plan seems more and more elusive as the days pass by and I laze around the house "enjoying my vacation." I couldn't have prepared myself for my homecoming and even though I knew what to expect and I tried to plan accordingly so as to counteract the obstacles I knew I would face it has still taken me by surprise. All I have now are the memories of what has been and the dreams that have developed as a result of my time in Rustenburg. Everyday I try to keep those dreams alive and continue on the journey I began 3 months ago when I first arrived. Thank you to everybody who has made this experience what it has been, you have changed my life. Peace and Love :)

Rise and Fall

The second morning at the In-Patient Unit and we walked in to find two of the nurses trying very dismally to insert an IV catheter into one of the patient’s arms. They constantly complained about how tough his skin was to break through and that his veins had collapsed, making it even more difficult to get fluids into his failing body. I looked at the thin frame that lay in the bed, the contours of his bones clearly defined under his skin. He lay there with his eyes shifting across the room not moving any other part of his body, what caught my attention though was his heavy and laborious breathing. I stood and watched as his chest, outlined by the bones of his ribs, rose up and down and up and down with each breath that he struggled for. The rhythmic rise and fall of his chest was the last remnants of life within him and after each breath he seemed to wait for a few moments before taking the next one. Lily and I would glance at each other and then back at his chest, hoping to see it rise, but expecting it not to. This man could no longer eat solid foods and even struggled to ingest the soft porridge that the nursing staff had prepared for him. He could not speak and struggled to breath and all that persisted was the rise and fall of his chest, pausing for a long while before rising and falling again. Many times while Sister Francinah tried to insert the catheter, we saw him drift in and out of consciousness and she would tap his head and loudly call his name to try and bring him back to life. After many attempts by a few of the nursing staff, they finally gave up inserting the IV and tried once again to orally feed his weak frame....I stood there and stared intently at the rise and fall of his chest, hoping but not expectant.
We spent the day doing whatever we could to help Bernard; as the morning progressed we fed some of those patients that could not feed themselves and after breakfast, we helped get them out of bed and into the sun for a while. Bernard explained that a lot of them often spend about 2 weeks in the wards and never go outside so any sun that they could get would be good for them. Making hospital beds seemed a more challenging job that I thought it would be especially after Bernard explained exactly what we should do and after realising that some of the linen had fluid from the patients and so we had to use extra precaution when changing those sheets. We changed all of the beds in both wards and even went to those in the TB ward where a newly admitted patient joined the three women we had seen there the previous day. As we were changing the beds, Bernard told us that another patient had passed away in the female ward. Lily looked at him inquisitively and we asked if we could see how they prepare patients for the mortuary and without hesitation he said yes, but only if we were sure. We walked into the female ward, changing each one of the beds and choosing not to pay attention to the corner bed that was kept secluded behind two curtains, that was where she lay. She has passed away only minutes before while we were in the male ward and with every bed change we came closer and closer to that corner. I tried to psych myself up to the experience, I have never seen a dead body before, except for open casket viewings at funerals and for some reason I thought that if I could stomach this then I would be ready for a career in the health professions. We finished changing the other beds, helped the patients back into the empty beds and nodded at Bernard as he asked if we were ready to see the body. He pulled back the white curtain and we huddled around the bed and waited for him to pull back the white sheet that lay over what appeared to be a frail female body. As he pulled it back, I watched and waited...her body lay perfectly straight with her arms lying by her side, the nursing staff had placed wet cotton balls over her eye lids to help them close and they had wrapped a bandage around her bead from her chin around the top of her head to help close her open mouth. Bernard went on to place a small pillow under her chin as well because he explained that if they didn’t do that then the mouth would stay wide open which is not how most family members wish to see the body of their loved one after death. I watched her feeble and motionless body, half expecting to see that familiar rise and fall of her chest but knowing that it would not come. Bernard replaced the white sheet over her head and as we left the ward I noticed that I was surprisingly a lot calmer than I thought I would be and we continued on with our day as if nothing had changed. While sitting down for a tea break I began paying closer attention to by own chest, I felt it rise and expand forward and later contract and fall again, breathing seemed so easy for me at that point but I began to appreciate this steady rise and fall that gives and takes life.

IPU

We walked into the In-Patient Unit, not knowing what to expect yet at the same time looking around in eager anticipation. Today was the day we would have direct contact with those people most affected by the AIDS pandemic in and around Rustenburg, those people that were at their lowest points and thus needed the most help. Tapologo’s IPU is essentially made up of three wards, a ward for male patients which lies adjacent to the female ward in the main IPU building. A stone’s throw away is the TB ward where patients with tuberculosis are quarantined to prevent TB infection of the other patients.
After a brief introduction given by Bernard, one of the nurses on duty for the day, we began our day just talking to the patients and as Bernard says, trying to establish if there are any social disorders they should address. We walked into the male ward where 4 patients all turned and glanced over at us as we stood awkwardly waiting for a cue or direction from Bernard. “Bo ausi ba ba tlo bua le lona ba le bolelele gore ke bone bo mang” he said (these ladies are just here to chat with you and tell you who they are and find out how you’re doing). I immediately felt the same anxiety that I felt that third week of march when we first arrived and were told to talk to the patients at Freedom Park. In my mind I wondered what exactly I would say to the 4 men in the IPU without being intrusive and asking them about their condition. My ability to speak Setswana put me at an advantage so I sat next to the bed closest to the door. The patient in the bed lay tilted up with his thin frame straight down the middle of his bed. The lower half of his legs were as thin as my arms but what startled me the most was the colour of his finger nails, the nail bed was a dark grey colour that I had never seen before but was told by Bernard that it was very common among HIV positive patients. I sat and listened as the male patient told me about where he was from and how he hoped to get better soon so he could go back to working in the mine. In the back of my mind I wondered if he would ever be strong enough to return to work, especially the tedious and laborious tasks required in the mines but I realised that for him it was something to look forward to. He spoke so passionately about how he studied engineering and what he did at the mines that I realised that looking forward to his work was the only hope he had of claiming back his old life, the only thing that would signify recovery and strength. I sat and listen to the zeal in his voice as he spoke about the future and watched the glow in his eyes as he said how he hoped to be discharged today, in the back of my mind, wondering if it was all going to be possible but hopeful for him.
We moved on to the TB ward, only after getting face masks from Bernard that resembled the beak of a duck when we put them on. Despite the mask fitting tightly around my nose and mouth I could still smell the faint scent of disinfectant that always lingers around in hospital settings, there again we spoke to the two female patients that were alone in the TB ward. Treatment for tuberculosis is taken for 9 months and because many of the patients are said to be ‘defaulters’ meaning that they stop taking medication once they see signs of recovery, Tapologo requests that the patients stay for the entire 9 month period to ensure that they take all of their medication as is required. One patient had not been taking her ARV’s or her TB medication and as a result her belly had swollen up so much that it resembled that of a pregnant woman at 9 months gestation. She explained to us that when the resident doctor at the IPU comes in he usually drains the fluid from her swollen abdomen and that just a few days ago he had drained 10 litres of fluid. She pulled back the sheets from her bed to show us her belly and explained the excruciating pain that comes with the fluid drainage. She later got up from her bed to watch TV in the other room and we went and sat down with some off the support staff at Tapologo for a cup of tea.
It had already felt like a long morning, not because of the time that we had spent there but mainly because of the things we had seen and the conversations we had had. When we approached Bernard again after tea he told us that he had to deliver some bad news to a family because a patient had just died. The patient was HIV positive, had had TB AND had cancer as well, way too much for one person to handle I thought. I listened in as Bernard make the call, “ausi, ke le tshwaretse dikgang tse di botlhoko” (I have some terrible news for you) he continued in Setswana as Lily and I stood behind the counter watching him closely. He explained that the patient had died and that because Tapologo did not have a morgue on site, the family needed to confirm which funeral home they should call to come and collect the body. We had not seen this particular patient because they were kept in seclusion due to their weaker condition in comparison to the other patients, I could not put a face to the name but in my mind I kept thinking that ‘someone had died today.’
By lunch time I felt weak myself, physically and mentally and Bernard looked at us and declared that we could help with feeding the patients and then should go home until tomorrow. We obliged and after feeding, as we washed the dishes before heading out for the day, I started talking to the nurse that had walked in to find the patient that had passed away. She explained how she closed the patient’s eyes and mouth and changed them out of the hospice clothes into their own clothes. She explained how she cleans the patient and covers them as they wait for the funeral home to come and take them away. “Maybe I should have called you to come and help me clean the patient” she said, I replied that she should have but still am not sure how I would have reacted to that experience, “you get used to it,” she said.

Almost up

The weeks run by and time draws closer and closer to the end of our experience here in Rustenburg. Tommorrow marks the beginning of our last full week of work yet it seems like we arrived just yesterday. I can see how this experience has changed me and wonder if other people will see the changes, especially because, unlike Lily who has had an uninterrupted time here, I have been back and forth between here and home since we came. We'll be working at the In-Patient Unit tommorrow! Like a reward, Stephen declared that since we had a few days left in Rustenburg we should do some work in the IPU and the other HIV/AIDS clinics that they have at their various sites. I remember the very first day that we arrived at Tapologo and how all we wanted was to work in the IPU, it seems like a fitting task to have during these last few days as we get ready to pack up and head out. The last assignments are being written and final tasks being done, we'll try and take in as much as we can of whats left of our experience here to add to the many storys that we already have to tell.