There may be something a little distasteful about the whole
thing, this sort of reverse medical tourism. Well-off western kids strutting
across the world to gawp at and have their consciences titillated by genuine
poverty and pain and squalor and violence and suffering. The kind you read
about and see on the tee vee. But then I’m not just gawping I guess. I just got the
results of my finals. The General Medical Council and two Universities have
decided the last six years were not entirely wasted. Weird as it sounds, I’m a
Doctor. And this guy on the trolley in front of me, who’s thrashing around and
bleeding profusely from his scalp, he’s my patient I guess. This is what I came
I’m in the Gauteng Province of South Africa. The Sesotho
word Gauteng means ‘Place of Gold’. It was the discovery of Gold and the
establishment of mines here in the 19th century that led to the
founding of Johannesburg. Forbidden by Apartheid laws from living in
Johannesburg, black men (men only) were permitted to live in squatter camps and
settlements south-west of the city.
The South Western Townships now sprawl over more
than 180 square kilometres. The official estimate of the population is around 4
million but it’s probably significantly more. Immigrants from surrounding countries
tend to end up here, seeking work in Johannesburg – the capital city of South
Africa and one that generates over a third of the country’s wealth. Soweto
supplies much of the labour force for Johannesburg. Sowetans say –
‘Johannesburg is the heart of the country and Soweto its pulse.’
Apartheid is officially over but you will not find many
white people living in Soweto. It’s finding its feet - not quite a city, but
more than a shanty town. A great number of residents still live in ‘Informal
Settlements’ – rows of simple shacks. There is little electricity beyond what
can be diverted illegally from the street lights. Electrical burns are
common. Cooking, heating and lighting are with coal or oil. The burns
that shack fires produce in these settings are unforgettable.
A single water tap may serve a whole street or block. The
government has started a scheme to provide chemical toilets to each house. New
housing is under construction but many people here will never qualify for
Founded by the British in 1941 to provide medical care for
the Imperial Army, the Baragwanath hospital is now one of the largest in the
world. An excellent essay on the history of the place is available at their
website. The name of the prominent anti-apartheid activist Chris Hani was added
after his killing in 1993.
‘Bara’ as it’s known locally is the only public hospital
serving the population of Soweto. In the Apartheid era it was a blacks-only
hospital and the majority of patients are still black. The surrounding area has
one of the highest rates of rape, murder, assault and other violent crime
anywhere in the world. The violence is almost entirely black-on-black. I ask
many of the people I see what it was about, what the argument was. Women, dice,
money are common answers. Football results. Simple mugging. One man who was
almost stabbed to death told me it was for his mobile phone and the money in
his pocket, 20 Rand. That’s about £1.25 or a little over $2. Puza is another
common answer, one well-known to anyone who’s worked in an Emergency
department. Puza means ‘drink’.
Morbidly, all this violence makes the place a magnet for
doctors - particularly aspiring surgeons. Military surgeons from around the
world come to train here. There aren’t so many places outside of active war
zones where you can be pretty much guaranteed to see a number of severe burns,
gunshots and stabbings every day. And largely in English.
I’m on a one-month placement in the division of Trauma
Surgery. The Trauma emergency room is known as ‘The Pit’. I see lots of Trauma,
you can imagine. We learn to perform procedures they’d never let us near back
home. Not without a few dozen more letters after our names. Chest drains and
central lines and suturing and suturing and suturing. But let’s draw the
curtain. Patients are entitled to privacy. If you see me coming out of the
cubicle you’ll notice my shoes are bloody. I liked those shoes. The cunning
thing to do would have been to don a couple of pairs of the overshoes they wear
in surgical theatre. Some things they don’t teach you.
They do tell you, before you come here, that the incidence
of HIV in people coming through the door is around 40%. We had a talk from the
medical school on transmissible infections before we went off on elective. They
gave us more statistics and sombre words.
‘The profession whose ranks you are
shortly to join, ladies and gentlemen, is still esteemed in some circles’ the
Prof said. ‘It is esteemed in part, because in past pandemics your colleagues
have had the choice of staying at home and ensuring their safety and the safety
of their families – or treating patients. They have historically made the
choice to treat their patients. Some of them have paid for this with their
lives… I fully expect you to make the same choice.’
rate of occupational transmission from an HIV-positive source is believed to be
0.3% for a percutaneous exposure and 0.09% for a mucous membrane exposure. The
rate of transmission from a hepatitis B-positive source to a nonimmunized host
is 6-24% and 1-10% for exposure to hepatitis-C.
Percutaneous exposure in this context means needlestick -
being pricked by a contaminated needle. Mucous membrane exposure means getting
blood or other contaminated fluid in your mouth or eyes. With blood and
scalpels and needles flying everywhere this is a real risk. Workers who are
exposed make a decision to start or not start anti-retroviral treatment. The
beatific calculus. The course is one month and reportedly makes you sick as a
dog. It is meant to reduce the risk of seroconversion but this isn’t really the
sort of thing you can run double-blind placebo controlled trials on.
Risky business, this. In real terms, if you’re sensible the
risks are low. We went to speak to the Prof after the talk, rattled. He told us
to observe universal precautions - foremost of which was to keep everything
zipped away - and we’d (probably) be fine. There are much higher-risk
activities after all.
Bla Bla Bla
And again I wonder if it’s the right thing to come here, me,
some middle-class prick from another hemisphere. Sitting in the evenings with
friends, sipping tea that I packed and brought with me or imported Tanqueray
and Tonic or wine from the vineyards of Stellenbosch and Paarl, thinking of
the people I’ve seen today, shot and burned and stabbed and broken, many of
them my age. I’ve had too much wine I think, that wasn’t sipping was it?
Thinking of what they went home to – the ones who went home. The Place of Gold.
How much have we changed since the first hominid saw something glinting in a
rock and thought – oooh… pretty… shiny… and his brother hominid cracked him in
the goddamn eye with a dull rock and took the shiny rock from him? I’m the same
age as many of these people, I think I said already. Some are younger. Young
men and women in their prime - with everything before them. With nothing before them. We’re all going straight to heaven. We’re all
going straight the other way.
It’s 3 in the morning at Bara. The shifts here are 24 hours,
7am to 7am. After hours of carnage, the Pit is quiet for the moment so I go to
the Doctor’s break room. I brought a bunch of books with me travelling as you
do. Fiction, non-fiction. I’m too tired to read but some things stick in the
mind and come back. This is John Maynard Keynes, you may have seen it before.
may still have to time to reconsider our courses and to view the world with new
eyes… The events of the coming year will not be shaped by the deliberate acts
of statesmen, but by the hidden currents flowing continually beneath the
surface of political history, of which no one can predict the outcome. In one
way only can we influence these hidden currents – by setting in motion those
forces of instruction and imagination which change opinion…
In this autumn of 1919 in which I write, we are at the
dead season of our fortunes. Our power of feeling or caring beyond the
immediate questions of our own material well-being is temporarily eclipsed....
We have been moved already beyond endurance, and need rest…. For these reasons
the true voice of the new generation has not yet spoken, and silent opinion is
not yet formed.
If you can keep busy enough you forget other aches and
troubles, they’re carried along with everything else. But when you have a
moment of peace in which to rest they begin to settle out again, sinking in the
heart like gravel. You close your eyes a moment and old old songs are heard
But troubles will soon be over. Besides, there are many who
have it worse - who have more pressing troubles. I’m not in the break room for
long before one of the Nurses comes in.
Hani Baragwanath Hospital official website
- Emedicine Needlestick
reading included The New Penguin History of the World by JM Roberts, which
quotes from John Maynard Keynes, The Economic Consequences of the Peace.
The complete passage (p296-8) of Keynes’ book is available on Google books and is
worth a read.