We have spent our last week in Durban, South Africa. First, we had a lazy Monday saying goodbye to Pietermaritzburg, driving, and later enjoying the bright Durban sun while lounging by the pool at our bed and breakfast. On Tuesday, however, we were set to work.
After an early breakfast we were dropped off in the ARV (Antiretroviral) and PMTCT (Prevention of mother to child transmission) wards of Addington Hospital. Our group of six was divided in half in order to cover both departments. The PMTCT ward was hectic, with long lines of antenatal, pregnant, and postnatal mothers lining the hallways. Feeling official, we learned to ask each of the mothers to step on a scale and write down her weight in her medical records as we waited for the ward’s one doctor to arrive. Once the doctor did arrive, we divided ourselves into the ward’s three sections: the doctor’s room, the counseling cubicle, and a room for blood testing.
Immediately one got the sense that Addington’s doctors are able to declare his or her own hours, leaving a stressful and rushed working environment. The PMTCT doctor made up for this laid-back mentality with her compassion and mothering. During appointments she guided mothers through their blood tests, explaining what the numbers meant for the patient and her baby. She openly praised patients for following drug regiments and “condomising,” and displayed visible disappointment toward those who didn’t. She disciplined young patients for needing to attend the clinic, scolding them in a rapid, mixed Zulu/English for not being in school. The patients I saw ranged from age 14 to 38. The doctor even strayed from protocol to assist her patients and their families, scheduling appointments and medications to the partners of her patients. “Sister (the PMTCT nurse) will kill me,” she laughed, as she scheduled such an appointment. I couldn’t help but smile.
The doctor, counselor, and blood testers explained the basic ARVs administered to HIV positive and pregnant mothers. The requirements for the drugs were previously low compared to countries such as the United States (a CD4 helper T-cell count of 200 or less), but given that South Africa is now the HIV/AIDS capital of the world, this number has now risen to 350 in an effort to eradicate the disease. This same CD4 restriction is seen in the US. Despite this change, stigma regarding HIV/AIDS remains so prevalent as to prevent many of the infected from seeking medical aid whatsoever. It is a vicious cycle at its finest.
The head doctor in the ARV clinic was a personality as well. She sat with us for an hour to explain her years of climbing the medical ladder to her current position, a medical officer who also helps run the pediatric department. This last descriptor we found ironic, as she later revealed her inherent dislike of children and even people. Luckily for her, after years of working she grew to enjoy a sense of being able to help her patients medically. She stated that she enjoyed being selectively chosen as a doctor by her patients as well. We left the meeting bewildered as to why she had become a doctor in the first place. Happily, none of us left second-guessing a medical career, despite her attempts to have us reconsider exactly what we are getting into. To her credit, an ARV clinic in South Africa would be a dangerous medical field in which to practice.
In the early afternoon we were brought to Albert Lithuli Hospital, where our host Reshmi works as a virologist. Immediately upon arrival, we were blown away by the sheer size of the building. Reshmi kindly gave us a tour of the hospital, which when compared to hospitals of last week looked like a high-end mall. The halls were wide and clean, ward entrances opened by automatic sensors, and the food court was spacious and colorful. Albert Lithuli has been explained to us as the country’s premier public hospital, the one most similar to the United States’ health care system. I can vouch for this statement; when I visualize a hospital, a picture similar to Albert Lithuli comes to mind. We were also given a tour of Reshmi’s domain, and were able to look at the multitudes of complicated machinery designed to test for precise viruses. Julie laughed when she found a machine that completed exactly what she had done in a lab of a Boston hospital last summer. For what had taken her several hours, this machine accomplished in minutes.
Due to its up-to-date medical status, Albert Lithuli functions primarily as a reference hospital. This means that Lithuli is where patients are transferred to when their health concerns have become too severe for other hospitals to handle. As an example of this, Albert Lithuli does not have a true Emergency Room (Trauma) department. Trauma cases are instead taken to the nearby King Edward VIII hospital, and if King Edward cannot provide the necessary care, the patient is then transferred to Albert Lithuli.
Overall we have been witness to a wide variety of medical care. The stark contrast between Addington, which can be likened in appearance to Edendale Hospital, and Albert Lithuli screams the after effects of apartheid in terms of both design and quality of care. Though Durban is a much more cosmopolitan area, Durban suffers similar effects by apartheid as we saw in the hospitals of Pietermaritzburg. Thankfully, rumors of refurbishing many of Durban’s hospitals gives hope to the possibility of an eventual, more equal health care system here.