I write these words from the veterinary clinic which doubles as an internet café. Outside the air is alive with red dust and the strident calls of densely peopled buses and street vendors.
It is summer, wet season in Swaziland. The recent welcomed rain has turned many of the roads to mud.
Yesterday, we played a familiar game of ‘sardines’ which involves packing several robust nurses and one skinny doctor into a diminutive but steadfast truck.
Perhaps the only thing more densely filled than our vehicle was the list of patients we had to see that day.
At one point we arrived at the foot of a tall and inhospitable hill. Strewn with jagged edged rocks and overgrowing wild grass, there was no road in sight.
However, knowing that at the top lived on of our patients, our intrepid driver found a way.
The truck careened, groaned and occasionally snarled as it awkwardly navigated the rocky slope.
Eventually we reached the summit, and in blind faith opened the creak y doors, cautiously stepping out into an endless sea of wild yellow grass.
“Careful of Mambas!” I said, partially to myself. A snake bite was the last thing any of us needed up here.
After unloading the truck, we carried food packs and medical supplies to the little thatched mud hut which we could see a few metres away.
“It’s been some time since we came here” Make Maposa exclaimed. “The man here is very sick Dokotella, very sick”. As we stepped into the hut, I understood what she meant.
Lying naked on a dirty, rat eaten mattress in the darkness, was a man in the end stages of HIV.
He was severely malnourished, a skeleton covered in a thin garment of brown skin. The contour and arc of every rib was clear visible, palpable.Next to him was a putrid pool of his own wastes. Since the onset of AIDS, his brain had become secondarily infected with Toxoplasmosis which had in turn precipitated a stroke. He could not move his left side. As I examined him I wondered how long it had been since anyone had touched him.
Make Maposa told me the story. “There is a daughter who comes each evening after work. She has her own family. They live at the bottom of the hill. She comes every night, feeds him and changes this bowl of his wastes. But you can see Dokotella, he is hungry.” That was a profound understatement.
We gave him an orange. He took it in his skeletal hands and devoured it. We took out a bag of maize meal and the nurses mixed it with some milk into a porridge. Within seconds it was gone.We shared the little gifts we had brought, leaving a toothbrush, nappies and simple medicines to help treat the incessant diarrhoea which can be so dehumanising in stage 4 HIV.
After he had finished his porridge, he looked at each one of us. He held our gaze for a moment, eyes swollen with tears, trying to convey something that he did not have the strength to explain. In one tremulous motion he lifted a brittle hand and said “Siyabonga” – Thank you.
I remembered the old catch cry which many of us who study international health have pinned to our lapels: “Give a man a fish, and you will feed him for a day. Teach a man to fish, and you will feed him for a lifetime.”
It is true. Change needs to be sustainable. Empowerment and engagement of individuals and communities necessitates helping those in need to assist themselves.But this man, with a CD4 count of 4 and a palliative diagnosis, was far too weak to even hold a fishing rod, much less learn how to fish.
So it was his community who would have to do the fishing for him. We sought out his daughter and helped her to cultivate a garden to give the man a sustainable food source. Then we left him with enough ‘fish’ for the month, till we came to see him again.
There is a story of a sparrow, which my Dad told me once. He was lying on a gravel road, with his little scrawny legs facing the open sky. A horseman was walking past and seeing the sparrow, alighted from his horse. He said “Little Sparrow, are you hurt? Why are you lying there so awkwardly? Face up to the sky?” The sparrow said, “I have heard, that sometime today, the sky will fall.” The horseman laughed and said, “And you think you can keep it from falling with those little legs?” The sparrow shrugged his shoulders and said, “My friend, I will do what I can.”
Sometimes here in Siteki, this little hamlet filled with pain, it seems that the sky is falling.
We do what we can.
From Siteki with love,