entrepreneur

i would like to say this is a south african story, but , truth be told, when people see the opprtunity to make money off the backs of the stupid and vulnerable, then it is pretty much a free for all (eg, eg.)

at the local state hospital, as it should be, there is an hiv clinic. as the name would imply they treat the many people in our area with hiv using modern antiretroviral medication which is proven to lower the viral load and can turn a once deadly disease into a manageable one, not unlike diabetes.

yet still there is a stigma associated with hiv and it gets treated unlike any other disease. you can't simply test someone for it like you would for diabetes. before testing someone, they have to be counseled so they fully understand the implications of knowing about the disease. if they refuse testing, then they are allowed to continue in their ignorance, without treatment of course. also, if they choose to be tested and are found to be positive, before they are permitted to see the doctor who will be managing their newly diagnosed disease, they are required to speak to the councilor once more. this is supposed to be a time where the councilor explains to the patient that hiv is no longer a death sentence and explains the importance of adhering to the treatment plan. yet this is also an opportunity for an enterprising charlatan.

the patient in question was back after having her hiv test the previous week. i think in her mind she actually knew she was positive. there was little else that could explain her symptom complex and she had already accepted the inevitable. all she wanted to do was to get through the obligatory counseling and to get to the doctor so they could work out a treatment plan. she sat down with the councilor.

"you are hiv positive,"

"yes, i thought as much."

"now you are going to see the doctor shortly and he is going to discuss treatment with you." this is exactly  what she wanted. she just wanted to get through this and see the doctor after all. "he will tell you about all sorts of western medicine that you will have to take every day for the rest of your life." again, no surprises. "but there is an alternative." what? this was not in the script. she thought she would rush through this so called post counseling and get to the doctor. yet humans are inquisitive creatures.

"what do you mean?"

"i mean there is another way." with this, she reached under the table and produced a second hand pepsi bottle full of some liquid. the patient looked at it in surprise. it had a slightly green hue to it. the lid had scratches on it indicating that it was probably quite old and had been used many times before. "this is a cure for hiv. it is a mixture that a sangoma has created. unlike the western treatment that the doctor is going to offer you, it has no side effects. the other advantage is, because it is a cure, you only need to buy two bottles and use it for only two weeks and you will be cured. and each bottle costs only two hundred rand." she smiled. it was meant to be a warm, reassuring smile, but the patient saw it for what it really was, an evil smile hoping to snare yet another victim and send her down a slippery slope after fleecing her of her hard earned money.

yes south africans can be entrepreneurs. i don't have it in me though.

savages

i spoke about foreigners and relative attitudes between them and myself. but, truth be told, one of the reasons they think they are in deepest darkest africa when they are here is because they are!!!

we pick up the story roughly where i left it off. the initial accident claimed two lives. then the young son has to survive a brain bleed and a neck fracture. somehow the neourosurgeon sorts all that out. then in icu he gets acalculous cholecystitis and i meet him, almost in exitus. we fetch him from the pearly gates and tie him up in icu for a while. he survives. he can walk. his maths and science still works. miraculous!

but for a moment imagine the father, the only one not really injured in the accident. he is in a foreign country. he has just lost 50% of his family and there is a real chance his son might die or be paralysed or retarded for life. the daily icu vigil alone must have taken a toll on him. and then things slowly start improving.

after too long away from home they are ready to leave. the son is amazingly well. he is neither paralysed nor retarded. also he is alive which everyone sees as a positive thing. then they have the unpleasant task of getting the bodies of the other two members of the family. what do they find? certain body parts are missing, including one hand!!! stolen from the dead in the morgue. you just can't make this sort of thing up. i dare you to try.

i have spoken before about body parts stolen to be used by sangomas for so called traditional medicine, so i suppose i shouldn't be shocked, but i was. i couldn't help feeling for him. over and above all the terrible things that happened to this man and his family he has to endure the bodies of his departed family being desecrated.

this story so affected me i followed it in the local papers for a while and pretty much put it together. at least some of the people were actually arrested so quite a lot of the story became public. it seems there were people working in the morgue who regularly stole body parts to sell to sangomas. they would target the bodies which were to be cremated and cut out the desired organs just before cremation. no one would be the wiser. the foreigners were targeted, it seems, because the body lay in the morgue so long while the boy recovered in hospital.

so, in conclusion, this is deepest darkest africa and here you will truly be amongst us savages.

colleagues????

the more i read this above sick note from a sangoma the more i find in it to appreciate. there are so many subtleties that just make it priceless.

and our equally ridiculous government wants to put these clowns on equal footing with proper doctors.

cuts

one of the aims of this blog is to touch on things specific to surgery in south africa. i notice panda is talking about 'alternative healing' so, not to be outdone, i decided to post on the same topic.

she was massive. her bmi must have been hovering around the 50 mark. then she developed severe abdominal pain, complete obstipation and vomiting. as is common, she went to her local neighbourhood sangoma. he did what sangomas do. he made cuts over the area the patient reported to be the problem (her abdomen) and smeared his muthi (in this case, apparently cow dung) into the cuts. the idea, i think, is that the medicine can get to work directly where the problem is.

but what if the problem is an umbilical hernia with strangulated bowel? due to her first being treated by our traditional colleague, by the time she turned up at our hospital, she was not well. systemically she was in septic shock and amazingly acidotic. she had a large necrotic mass over her central abdomen. at that stage the only thing that could be seen were the multiple cuts on the necrotic skin. it seemed like necrotising faciitis. there was no way of knowing that below this necrotic skin in her abundant fat lay strangulated necrotic bowel.

it was the turn of western doctors to take up the knife, like the sangoma before had done. the difference, however, was there was method to their madness. she went to theater. the necrosis was debrided, revealing the dead bowel. a resection was done. i was only a student at the time, so i was pretty far down the table. the smell also had a numbing effect on my faculties, so, to be honest, i can't remember the details of the surgery. suffice to say, an extensive debridement was done. living bowel was brought out (somewhere). and the wound was left open. she did the obligatory time in icu with multiple follow up visits to theater. after many months, she actually made it.

i sometimes look back and wonder if we really can critisize the sangoma. he did take a knife to the patient, which was the right treatment. he did have some concept of the problem having something to do with feces. i may advise that, unlike fire, feces can't be fought with feces, though. but many of the basic concepts where there, albeit in a non western format.

when reflecting on these incidents, i am always amazed by the fact that there is so much leeway given to these 'healers'. they are never made to account. they are never held responsible. they have free license to do what they want. there was even a government statement that the sangoma's 'art' cant be scrutinized like western medicine, because it is based in a belief system rather than science. the ancestors will heal you. believe it and it will be so. and when the patient finally does turn up at our doorstep at death's door (same doorstep?) when we can't actually pull them through, sometimes the sangomas will say "you see! the western doctors just kill you". no mention of the tried and tested methods of smearing feces into open wounds over strangulated bowel.

balance

i have often given a very critical opinion of our sangomas. to tell the truth i try not to write about them too much because if i were to write all the stories i'd probably not write too much else. but there is another side to the whole thing. so for balance, the following...

some time ago i went on a sort of tour around the lowveld to introduce myself to the doctors as a new surgeon. in one of the neighbouring little communities i met a gp. he told me a story that i actually believe. he said that a growing portion of his practice is made of hiv patients. some he keeps controlled on antiretrovirals. some present too late, basically in terminal aids. he usually tries to bustle them off to some or other hospital. (if you've been following my blog lately you'll know this is not too easy at the moment). these people, in their desparate state often ask for a drip, possibly thinking it some sort of powerful western medicine. he complies, reasoning it may not do much but a vitamine boost isn't the worst thing for them. he then told me he struggles to charge them for this. sometimes he doesn't charge. sometimes he works it out that the equipment costs about r40. he puts a small profit margin on and charges about r60. (this is probably around $5). but then he said some of his patients complained because he wasn't giving them the good drip. when he asked what they were on about he was told that other doctors in the area (medunsa graduates according to him) were charging r1000 for putting up a drip for these terminal hiv patients!

interesting. if you are charging that much you are selling the idea of a cure. even if you don't say it the fact that poor people pay that much means they believe it will cure them. the target audience is also a group that is particularly desparate for a cure. especially now that the state hospitals are basically not working. this is intensely shocking to me. they are willing to fleece poor people for their lasts cents just before they die.

now i wonder. who is worse? the sangoma who kills someone by giving him a cow horn enema that he truly believes will help or the doctor who knowingly charges more than the patient can afford for the promise of a cure he knows won't work. yes the modern sangomas are now amongst us.