VIII. A Visit to a Public Health Clinic, Stereotypes, and Reverse Culture Shock

Tuesday morning bright and early, we got in vans and drove to a public health clinic in Macassar where we met our Public Health professor, Dr Stefanus Sneyman. All these Afrikaans names! Jacob and Jan Villem ...

Before you read any further, I have to warn you, the rest of this post is going to be graphic - but no photos because that would be extremely insensitive to the people I saw.

The economic disparity was shocking, the physical diseases we saw literally made people vomit, and the whole experience quite shaking. I'm sad to say it lived up to every single awful stereotype image I had in my head of what a poor healthcare clinic in Africa would look like. And was even worse. Every book I have read in my global health classes could not have even begun to prepare me for what I saw. Hundreds of people, babies, families, mentally ill patients, women in labor, malnourished children crowding the waiting room of the clinic waiting to be seen. Many of them won't be seen for days. Doctors here burn out very fast and move to other countries or into academia, so there is an extreme shortage of doctors and nurses too in this country.
There were posters everywhere advocating pap smears, mammograms, HIV testing, good hygiene, vaccinations, healthy nutrition...yet according to their records only 30% of their patients are literate.
The head nurse gave us a tour of the hospital. She clearly ruled the roost at this facility, even bossing around the doctor and psychiatrist we saw. 10% of the population has schizophrenia, either from genetic conditions or from crystal meth (called 'tik' here) abuse. Depression and other mental health conditions abound. Obviously. Yet for this hospital that serves tens of thousands of people, there is a psychiatrist who visits it once a week for 4 hours. The nurse barged in on a counseling session to tell something to the doctor. Patient files were spread everywhere and open for all of us to see. HIPPA obviously doesn't exist here. There is no room for privacy in an overcrowded hospital in a poor township in South Africa. Even privacy, something I've always taken for granted, even that is a luxury here. We saw the pharmacy, which seemed to be decently stocked, but mostly with ARVs and antibiotics for TB treatment. The waiting line for patients to pick up their prescriptions was 4-5 hours. I will never again complain for having to wait 20 minutes in line at CVS.

In the hospital I saw a man lying in a bed literally shaking violently in pain because he had something wrong with his abdomen but there was no radiology or diagnostic laboratory equipment in the hospital to find out what was wrong with him. So he was literally shaking from head to foot in pain. I've never seen anything like it.
I saw malnourished babies and mothers.
A mother lying on a hospital bed in the waiting room because the hospital was too crowded, but she was in labor.

I went with a couple other people with a home-based carer to a few homes she visits. There was an old diabetic woman with a sore on her foot so she had had one of her toes amputated and needed the dressing changed. The surgery had been in August, and the wound was still gaping open and her foot was black and I did not even recognize it is a foot with toes. It was just black goo at the end of her foot. It was horrifying. The nurse had to be careful not to knock the remaining toes off. She cleaned it with that stuff you put on horses' feet when they get holes in their hoof pads. The whole foot needs to be amputated or she will die. But she is refusing amputation because then she won't be able to walk. So she will die soon. It smelled and looked so awful. I didn't know how to react. I was paralyzed. We asked her if it hurt - she said no. I asked her if she was able to get around at all - she said "I can walk. I can do anything I want." No wonder she doesn't want to get it amputated. Old people are so stubborn. And no material circumstances or disease will change that. If she loses her foot, she loses her independence, her life. The home-based carer has tried to take her to the clinic hospital several times, but the old lady has freaked out and run away - on her rotting foot - every time.
I went with the nurse to visit another man, a 33-year old stroke patient paralyzed from the waist down. He was lying outside a house underneath a rotting wooden board propped up against the wall but the board only covered the upper half of his body and it had rained yesterday morning so he was soaked. The house is his brother's, but his brother won't let him in because he used to be a gangster. And he has no ID so he cannot go to a shelter or receive care at the clinic. So he is going to die out there. The nurse just took us there to show us. I think she thought we could help him. There is nothing to do. She wouldn't let us talk to him either, so it just made me think we were making him into a spectacle. I couldn't even see his head, so I don't know if he was conscious or knew we were there. But still, it just was awful. I know the nurse was just trying to help him in some way. She was so compassionate and clearly struggles with her patients who are her neighbors and fellow community-members. But she can't do anything for them beyond the resources the clinic gives her in her small bag.
I went in another home where a man - another stroke victim - was lying in his bed, completely paralyzed on one side of his body. He can neither speak nor hear. So he uses one hand to make gestures and communicate and he reads lips. I'm sure there are no bed turning services and his tiny home - I can't call it a house - it was a lean-to shack behind some other houses - smelled like urine. It smelled about ten times worse than the worst day I've ever smelled working at the dog shelter. It was awful. I wanted to cry, but all I could do was smile because how would that make him feel if I cried. It made me feel sick and horrible. And so intrusive.

Sorry, I know this is intense, but I needed to be honest. It was a lot to handle. I don't even know what to do or say. I'm just confused.

In the evening, we visited a private hospital. When I went through the revolving door of that building I literally felt as if that revolving door spun me from Africa to America. Outside the door was the world of the public clinic - smelly, dirty, starving, disease-burdened, illiterate,  impoverished. On the other side was the shiny, American hospital smelling world of a not super fancy but moderate first world hospital. That was the biggest culture shock I felt so far. Like that hospital looks almost as nice as the place where I spent a good portion of my time during the last few weeks I was in the States. Yet I literally became weak-kneed and wanted to scream and cry and suffocate when I was in there. I don't even know. We toured this hospital too, and of course it was impossible to not compare. Not to think of the man lying next to the house a few miles away. Just a few miles. But as far as this country works, this hospital might as well be on Mars... or in America... as far as he's concerned.