The Passions of a Zimbabwean Physician working in South Africa

October 10, 2009

On the plane from Cape Town to Johannesburg today I sat next to a OB/GYN physician from Zimbabwe who has been living in South Africa for 18 years and had just attended the triennial international gathering of OB/GYN physicians in Cape Town.Our conversation became very animated when I asked about the question of maternal transmission of HIV during pregnancy. This subject, of course, had great meaning to me having just met scores of beautiful children with HIV+ and AIDS. I didn't realize that maternal transmission of the HIV virus is virtually 100% preventable! He has not had a case of an HIV+ baby being born in his private practice for over 7 years.

The mother needs to take tablets twice a day and if started at 14 weeks of gestation (the American protocol) the transmission rate (chances of the baby being HIV+ if the mother is) is less than .1 %. If started at 36 weeks (the Thai protocol, to save money), the rate of transmission is 13%. If started when the mother is in labor the rate is 30% and without treatment the rate is 45%. So, it is clear. Medical science has done its job in this arena. Pediatric AIDS can and should be a thing of the past. The only thing that is needed is the will and the money. The only thing,.... And then I think of the many dying or having their lives seriously compromised because of lack of food - a problem, I infer, throughout the continent. That's the same thing, isn't it? The food is here, but not the universal determination to eradicate hunger.

The physician also addresses some psychosocial aspects of treatment in his practice. In particular, he requires that all of the women AND their partner both be tested for HIV and STDs. He refuses to test only the woman only. He does this so that both become aligned with treatment, if needed. When only one member of the pair is HIV+, which is a common occurrence, this allows him to explain that if the affected member takes his/her treatment both the other partner and the children will all be healthy and don't have to worry about their life being compromised. Whatever the HIV status of the two partners, they can be true partners and supportive of each other. Because of this approach he does not see spouses leaving or being left in the relationship because of their HIV status., which otherwise does happen with some frequency.

The physician also shared with me how he, a poor fellow from Zimbabwe, became a successful medical specialist. He had received inspiration and encouragement from his nonliterate dad ("Education is salvation.") and was very determined. He would walk 25 km to read things at the library and from there got the idea to seek out scholarships. The physician also shared how he and his wife (a pharmacist) had recently decided not to put any more money into investments for themselves but to use it to help the desperate Zimbabweans who are migrating to South Africa and have a very hard time getting the basics, (food, shelter,..) that they need. Looking at the magnitude of the suffering was hard for both of us.

I am feeling a little self-conscious as I write this. So much of what I write is about the hardship of people here; I have occasionally been asked "Do you revel in people's suffering?" I would say revel is not exactly my experience. But hardship and trauma are a focus of this course in Narrative Practices that I am involved in. And it is also something that moves me greatly, that I wish to diminish in some small way by my presence and/or skills. The combination of the hardship, and the hope, and the means of resisting the feeling of powerlessness that often is associated with hardship do draw my attention keenly. I don't know how my writings and ruminations will be similar or different when I move on to the teaching part of my trip (starting Oct. 23). My hunch is that it will change some, but I suspect the challenges of the people will be frequently present with me.