We rejoin Zainab and her peers in the middle of their medical adventure in South Africa. Our next and final instalment of her story continues below…
If you haven’t yet read the first instalment, you can find it here.
CHAPTER THREE: The Witch doctor and the deadly enema
Children everywhere get gastroenteritis. Indeed, diarrhoea is the leading cause of child mortality globally; namely in the developing world.
In South Africa, alongside the public (Western medicine) health system exist traditional healers who offer similar services. There are broadly two types of traditional healers. Inyangas: Herbalists, and Sangomas: diagnostician/Medium to the dead. Everything from winning back lovers to curing cancer is promised.
Children with viral gastroenteritis die from dehydration following fluid loss through vomiting and diarrhoea. Keep them hydrated and you keep them alive.
Children with gastroenteritis in Kwa-Zulu-Natal who are taken to see an Inyanga invariably seem to be prescribed the traditional enema; accepted and widely practised as a method of “cleansing”. The concoction may contain anything from herb plants, to toothpaste and shoe polish. Sometimes the preparation is toxic, sometimes it isn’t. It’s impossible to know. What is known however is that this practice endangers children either from its inherent toxicity, or by worsening dehydration, or by delaying presentation to medical care.
I’d like to share the story of X; a 3 month old baby girl brought to the emergency department by her mother. She had vomiting and diarrhoea for 48 hours. 24 hours previously she had been taken to a traditional healer and given an herbal enema. Her condition deteriorated with poor feeding and decreasing activity, at which point she was brought to Emmaus hospital.
She was seen by the Paediatric nurse who attempted and failed numerous IV line insertions. 15 minutes after X’s arrival to hospital, the nurse attended our consult room, appearing frantic by this stage. The doctor and I had spent the night on call, it was 10:30 the following morning, and we were managing a patient who had presented with a blood pressure hardly compatible with consciousness.
There was no handover. Not an appropriate one. No one knew what dire straits this poor creature was in. Not until we heard it. That single feeble cry that makes your heart skip a beat. The Doctor began attempting to insert a drip into the jugular vein. Simple, life preserving water is what might save her.
She stopped breathing. The Doctor commenced bag & mask ventilation. I began chest compressions. All I needed was my thumbs. She was severely malnourished—Another Kwashiorkor baby. Her ribs gave way under my fingers. I listened. Still no heartbeat. Regurgitation of gastric contents under compressions. Nasogastric tube insertion + aspiration. CPR ceased at one minute. Pupils fixed and dilated.
One study indicated that in Africa up to 80% of the population uses traditional medicine to help meet health care needs. In Sub-Saharan Africa, the ratio of traditional healers to the population is approximately 1:500, whereas the ratio of medical doctors is 1:40,000. The ratio of traditional healers to population in South Africa is 1:100.
So besides availability, why else to people attend traditional healers?
- Belief in external illness influences such as spirits or ancestors
- Long waiting times at hospitals.
- Fear and lack of understanding of medical procedures
- Privacy (no medical record)
- View that herbal medicines are harmless and free of side effects
She was so severely malnourished, she didn’t have a fair chance. The enema. The delayed presentation. You wonder what could be done differently.
The only thing in our power to change, is ourselves.
What does it mean to me, this story?
This is the world we’ve inherited. Closing our eyes or wishing otherwise doesn’t change things. Suffering is ever present. Everybody suffers. You are born, and you will feel pain. That is certain. Should this make us angry? Should it humble us? Make us grateful?
Injustice. Injustice should stir passionate anger within us. It is unjust not to care. It is unjust not to be grateful.
It is our responsibility to firstly, be aware. Secondly to contribute in what little way we can. Through education, advocacy, donating, volunteering, making dua…whatever way we can.
We are the lucky ones.
CHAPTER FOUR: The inescapable rhythm of hard land
A young man yells at his elderly mother in the waiting room to stop crying. She is embarrassing him. You do not cry here. You do not speak of your pain. Indeed, I felt an invisible curtain between myself and them; I felt I should cry at all the misery. Except, it wasn’t misery to them; not misery as I understood misery to be. It was life. No one was fighting fate or writhing against their circumstances.
They sit in the ward. Strong, silent, dignified. And the morning following they are gone. What happened you wonder—that was not the face of someone losing their grip on life?
There is something indestructible within the human spirit that pushes us to hold on and live despite these things. The spirit of survival is strongest in these places. Struggle is accepted. There is no fear. There is nothing to lose. “Life is cheap here”, they told me.
It is a land of contrasts. Affluence, luxury, and privilege live beside poverty, illness, and desperation. I understood the crime. Such extremes cannot coexist without repercussions.
It is a land of music. Music is in their blood. Here, everyone can sing, and beautifully too. In happiness, in sadness, in anger, there is music here in all these moments.
The people have a beautiful condolence. “T.I.A” they said to me.
“This is Africa”
Driving through a thunder storm in the deadly dark; I hit a pot hole; my tyre flattens. We pull into a Bed n’ Breakfast and change it in the pouring rain—this is Africa, we laugh.
This is Africa I tell myself, when in the black darkness of my hut, using my torch to read, a bug flies into my eye. And again the same when my hut floods, the water stops running, when I see a wild dog walking past the outdoor bathroom as I walk through the rain to make wudu for fajr; now lamenting foregoing those $300 rabies shots.
You know this is Africa when your 100% juice bottle is actually 100% cordial, refilled into a used bottle and sold to you at full price.
Again you’re reminded when it’s said to you, “Don’t walk down the street or you may be kidnapped and forced to marry a local king, he may gift you many cows though”
And you definitely know it when stumbling onto a witch doctor initiation ceremony on your way to meet a friend, “That cow tied to the tree, they’re just about to sacrifice and skin it— you made it just in time”
“Nobody returns from Africa without leaving a part of their heart behind”, they said to me.
They were right.