Stranded in Lusikisiki

Stranded in Lusikisiki
Part I

This day is already starting off on the wrong foot. I had counted on having a nice long day with Robert, even if I do have to spend a few hours at the Lusikisiki hospital with my students from the medical school at UNITRA. Our medical school in the old homeland of Transkei is said to be one of the most innovative in all of South Africa. At the moment, the second year students are out in the community hospitals and clinics learning to apply their “book learning” to real patients. Although I’m a brand new faculty member this year, already I’m assigned to visit and evaluate the students at Lusikisiki. But Robert, who is a driver for the University, and I would have had a leisurely drive together there and back, and we don’t get all that many opportunities to be out in public together. Robert is Xhosa, a native black South African, and I, I am a native colored South African, that insane in-between category that the Afrikaners have insisted upon. Here in the Transkei, the traditional Xhosa tribal lands, the Xhosas are king, especially in this New South Africa. So Robert and I are pretty quiet about being lovers. Plus he has only high school matric, which is good for local men, but I have a PhD, which is unheard of for women, especially colored women. There aren’t any single men here with my color and with a PhD which means that even though my father would kill me if he knew, I am glad to have Robert.

But, as luck would have it, I was hardly awake this morning when my phone rang. I thought it might be my father so I answered quickly before it disturbed Mother, who is separated from my father. But no, it was Prof. Mputo, the chairman of my department on the line.

“As usual, the transport is all confused and there is no car for you or for Dr. Ricardo,” he said, “and also Prof Roberts from the U.S. wants to see the students in their community sites. Will it be all right if they all go with you? The driver can drop off Prof Roberts and you off at Lusikisiki and go on with Dr. Ricardo to the hospital he is supposed to visit.”

What could I say? The damn transport system is always screwed up here even though we are five years into the “new” South Africa. Just as it always was, everything here is substandard, or breaks down and doesn’t get fixed. But we accommodate. This morning, Robert, the driver assigned to take me to Lusikisiki, volunteers his own car as there is no University vehicle available.

The American woman is not as impressive as I expected. She’s shorter than I am, and a bit thick around the middle. She doesn’t have on the dark suit and low-heeled pumps that our white professional administrators all wear. She comes to the car wearing flat black shoes, black slacks and a fiery-red long-sleeved blouse. As if she won’t stand out enough just being white. But she’s the guest, and I’m just the local host, so far be it from me to say anything. Of course, she may be looking over my attire as well, seeing that I’m in my most comfortable jeans and sandals. Prof Mputo probably wouldn’t approve of my outfit; he’s always in a suit and long-sleeved shirt and tie. But he was trained in the classical tradition in Uganda. It seems like half our faculty are also graduates of his alma mater. There are so few of us locals; so few of us with appropriate credentials, thanks to the Afrikaaners and their apartheid system.

Prof. Roberts is all smiles when she gets into the back seat beside me. We ride Africa-style, of course, with the male physician Dr. Ricardo riding in front with Robert. We speak English, although Dr. Ricardo, who is Cuban, is difficult for me to understand. But neither he nor Grace speak Xhosa or Zulu or Afrikaans and we don’t speak Spanish. My family spoke English at home and I learned Zulu from the other children in school in Durban, and we were taught Afrikaans in school. I’ve picked up the Xhosa language here as it’s not so different from Zulu. It’s what most of our students speak at home. But English is the only language we all speak in this car. Prof. Roberts insists I call her Grace, so of course I tell her to call me Sylvia. She’d never remember my last name anyway. And it doesn’t even have a click in it, like some of the names here. But here we are, Robert and Guillermo, Grace and Sylvia, a veritable United Nations rolling along to Lusikisiki.

A few miles south of Umtata, we turn off the two-lane highway that is one of the few well-maintained roads in the whole homeland and begin the climb up the mountain on a gravel road. There aren’t any towns or villages or even settlements on this road until you get to Lusikisiki. Occasionally we do see flocks of goats and young boys tending them, and once in a while there’s a round mud rondeval or two where a family lives.

I will give Grace this much, she’s interested in everything. She asks questions incessantly.

“Why do you drive on the left side of the road here?”

“The Brits built the roads and drove them like they were used to at home,” Robert says.

“Why are all these burned-out cars and vans along the side of the road?” Grace asks.

“Bandits,” Robert says. “During the homeland years this area was notorious for hashish. Ganja was the main cash crop and smugglers controlled this road. They would stop cars that they thought might be carrying hash and steal it from them. It isn’t so bad now.”

The road becomes black-top again on the outskirts of Lusikisiki and we aren’t subjected to so much fanny-pounding from the washboard gravel road and the poor springs in the loaded-down car. I’ve always thought Lusikisiki was depressing. I can just imagine what Grace thinks of all the litter, everything the color of dirt, and most of the houses and buildings are run-down.

The road leads right up to the gates of the hospital complex, which, like everything of value in South Africa is walled off and topped by barbed wire. Grace remarks on the fact that the hospital is a cluster of one-story buildings, not a giant multi-story thing. The buildings have been recently painted, but they still show the years of continual wear since the hospital was established by the Catholics, I’m not sure when. Back before the homeland was established, probably, when these hills and valleys were home to whites as well as blacks, mostly farmers and businesspeople. The main buildings are for hospital patients and for clinics. Other buildings on the grounds are houses for the doctors and for our students, and some of the staff, and also buildings for maintenance and storage, and garages for the ambulances and other hospital transport.

Grace is staring at all the people coming in and out through the hospital gates. They pass by the guards in their drab uniforms who hardly notice them. The ground between the hospital walls and the road is lined with street vendors, mostly women who have set up a table or a blanket on the ground.

Grace stops to look at their goods-- apples, pears, oranges and bananas, soft drinks in cans, empty glass bottles, old clothes, old shoes, empty tins, anything that they don’t absolutely have to use for themselves. Most of the women have covered their hair in a large cloth wrapped and tucked in, as is the Xhosa custom, although they are wearing Western-style, but mismatched skirts and blouses. Some are barefoot, but some wear worn-down shoes that they probably bought on the street themselves. Lots of the ladies bring their babies with them and one or two are nursing a child. Watching Grace take everything in makes me notice a lot more about the place than I usually do. I’m a little embarrassed by all the trash and dirt, but it’s everywhere.

Robert drops Grace and me off in the courtyard just inside the entrance to the hospital and he and the Cuban doctor drive off to the hospital he needs to visit, another half-hour drive away according to Robert. We agree to meet up again at the hospital entrance at 2:00 pm, four hours from now.

Grace and I have a very full four hours ahead of us. We walk around the outside of the main building to a smaller cottage where we find the students in a conference room along with their on-site teacher. She’s a hospital doctor and is herself a graduate of our medical school. The students each give us an oral recitation about one of their patients and they include long and detailed explanations of the anatomy and physiology and pathology, and also social, cultural and economic factors. This is how they integrate their science studies with clinical medicine.

I also listen to student comments about their living conditions and their educational experiences at this hospital.

“The accommodations are very nice,” says one female student “except for the hot water. There is none. They say the boiler is broken but no one can tell us when it will be repaired. Meanwhile, cold showers. But at least there’s TV in the common room.”

They like the teaching they get from the hospital doctors and nurses and there are lots of patients to learn about. They like feeling important and not being treated like “students”, which, of course, they are. Then we go on “rounds,” in the hospital building, visiting one patient with each student.

Grace is surprised to see that all the patients are in wards—male or female—with up to 20 patients in a long room. Some wards have curtains that can be pulled between the beds, but most wards don’t.

“Patients in the USA would never stand for that,” Grace says. I’m surprised by her surprise. I’ve never seen a hospital without wards. The only patients in isolation here are there because they are contagious.

We stop at the bed of a 13-year-old girl who is sitting up, leaning on pillows against the metal headboard, her body and legs covered by several of the traditional Xhosa blankets that probably belong to her. Her hair is cut short, very close to her head, and she has a round, babyish face. She looks around at all of us without expression. She speaks only Xhosa and doesn’t understand what is being said about her, which is a good thing, I think, when we hear the student doctor’s report.

“This girl was admitted to hospital complaining of productive cough,” the student says. “Presumptive diagnosis is tuberculosis, as it is very common here in the rural areas. We haven’t been able to get a chest X-ray on her as the X-ray machine is broken, but she has been started on antibiotics anyway. We are awaiting results of a sputum test and also an HIV test. If her HIV test is positive, we’ll assume she has antibiotic-resistant tuberculosis and she’ll be discharged.”

Grace actually gives a little gasp at this. “What do you mean, discharged?”

“She’ll be sent home as we have no drugs for HIV positive patients.”

“What will happen to her then?” Grace asks quietly. Although the patient does not speak English, others in the ward might.

“She’ll have to fend for herself until she dies,” says the student. “The sad thing is she most likely got the HIV from someone in her family.”

“How is that?” Grace says.

“There’s a superstition here amongst the more traditional people that intercourse with a virgin will cure them of AIDS. So probably some member of her family infected her.”

The student doctor reports all this matter-of-factly. This isn’t the first case like this the students have seen and it won’t be the last.


Part II

At the male ward we stop at the bedside of an adolescent patient. He is lying on his back with his blanket pulled up under his chin. There is a putrid smell coming from somewhere in this bed. The student doctor in charge of this patient begins her presentation with “this 14 year old Xhosa male is recovering from septicemia, a bloodstream infection, secondary to circumcision. Although his bloodstream infection appears to be subsiding, his penis is massively infected and he risks amputation.”

“Is it common to be circumcised at this age?” Grace asks.

“Oh, yes,” says the student. “Xhosa males undergo circumcision as a rite of passage to manhood. This unfortunate boy is the victim of unsanitary practices in the village. He arrived here with his penis packed in leaves and mud.”

I’m thinking I’d better show Grace something more uplifting after these two sad, but typical patients. We go along to the children’s ward where several small boys, ambulatory and all smiles are being cared for by the ward nurses. The little boys are totally intrigued by Grace and her camera. I don’t know which is more interesting to them, having their picture taken, or touching her white skin.

Grace asks, “Why are these healthy looking boys here at the hospital?”

The matron says, “Some are nearly recovered from burns and falls, but some have been abandoned by their mothers. Sometimes if they suspect that their child has AIDS they bring them to the hospital and then just disappear. This is very different from the other children here, whose mothers stay with them and hold them and care for them, and, for the younger ones, nurse them.” Grace’s smile disappears.

By now it’s time for lunch, and Grace is looking like she could faint. I think she has been exposed to much more than she bargained for. But this is a good regional hospital by black South African standards, and the hospital staff—the nurses and the doctors--are dedicated and doing the best they can. They know their few successes make only a dent in the mammoth health problems of the rural people, but they press on. The best thing about this community exposure for our students is that they aren’t surprised when they graduate and go into practice themselves. They can hit the ground running.

The hospital cooks have prepared plates for Grace and me and for the students, so we eat together in a small lunchroom. Grace refuses to drink any water, although I know she must be dying of thirst. It’s been rather hot today.

“That’s OK” she says, “I’ll get liquid from the cooked corn and peas. And this is very tasty, by the way, especially by comparison to American hospital cafeterias.” Just as she is polishing off the last of whatever the casserole is I say “I hope I don’t get sick from the food like I usually do.” I don’t know exactly why I say that to her, since I haven’t been sick since that first time I visited here. Maybe I’m testing her stamina. Maybe I’m just aggravated that I’m babysitting her. I don’t really know, but she looks stricken and quits eating, and now I feel a little bit guilty.

For a while after lunch we meet with the staff doctor who is supervising the students. As it’s nearly two o’clock, Grace and I say our “goodbyes” and “thank you’s” and walk back to the courtyard at the front of the hospital grounds. There aren’t any benches outside and the local people who are waiting to be seen or who are family members are sitting or lying on the ground. Grace and I head toward a set of concrete steps leading up to a side door and sit down there to wait for Robert and Dr. Ricardo to come pick us up.

We’re there for a few minutes when a doctor comes out of the main entrance to the hospital waiting room and walks over to us in a big hurry.

“Ladies, please. I think it isn’t a good idea for you to be sitting there. I’m so sorry there’s no seating, but this is not a good spot. This door leads to the morgue and these steps are used to bring the bodies in and out. So, please, ladies, do not be sitting here. I’m so sorry. There could be germs. I am so, so sorry.”

We move out through the entrance gates to the trees that line the edge of the road, which create shade in the heat of the day.

Well, just as I predicted. A white lady in black slacks and fire engine red blouse stands out. No one says anything to us, and no one directly stares, but the Lusikisiki police car, a tiny vehicle with two young black male police officers inside, cruises by at least ten times while we’re standing there. Of course, we are on the main drag, so maybe we’re just on their patrol route. Perhaps. But I bet everyone in town knows by now that there’s a white lady standing out by the road at the hospital.

OK, now it’s 2:45, and I’m getting nervous. I mean even on “African time” the guys are late. I dig some coins out of my pants pocket, and head over to the public phone.

“Where’re you going?” Grace says with some anxiety.

“I’m just going to use the phone to call the other hospital,” I say.

“What phone?”

I guess Grace has never seen our local version of a pay phone. This is a wooden shack built by the side of the gate, presided over by a large woman who can speak English. She owns two phone lines, and she brings two phones from her nearby home every day to the “booth”, and charges a few cents over her cost so local folks can make phone calls. I wonder how long it will take cell phones to make her business obsolete. Well, there will always be the poor who won’t have a phone of their own. I persuade the Phone Lady to let me call information without charge to get the number of the hospital where Robert and the Dr. Ricardo have gone. Of course, on the first try, no one answers the phone there, but on the second try (and more coins paid to the Phone Lady), someone answers, and after a very long delay and apparent consultation with other people, comes back on the line to tell me that yes, the Cuban doctor has been there but left some time ago. Grace and I relax a little bit, expecting to see them at any moment.

OK, now it’s 3:30, and I’m sure there’s been an accident. It isn’t like Robert to be this late. Grace suggests that I contact Prof Mputo back in Umtata and tell him our situation. I get him on the phone and he says he will see about getting us home. He says for us to check with the hospital superintendent about where to wait for a new ride, as the hospital will be closing the gates shortly.

By this time it’s nearly 4:30, and still no Robert. The crowds of people who had been walking in front of the hospital are thinning out. The vendor ladies are beginning to pack up their stuff, and the police patrols in the tiny car are getting more frequent. I’m sure people are beginning to wonder what will become of Lady Red Blouse. And I’m sure there’s been either a bad accident or maybe even a carjacking.

Grace and I abandon our spot near the gates of the hospital and walk back to the main building where we ask about the whereabouts of the hospital superintendent. We’re told that he is seeing patients but will meet us in the waiting room in-between patients. We sit down on the bare wooden benches in the deserted clinic waiting room. Earlier in the day every single spot was filled with patients and their family members, hoping to be admitted or to get a prescription filled. After a little bit, the superintendent, also a Cuban physician, rushes into the room.

He says, “ I have just spoken with your Prof Mputo on the phone and I assured him that you will be well tended to. He says he will come to pick you up himself, if necessary.” Then he heads down the hall to see his last patient.

At last, at nearly five o’clock, I call to Grace, “There they are!” I can see Dr. Ricardo in the courtyard, looking around trying to find us. Robert and the car must be outside the closed gates. Grace runs down the hall to the examining room where the superintendent is seeing his patient. She knocks and opens the door. I can see past her that he and the elderly Xhosa woman patient are very surprised to see a white face peeking through the doorway.

“Excuse me, please, but we have been rescued,” Grace tells him. “Our driver has arrived. Would you be kind enough to call Prof Mputo and tell him we have transportation now. Thank you so much for looking after us.”

Then we join Dr. Ricardo and Robert at the car and get their story. Robert explains that “the other hospital was one and one-half hours away, not just thirty minutes as I thought. Then when we finally got to the hospital some of the students were not there. They had gone to a community clinic another twenty minutes farther away.” He shrugs as if this is no big deal.

Dr. Ricardo says “It wouldn’t have made sense not to see them since we’d already come so far. I tried to call you on your cell phone.”

I laugh at that. “Did anyone answer?” I say. “Someone stole my cell phone last week. Now I’m the only employed person in South Africa without one.”

“Well, anyway,” Dr. Ricardo says, “we came as soon as we could.”

Needless to say, I’m immensely relieved. I probably could have found a place to stay in Lusiki, but Lord knows what I would have done with Grace. And I wouldn’t have been able to rest not knowing what had happened to Robert.
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Again we make the teeth-rattling trip down the gravel mountain road, during which Robert does his best to teach Grace about the history, geography, and politics of this region, the old Transkei. Finally, at dusk we arrive back at the main highway to Umtata. But Robert turns away from Umtata and toward Port St. Johns because, as he says “it would be a shame not to have seen it.” That turns out to be true, although probably not in the way he meant it.

Port St. Johns is a small town on the “Wild Coast”—a stretch of undeveloped coastline on the Indian Ocean from about Durban on the northeast to New London on the southeast. It used to be notable as an artist’s colony and a place where there was more racial tolerance than in other towns in South Africa. When we get to Port St. John’s, the moon is just coming up over the Indian Ocean. That is truly beautiful, even though I’ve seen it many times, but the condition of the town itself is only marginally better than Lusikisiki.

All of a sudden, Grace says “What in the world is THAT?”

“That” is a depressing sight-- the gargantuan police patrol vehicle, as large as a tank and equally well armored. It does have wheels and tires instead of treads, at least. Hearing Grace’s reaction to seeing the vehicle, Robert, who is too fearless for his own good, stops right by it and asked the officer if Grace can take a picture of the vehicle. The white South African officer says “fine” and Grace snaps a couple of shots.

“Why such a huge vehicle for little Port St. Johns?” Grace asks.

“Crowd control,” the officer says.

I guess so. You could control a whole city with that thing.

Finally, as it really gets dark, we head back towards Umtata. We stop once, at a real public phone booth, for me to try, unsuccessfully, to call Umtata to let people there know we’re OK and on our way home. About nine pm we finally deposit Grace back where she’s staying at the Bagumah’s house. They had heard from Mputo who had heard from the hospital administrator that we were on our way. Of course, the Bagumah’s hadn’t factored in the two hour side trip to Port St. Johns so they were beginning to wonder whether Grace was lost again. But they know that you have to be long overdue in Africa before anyone comes looking for you. The world is too unpredictable here for anyone to stick too closely to a prearranged time schedule.

Thus ends the day trip to Lusikisiki for the White Lady in a Red Blouse. For me, pretty typical. For Grace, I’m thinking it was quite an adventure. She wasn’t so bad, though, and actually was a pretty good sport about the delay this afternoon. I wonder what a day in her life is like. I don’t guess I’ll ever find out.