Kimmy's comments - The ugly side of poverty

Firstly, I realise I always write sad things on the blog, I’d like to say that it is awesome out here too, and I;m happy, but I don’t want to make you all jealous by writing happy stuff all the time, plus the most interesting things are usually grim. But that is life...if you want cheering up then don’t read on.

Only a few months to go until we go back to The UK and it is strange looking back on my year here. I had a great three months on Paeds ward and now have moved on to female ward. Each ward change brings new challenges and it is a thought provoking time.

I have 25 beds on my ward, most people are pretty sick. One room is full of TB and there is a good scattering of HIV +ve women too. 25 year olds with brain damage from fitting for a day (a reflection of poor transport links here and inability to reach medical care.

To start a HIV+ve person on Anti retroviral Therapy (ARVs) they need counselling and also a treatment partner, someone who also understands that the pills are everyday for the rest of your life, and that they MUST be taken at the same time twice a day. Having a treatment partner means that if you are too sick to remember your ARVS they can give you them...pretty essential to the whole theory of ARVS needing to be EVERY DAY not to miss ANY as it risks the HIV will become resistant to the pills. And don’t forget these pills are horrid...nausea, vomiting, diarrhoea, numb feet to list but a few side effects. But they’re a life saver too....so you bear the side effects.

Anyway, one poor lady on my ward has a very suppressed immune system from HIV and needs ARVS but they say she has no treatment partner. So today on the ward round she sits in bed looking gaunt and thin and ill. Her lips are purple from the gentian violet liquid we put on her blistered mouth. She looks so sad and weak. I ask her (via the nurse) if she can think of ANYONE to be her treatment partner, and she says no. Her father and mother I ask?...dead. Her sisters and brothers.....dead, her husband...died 2004. No friends. The only person she has is her 14 year old child. I discuss it with a colleague, we have no choice, we’ll have to try and get the 14 year old to be her treatment partner or she’ll surely die in the next year or so and then that child will be entirely alone. It seems the best option, the only option really. Shame to put such a big thing on a 14 year old but I guess already there life is a struggle finding money and shelter etc. As they say in SA...’Hectic’.

The other thing I’ve noticed today is “the ugly side of poverty”. Just to give a background, unemployment is massive...it’s rare to find anyone with a job here. There simply aren’t any jobs round here, just rolling hills with rondavel huts on them but not much economy or work. The govenrm,ent gives grants for children, old age (>60 years) and disability. We have to fill out forms for them to be assessed, and they collect the grant monthly from a local shop or something. It isn’t much but large family networks of 8-9 people or more end up relying on a few family members grants from the government to get them through each month. Even more so with the HIv deaths in 30 something year olds leaving orphaned children being looked after by their gogos (grannies). They’re surviving on £30 for all of them or something like that. The problem comes when the gogos die and they wont be replaced with new gogos because lots of them are not living long enough. A flaw in the plan of life round these parts.

Disability Grants (DGs)are a nightmare for us, everyone wants them but the government lays down strict criteria. Unfortunately you don’t qualify for one just because there is no work, it’s more about whether you’re fit for work. And, no job centres out this way, oh no no no. But, in times not so long ago people could ‘buy’ grant, so there is still a lot of unrest because people who may be used to have a grant are now ineligible. And the families are so desperate that they waste time and money and effort on trying to get a grant, when these efforts would be better spent on finding work or working the land and planting food instead. Apparently in other parts of the country there is a black market on TB sputum. You get a temporary grant for having TB treatment (6 months usually) and some clever souls have cottoned on to this, that because TB is often diagnosed by culturing a sputum, they can sell their dirty Tb sputum to health people who hand it in as theirs then get put on TB meds (which are potent and have SE but they don’t care) and then get a DG.

Anyway, back to the ugly side of poverty. So today is grant collection day, or ‘epaye’ as they say. So all these young relatives of the old ladies on my ward with TB and strokes etc who are over 60 come crawling out of the woodwork to drag their old gogos to the shop to collect their pay. It just made me feel furious seeing these poor old ladies being wheeled out in wheelbarrows and all sorts to go sign for their pay (they have to go in person.). I am asked for permission to let them take the old ladies, what can I say....from a drs point of view NO, I want them on the ward being treated, but from a broader perspective you can see how this grant is essential for the families survival on a day to day basis. It is just that fair enough, if the family had been around before hand caring for their relative and then took them for grant that would be more palatable than them just turning up randomly on grant day.

So, I say yes, they can go, but I think the relatives sense my anger. Sometimes I long for the UK and its functioning welfare system. People just don’t know how lucky they are back home. I am going to be SO ANNOYING when i get back referencing my time here, I just know it! Sorry in advance, but poverty is ugly.