Journals of a Medic
By Suzanne Meehan
The following are excerpts from the journal that Suzanne Meehan kept while doing a summer externship program in South Africa through Child Family Health International.
I am living with Mary, one of my medical school colleagues, in Mitchell’s Plain, a “colored” area inhabited mainly by Muslims. It is about a 45-minute drive from Cape Town proper. Getting around is a problem, as public transportation is not an option for safety reasons. Our host is a Muslim widow of Indian/Malay background. She is quite talkative and also a great cook. She packs us lunch every day and gets up early to make “her girls” breakfast before we set off for the hospital in the winter morning darkness.
This past week Mary and I were at Somerset Hospital. We began the week with general surgery, followed by a stint in maternity. Next we spent the entire day in surgery, or “in theater,” as they say here. The morning began with what was supposed to have been a gastrectomy, but the poor patient was so full of cancer that she was simply sewn back up.
Thursday we spent the morning in the neonatal intensive care unit with premature babies, many of whom were less than 2.2 lbs. They were impossibly frail and suffered mainly from respiratory problems. We spent the afternoon in the pediatric wards. Probably half of the kids in the pediatric wards at Somerset are HIV positive. Many didn’t have mothers, as they had already succumbed to AIDS or tuberculosis, both of which are rampant.
We work with Dr. Bhagwan, a tiny Indian woman with a long silver braid down her back. She is a calm woman who begins her day by lighting an aromatic candle, likely the only symbol of hope her patients see. The HIV patients are overwhelmingly female—many older, some younger, all with similar complaints: losing weight, stomach and back pains, often complicated by diabetes and hypertension. They all know about antiretroviral drugs. Many ask, but only the lucky ones might make it to a clinical trial at a larger hospital. Most know they will be dead before they have the opportunity to try these drugs. Most of these women live in corrugated, one-room tin shacks with open fires in barrels for cooking and heating and little, if any, access to clean water. The scent of wood smoke is everywhere in the hospital.
Today, as I walked into the packed waiting room, an elderly woman approached me, took my arm, and said, “Please doctor, use your knowledge to heal me.” I smiled, explained I was only a medical student and didn’t know anything yet to help her, but I stopped to talk with her a bit. She smiled so beautifully and seemed happy that I had even responded to her. Mary and I are the only white people in this place. The attitudes of apartheid, although clearly waning, haven’t died yet altogether. The black patients appreciate being treated with respect and dignity but don’t seem to expect it. We spent the day in the casualty ward with a young Burmese doctor who was trained in Pretoria. The log book showed a large number of admissions from gun and knife wounds, burns and what struck me as an inordinately large number of suicide attempts—overdoses with such agents as are available to the very poor—bleach and paraffin.
Though many South Africans are living in dire circumstances, the degree of optimism is astonishing. The people that I’ve met, mainly from the African and “colored” communities, are united in agreement that things are much better than they were 10 years ago. And there seems to be a great deal of agreement that the only way forward lies in working together.
At the time of this writing, SUZANNE MEEHAN was a second- year student in the Ben-Gurion University of the Negev M.D. Program in International Health and Medicine in collaboration with Columbia University Health Sciences (BGU-CU M.D.). She received her B.A. in Economics from Barnard College and an M.A. in Economics from the University of California at Berkeley. Suzanne then worked as an international and labor economist at the International Monetary Fund. To adapt her economics background to the international health issues in which she had become interested, Suzanne completed a master of public health degree at Johns Hopkins University. She now plans to pursue a career that will integrate scientific research, policy making and active clinical practice on an international scale. Contact her at smeehan@bgumail. bgu.ac.i