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Taking Alfred to the Hospital

About 5:00 pm I got a call from the Mlondo's who are one of my home teaching families in Port Dunford. They said that the son in law Alfred who is in the army was very sick and needed to get to a hospital. I asked them to take public transport but they said he was too sick to get on a taxi. I went up right away to find a pretty emaciated young man who had been very healthy two weeks before when I had last seen him. I had to literally put him on my shoulder and let him walk with almost no weight. His wife Thandazile(Thandi) and sisters Ntombifuthi and Ntombiyenkosi got in the back of the car to go with us.

Alfred is about 32 or so, his wife Thandazile is 29, Nthombiyenkosi, her sister, is nearly 23 and Ntombifuthi another sister is 21. Alfred and Thandi have two children. A little girl Menihle, four years old, and a son Samwele, about to turn two.

We went first to a doctors office in Esikhawini to get a permission slip so we could take him to the hospital. He wasn't there so we went to his home and waited for him to arrive. He was nice enough but didn't have his official stamp which he has to put on a permission slip to show that it's not forged. Since he didn't have the stamp he called the clinic and told them we were coming and asked them to check Alfred and if it warranted to send him to the hospital.

The clinic is in the middle of the large township Esikhawini and of course by then it was around 7:00 pm and very dark. The clinic is surrounded by a high concertina (razor wire) fence and is patrolled inside and out by guards with sawed off shotguns. I drove in because Alfred couldn't walk and they told me to come back out as soon as I unloaded him. I really didn't want to leave my car outside the compound in that place so I left it inside but they came after me in about 15 minutes and I had to park outside.

Ntombi went out with me to park the car and as we were getting out Ntombi spotted a girl in the parking lot pulling up her panties being helped along by her boy friend. What a place to be having sex!

I carried Alfred as he limped along into the clinic. We sat on some benches in the hallway while we waited our turn to get in to see what I thought would be a doctor. We hadn't been there ten minutes when a man who had been stabbed in a fight came "walking" into the hallway. He was bleeding all over the place. His chest and back were bathed in blood and he had blood soaked pants on. Of course he was dripping blood everywhere. He walked past us and another man that I think was a friend followed giving him guidance. He returned shortly after, having left a trail of blood down the hallway and this time he fell down just past us (he was very drunk) and of course splattered a lot of blood on the floor. I was getting pretty nervous knowing that HIV/AIDS is rampant here with probably more than 25% of the black people infected. I didn't want to get blood on me. Even Alfred who was really incoherent warned us to stay away from the blood.

The blood dried rather quickly in the heat and being mixed with the dirt and sand on the hallway floor it wasn't long before it wasn't very evident. The place was pretty dirty by our standards and had posters all over warning of the HIV possibilities and how to prevent them. All were in Zulu of course. There was also a poster demanding that the government quit buying fighter airplanes and stating that the cost of one plane would pay for AIDS drugs for 11,800 people.

About that time another man who had been stabbed in the same fight came wandering in. He had been stabbed in the left forearm. He too was leaving a trail of blood with drips about 6 inches apart. The two of them knew each other and were eventually herded into the office where the bleeding was stopped and they were sent walking down the road to find a way to get themselves to the hospital about 25 kilometers away so they could be sewn up.

While we were waiting Alfred decided that he needed to go to the bathroom. I again put him on my shoulder and helped him walk to the bathroom. There was no light in either bathroom. He wanted some privacy so I left him leaning against the wall and his wife helped him find the toilet while she held aloft a match.

When we were again in the hall waiting two guys started flirting and generally causing problems with Mfuthi and Tombi. They were pretty crude I could tell by the looks and comments in Zulu. The girls slid over and I sat down between them, put my arms around the two of them and politely told the boys that these were my daughters and they could bug off. Surprisingly, they left rather quickly and I didn't have to go any further. I certainly got a lot of looks from the local people as I'm not sure they had ever had a white person inside the clinic let alone late on a saturday night. I think maybe the guard with the sawed off shot gun who kept passing by every few minutes would have helped me in the case of trouble and that helped resolve the situation.

We finally moved up close to the door of the person taking care of the patients. I was the center of attention as I carried Alfred into the office. It turned out to be manned by two ladies, one an RN and the other an LPN by our standards. People sitting around couldn't believe that a white guy was packing a black one.

I returned to sit with the two sisters and wait for the results. I could hear the girls talking to the other people waiting in the hallway and the word "obishop" kept being used so I knew they were talking about me. The people waiting were asking "Where did you find this good whiteman that is willing to help our people?" That was an opportunity for the girls to tell them that I was their bishop and that we were members of The Church of Jesus Christ of Latter day Saints. I heard them say that about three times because the people hadn't heard of it before. There ensued a discussion of our church and where our building was located etc. I couldn't participate and only knew what had been said when I later asked the girls what the conversation was about.

I guess we did some good on the missionary front at least and maybe when the missionaries knock on some of those doors the people will be willing to listen.

Alfred had a high fever and was dehydrated so the nurse signed a slip allowing us to go to the Ngwelezane hospital which is a hospital run by the government and is only used by poor people with no insurance or money.

I couldn't bring the car in so we struggled as I packed and dragged Alfred back out to the car.

It only took us about 25 minutes to get to the hospital which is located in the township of Ngwelezane. It was just coming on 9:30 pm when we arrived. The guards were helpful in showing us where to go and others in helping us get Alfred into what served as a wheel chair. It looked more like a rocking chair with four, five inch casters on the bottom. One caster incidentally was broken and didn't work but it was still easier than packing him and I'm sure he felt better not being half dragged as he struggled to walk.

The hospital was as dirty as the clinic but with the added distinction of having cobwebs so thick above the fluorescent lights that they looked like they might pull the lights down. It did look efficient though.

We were chastised by the first nurse we encountered for coming in so late on a Saturday night when there was little staff on call. Other than that the people were friendly and doing a good job of moving things along.

After a quick checkup Alfred was sent off to have a chest X-ray. I say "sent", but in this hospital, family act as nurses so we wheeled him down the hall following the orange foot prints. Incidentally, the halls only had roofs and floors, no walls. It was a group of buildings connected by outside hallways.

On the way to x-ray we passed an AIDS patient just laying on a gurney with a drip IV in his arm waiting to die. He was very emaciated and barely breathing. They implied that 5 - 6 people die in the hospital every day from AIDS. There isn't anything they can do for them so they move them into the hall and give the rooms to people they can help.

There were several large X-ray rooms and we were ushered into one nearby. I unloaded Alfred on to a bench in front of the x-ray film that the technician placed in a frame. I don't think they would have even asked us to leave the room but knowing the dangers of radiation I hustled the three ladies out of the room and told them how it could hurt their chances of having progeny.

Upon our return Alfred was taken into the emergency area which was manned by two Indian lady doctors and a couple of nurses. They reviewed his x-ray which showed large white spots near his stomach or liver as best I could see. I didn't know what that meant but it didn't look normal to an arm-chair doctor like me.

They quickly hooked him up to glucose and saline to help get him hydrated again. Then they proceeded to put a tube down his nose and into his stomach to try to relieve what they thought was excess fluid in his stomach. The girls and I sat patiently waiting for nearly two hours to find out what was wrong and if they were going to admit him to the hospital. Finally at nearly 11:30 pm Thandi his wife suggested that we go home as it looked like they would be admitting him and we really couldn't do anything more. We all gave her big hugs to comfort her and headed for home.

On the way to the car we saw two other white guys which was a first for the night except for one ambulance driver that had arrived with a patient. They wanted us to give them a ride to Richards Bay. I really didn't feel good about doing that as they really looked like "white-trash" and I couldn't figure what they were doing in the middle of the night in the middle of a township. Only "insane" white people and bishop's go there at night.

I got the girls home before midnight and myself back about a half hour later. I had called Karen[my wife] twice to let her know that I was okay. She was nervous but not as excited as she usually is when I'm off in the township doing church work at night.

On Sunday I called to see how things were going only to find out that they hadn't admitted Alfred but had allowed them to spend the night at the hospital and had ushered him out early in the morning. They had gotten him home in a taxi. Incidentally, the Mlondo's phone is a pay phone out in the country that happens to be about 50 yards from their front door.

They had given him some sort of pills but hadn't given any kind of diagnosis. It frustrated me and I'm sure his wife was paniced. I figured that it was something that he would quickly recover from when the medicine took hold and didn't worry about it. I did run up to return the x-rays that they had forgotten and left in my car. I didn't call anymore and assumed things were okay.

On Tuesday I got a paniced call at work that Alfred was worse and that they needed me to get them to the Bay Hospital in Richards Bay. I sent them to all of the members that I could think of that might be able to help them but no one was available to help so I finally told my secretary at work that I had personal business to take care of and would be back in an hour and a half.

It takes a half hour to get to Port Dunford so I should have known it would take more than an hour and a half but as it turned out we had to get a permission slip from Alfred's military doctor first before we could get him into the hospital. His military camp and doctor are about an hour from Port Dunford. I couldn't think of any other way to get him there so I had the sisters call ahead and made arrangements to have the military take him from Mtubatuba, his base location, back to the Richards Bay hospital.

The base was actually quite large and it reminded me quickly of my time in Vietnam and basic training. Fatigues were more of a desert brown rather than the jungle stuff we had but people were marching everywhere. There were guards at the gate that didn't want to let us in or didn't know what to do with a car loaded with a white guy and two women (Mfuthi stayed home this time).

Since we didn't know the base and Alfred was almost completely incoherent now, one of the guards got in the car with us and showed us the way to the infirmary. He was a great help in getting Alfred up a ramp and through a lot of hallways in to the doctors waiting area. I think the guard was a friend of Alfred but not understanding Zulu I wasn't sure.

By the time I got the car moved out of the emergency driveway, they had already taken Alfred into the office. There were several army guys sitting in the "waiting room" and they all wanted to talk to Ntombi. I could tell that what they were saying wasn't something she wanted to hear. She was twisting the ties on her blouse and very nervous. I had to intervene again as her father and she finally settled down. I didn't get out of her what they were saying but knowing army guys it wasn't too hard to figure out.

What impressed me about the military hospital was that it was much cleaner and there wasn't two square feet on any wall wheret here wasn't a poster warning about AIDS. Most of them I hadn't seen before and this time they were all in English so I could read them. AIDS must be a horrific problem in the military here with the promiscuity that always takes place among young men far from home.

After half an hour the office opened and I could hear that things weren't going well so I stepped to the door to listen. The doctor was white so this time I could understand that he was making out a permission slip for moving on to the Ngwelezane hospital again. This certainly wasn't where we wanted to go! Furthermore he was saying that even though he was making out the permission slip they weren't going to let Alfred in. I interjected at this point telling him that I was an American and didn't quite understand what was going on and could he please explain why we weren't going to the Bay hospital as we'd requested. He told me that there was nothing that the hospital could do for Alfred. That was a shock to me. Then he said do you understand? At that point I realized that he was in the last stages of AIDS even though the doctor hadn't said it.

With that bit of insight I wanted to pursue things a bit further with the doctor but several of the enlisted men there came in and began a discussion of why Alfred couldn't be sent to the Bay hospital. The army people belong to medical aid which allows them to go to the private hospitals and these guys were very upset that the doctor wasn't willing to give permission. The ensuing discussion was that the army hadn't been paying their bill for the past year or more and so private hospitals were not allowing any military people in. The government was still deducting the medical aid payments but it was on no value! It looked like that would continue indefinitely.

Thandazile (Alfred's wife) finally decided that she didn't want any part of going back to Ngwelezane hospital especially since the doctor was adamant that they wouldn't let him in anyway. I decided to see if I could make sure that my assessment that Alfred was on the way out with AIDS was correct so after explaining that I was Alfred's bishop I asked him directly if Alfred had AIDS. He didn't answer directly but with his eyes said yes and then verbally told me that they weren't allowed to disclose the cause of illness in cases like this. I asked about his telling the family so they would know what they were dealing with and he said no they wouldn't tell them either!

I left the office to talk with Ntombi and break the news of what we were dealing with now. She accepted it like Zulus accept most negative things, with no sign of emotion. I could see her mind working and accepting the fact that this was very serious. Then we talked about the status of her sister Thandazile since she would have a 90% or more chance of being HIV positive as well. There wasn't much either of us could say.

The pharmacy brought out some more pills (what I don't know) and we put Alfred on a stretcher and took him to the car for a return trip home I think they just gave him the medication to satisfy his wife. From the way the medic acted I'm sure it was of no value to Alfred. Thandazile was crying now so I sat next to her and put my arm around her. That was not well accepted by the white people nearby. Frankly, I didn't care, but it does hurt to know that there is that divide still, even when lives are in jeopardy and nothing will be gained by being enemies.

Reality set in hard for me. The trip home was very subdued. We stopped once to get a bottle of water for Alfred who was very thirsty but no one felt like talking.

At home I took the mother of the girls and the two daughters aside and again told what the diagnosis was. I told them it was up to them if they wanted to tell Thandazile and Alfred what the doctor had told me. It really doesn't make much difference other than to help them quit wasting what few resources they have on trying to get Alfred into a doctor or hospital. There's not a single thing that they or I can do at this point other than wait. Thandazile needs to get tested for HIV but waiting a few days or weeks until Alfred dies probably won't make much difference in her life expectancy.

The poor mother of Alfred, Ntombiletu, just said "more sleepless nights." Earlier that year, she had buried her grand-daughter. I conducted the grand-daughters funeral the week I got back from Christmas vacation to the States, in January of this year. The grand-daughter had died of malnutrition. Her mother looked to me to be far down the path on AIDS as well. I really don't know what happened with the mother of the child as she moved back with her parents since she and the Mlondo son weren't married anyway.

This is a very frustrating country to live in with so many poor people. They portray behavior that's indicative of having little knowledge and willingness to live to improve their lives. They have so little money to try to help themselves.

I promised myself that I would never again complain about problems that bother me. I have no problems compared to the average person here.

I stopped that day at their house because the girls stood in the middle of the road and stopped me. They told me they had been to church and were going to be baptized soon so I stopped and got to know them a bit and took their picture.

As you can see, things took a turn for the worse this week. Alfred is in pretty bad shape and I don't know how long people in this condition live but I've heard that once they have full blown AIDS its only a matter of months.

That leaves a family with no or little income and two more children facing the world with no dad and a very real possibility that their mom will die within a few years of the same disease. Even the kids could be HIV+ as it's easily transmitted from mother to child. I'm sure she will be tested after Alfred dies but the odds are bad for women. They contract HIV much easier than men and so are much more likely to be HIV+. Right now 35% of the pregnant women attending prenatal clinics in Kwa-Zulu Natal are HIV+. According to S.A. Business Institute(sifsa) there are 920,000 cases or AIDS in the U.S and Canada and 25.3 million in the Southern half of Africa.(2002)

With this change I'm now worried about some of the men in the ward who had multiple partners before they joined the church. Hopefully none do but one can never know. It's frightening me more and more now that it has struck our ward twice in the past month. I guess I hadn't realize the enormity of the problem or I thought of it as someone else's problem. It has suddenly become very real.

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