This world is crazy, mixed up

Ntabamhlope is one of my favourite clinics. And it’s not just the fascinating name that I enjoy. It’s the cross-country journey we take to get there. It’s the ancient, broad trunked tree in the corner of the compound. It’s the way someone has planted flowers around its base and is taking the trouble to tend them. The pharmacy is almost bare, but the limited stock is stacked neatly on the shelves in alphabetical order. The nurses there are already very skilled, but they let me teach them what I can and their uniforms are the whitest I’ve ever seen. Arriving today, though, feels different. I’m greeted by a tense nurse. “We’re glad you’re here.” I fight the urge to look behind me, even though I know I’m alone and they mean me. Suddenly, I’m not glad to be here at all. My heart sinks a little as I’m led into the clinic room. The patient is a young woman. She’s emaciated, exhausted. I’m relieved to see her make eye contact with me when I greet her. Less relieved when I instinctively reach for her wrist, and find no radial pulse. I watch her carefully. She’s taking a short, shallow breath every second. Every second. Too much and not enough. The three of us work together. We can’t get a drip in. We can’t get a drip in, and then we do. Fluids. A double dose of co-trimoxazole. Whatever intravenous antibiotics we can find. A flurry of activity and then, much, much too quickly, there’s nothing else to be done. We look at each other. Idle hands are a nurse’s biggest fear. We need to transfer her to the provincial hospital, which is nearly ninety kilometres away on terrible, bone-shaking roads. We carry her to the land cruiser and lay her on a sheet in the back. Jury rig a drip pole. Something soft for her head. It’s a long, uncomfortable journey for me, watching my patient’s chest rise and fall much too rapidly. Longer for her grandmother. Longer still for her. We take her to the female medical ward and transfer her onto a stained mattress. There’s no oxygen. A hospital without oxygen. And she’s exhausted. We hand over to the nurses, and I leave hoping we’ve offered more to her family than false hope, and the burden of paying to have her body returned ninety bone-shaking kilometres back the way we came. At my next opportunity, I go to visit her. A couple of days have passed and I’m expecting to hear the worst, hoping to hear better. I go to the nurses’ station and enquire after her by name. The nursing sister looks at me. “She just stopped breathing,” she says. Just stopped breathing? JUST stopped breathing? Then grab some oxygen, a bag-valve- mask. She’s twenty-six years old. Put out a crash call. Do something. But there’s nothing to be done, and the nurse in front of me has seen this too many times. “Does this happen in your country?” she asks. I’m shaking my head. No. The short answer is no. I could elaborate on this. Of course people die young. Of course people suffer. I could talk about statistics, demographics or philosophy or religion. But I’m talking to a woman who is nursing in a country with one of the lowest life expectancies in the world. The whole world. So, essentially, the answer is no. No, it doesn’t happen in my country. I’m still shaking my head slightly when she turns away. “Does MSF have gloves?” she asks. “Please. Bring some gloves.” How about piped oxygen? A defibrillator? An anaesthetist? How about some justice? Gloves. Right. No problem. Recently, I was talking with a friend at the office who had just returned from yet another family funeral. I’m so sorry. “It happens, Jessica, it happens. Jessica, it happens.” Shaking his head gently with an acceptance that both awes and infuriates me. It happens. But not to everyone, not everywhere. Some people have a greater chance of dying young, or losing someone young, than others. It’s the inequality that is most painful. Life is hard, sure, but harder for some than others. Which, I guess, is why we are here. This world is crazy, mixed up. And in the crazy, mixed up world of MSF, the most obvious reason to leave becomes the biggest reason to stay. We weren’t able to save this woman’s life and today I can only tell the story. But at least the event won’t go unrecorded. At least it will be noted by someone other than the children she has left behind. On Monday, in a small town in southern Africa, a young woman who shouldn’t have died, died. Her name was Gunya. This is all we can do. We prevent the suffering we can, and bear witness to the rest.