First Patient

Two women I don’t recognize are sitting outside our lodging when I first wake up. I assume they live or work here until several hours later, when the EMTs start scrambling and saying we have our first patient. The excitement is palpable.

The women are taken inside to the sofa in the living room. Jacquie and Dr. Bill Fridinger follow. The rest of us are told to wait outside for the time being.

A few minutes pass. Jacquie emerges from the building. “EMTs, I want you to hear what tuberculosis sounds like. This woman has volunteered to be a learning case." The EMTs rush inside with their stethoscopes at hand. I remain outside, out of the way.

I am writing my senior thesis at Vassar about treating drug-resistant tuberculosis in developing countries. I know how many people die from perfectly treatable tuberculosis because they do not have access to anti-TB drugs, which are very cost-effective.

When I come inside, the woman is laying on the couch, rebuttoning her dress. The EMTs have dispersed. I find Dr. Fridinger outside.

“That woman has HIV and TB,” he says. “She’d be in an intensive care unit in the United States. She walked here from three towns over. The people here are tough.”

I have read about situations like this, but it’s a different thing entirely to see this woman, sitting in the sun in her elegant yellow dress, with no water or sustenance for hours on end. I don’t know anyone who would endure this without complaint, and with such gratitude, even in perfect health.

I go into one of the bedrooms where some of the EMTs have congregated to debrief and pack supplies to take to the orphanage.

“What happened with that patient?” I ask, knowing we have no antiretroviral drugs and less than enough anti-TB drugs to treat one patient.

“Bill isn’t sure whether the hospital will give her TB meds because she has HIV and TB, and she’s going to die soon,” someone says. “They have limited resources, and they may want to give them to younger people who could live longer.”

I stare straight ahead and feel the weight of what I’ve just been told. It’s too much to handle. My eyes well with tears, and I try to hold back.

I am finally angry. Infuriated. My 50-page thesis rationally assesses how to allocate “limited resources” for anti-TB treatment in a “cost-effective” way. While I’ve acknowledged that it’s morally reprehensible to have to choose who to save, my “rational” analysis of who to treat suddenly feels beside the point. That this person may suffer and die from a disease that could be cured for the price of few frappuccinos is NOT acceptable—and it is certainly not the fault of the medical professionals.

I’m not fooling anyone with my attempts not to cry. “Just let it out,” Jacquie says. I’m frustrated with myself for being unable to control my emotions—patients should not see me upset, and I need to learn not to react. I fear I won’t be able to handle what I’m going to see in the next week. I try to hold back, but the tears trickle down my face, and I soon find myself weeping in Jacquie’s arms.

I don’t know if these emotions can be translated into writing. It is easy to be hardened against the suffering in Africa when sitting in the comfort of our homes in the US. But after meeting this woman, it is impossible to ignore her plight.


Update:

We are later told, to our great relief, that there are enough free anti-TB drugs for everyone, provided by the Ministry. However, HIV/AIDS treatment is not universally available because it is very expensive. A doctor told us that of 2,500 HIV-positive patients registered with the hospital, approximately 300 have access to antiretroviral therapy.