Straight For The Jugular

Several days per week we attend the pediatric HIV clinic at Bara, the behemoth hospital on a former army barracks in Soweto. (See attractive exterior at left.) On Fridays there are about a dozen other medical students there, which has been very interesting for us. Med students here complain about many of the same things we do -- long hours, scut work, unfair treatment, administrative problems. The whole "Humanism in Medicine" movement has yet to evolve here, evidenced both by the students' attitudes and behaviors towards patients, and physicians' opinion and treatment of students. They definitely get a busy, hands-on experience when they rotate through this hospital, however, which cannot compare even to some of my classmates' hectic experiences at places like Harlem Hospital.

I was sitting in on a visit with a 2-year-old girl and her teenaged father. The doctor said she needed to draw blood, and one of the students I was with jumped up and said he would do it. He then asked the father to leave the room, had his classmate pin the baby down, and proceeded to draw straight from the brachial artery. I was confused because they only needed routine bloods, and he had not even attempted to look for an accessible vein (which is both safer and less painful for the patient). When I asked whether this method was routinely used, both students and teacher replied that they generally go straight for an artery in any child age 3 or younger. In fact, the physician joked that she tends to go straight for the jugular vein in this age group. Later, when Kemi and I asked the resident Sparrow physician about this, he was similarly shocked and said he always attempts a vein in the arm or hand before resorting to other routes. As I have said though, we have never seen him miss a blood draw, in any age and under any circumstances.

We have also gotten to see some of the inpatient wards, which are nothing short of heartbreaking. Each hallway contains glass-enclosed rooms with row upon row of metal cribs containing wasted, desolate, dying babies. Many young mothers were at the bedsides of the healthier children, feeding them and chatting with each other. We even saw one father playing with his infant daughter and feeding her a bottle. But in other rooms there were no parents, who likely are already dead, and the babies lay on urine-soaked cloths, ribs showing, alone and too weak to look around or even to cry.

Perhaps the most poignant moment to me was when the head clinic physician described a visit to New York City in 1998. By that time, ART was already widely available in the States. She said she looked around the clinic there and saw all these hardy, thriving kids on ART. Next I thought she was going to say how amazing it was to see the transformative effects of treatment (which routinely bring a skeletal, miserable child from the brink of death to normalcy in a matter of weeks or months). But instead she remarked simply how unfair it was -- to see the miraculous effects in these American kids, knowing what awaited her patients back at home, which was nothing. Now 10 years later, although theoretically all her patients who need treatment can get it, the complex issues of diagnosing children and getting them to start and continue proper treatment, and the prevention of mother-to-child transmission, lag maddeningly behind the capabilities of the currently available medications. Thus the cycle of death continues here seemingly unabated, even while the scourge has been all but eliminated from children in most parts of America.

As far as the famous area of Soweto, I had heard it has gone tremendous transformation over the years into a popular area of the city, with desirable residences and nightlife. We have found it to be indeed bustling and full of evidence of an active economy, but the dirt roads and tin shacks can still be seen everywhere. Certainly it has more commercial action than today's townships, with stands and stores on every corner, but it does not look like the trendy if gritty suburb I expected.