Where Is the Line Drawn? a Difficulty in Cross-Cultural Health Care
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For whatever reason, they didn't go, because within a couple hours the sick woman was called into the room where I was assisting one of the nurses. Her daughter, in her early 20s, followed. The weakened woman, in her second term of pregnancy, was also HIV positive. On any other day the HIV nurse would have seen her, but on this particular day, Ivy* (the HIV nurse) was busy filling in for the absent pharmacist. This left her in the care of Linde*, a nurse as unpredictable as Cape Town's summer winds.
Her diagnosis of the patient was in no way said in a thoughtful or empathetic manner. Per usual, it was said in a rather belittling tone, "Mommy, the reason you are feeling so sick, and so weak, is because of your HIV, you have had it for a while, but now there is much more HIV in your body. Okay?" The daughter, whose dark facial features were covered with a visible yet translucent layer of white paint, was sitting on the bedside footstool, and her posture seemed to shrink as Sister Linde spoke.
Linde left to consult with Ivy, and I was momentarily left alone with the two women. The only exchanging of words occurred between the mother and her daughter. They spoke in Xhosa, which to the best of my knowledge-explained the painted white face. Their speech was almost at a whisper and succumbed to the return of Sister Linde.
"Mommy, why did you go and get pregnant if you knew you were positive?" she asked while rounding the corner. I was wearing a mask, which would have hidden my dropped jaw, but not the rest of my body, which went from being somewhat relaxed to frozen and tense. As much (or as little) as I knew about HIV care, there was not one part of me that could make sense of her words or her motive for that matter. "Who is going to take care of this baby?" she said to the mother, "You?" But before waiting for an answer she turned to the daughter, "Who is going to take care of this baby? Are you?" The daughter's gaze had moved to the floor tiles, one could only imagine what was going through her mind. The conversation in the room consisted only of Linde's seemingly heartless and nagging questions. "Why are you cross, sissy?" She said to the daughter, "Are you cross at me?" With her head held in her hands, the young woman let out the slightest "no."
"So you're cross at your mommy?" Linde continued. The paint around the young woman's face was cracked, but tears had made their way to her chin, where they collected bits of white pigment before dropping to the floor below. Her questions weren't completely uncalled for; however, the implications paired with them were. She was giving them a false death sentence, especially considering the fact that the women had never been treated for HIV before. She could start antiretroviral medication now that her CD4 count had fallen below 200 and expect to live many more years if all went well. But this wasn't the message that was being conveyed.
When Linde left the room for the second time, every bone in my body was jumping at the opportunity to reverse the bleak prognosis. But I wasn't a counselor, a pharmacist, or even a legitimate nurse. I was a volunteer-a student-so I stepped back from the line that I was about to cross. There was an entire team that would be helping this woman, educating her about her treatment, and encouraging her to stay compliant. They were the professionals, not me.
At the same time, considering the treatment they just received, what was there to convince them to return to the clinic? With that in mind, I reached for a box of tissues and handed it to the daughter. She looked up just enough to grab a handful of tissue. The mother had assumed a similar solemn disposition and had her head hung low, in the direction of her folded hands that rested in her lap.
"I know...I know that some of the nurses may seem..." I started in and then paused. She nodded. "Have you met the HIV nurse yet?" I asked in the nicest way I could. She shook her head. I had been working primarily with Ivy the past few months, and I admired her daily for her sincere kindness toward each and every patient.
Acknowledging the language difference, I said to them the little that I could, "uShe umnandi. She's very nice." Amazingly, at that moment no communication barriers seemed to exist. The daughter looked up at me, and while whipping away the last of her tears she gave me a subtle yet most assuring nod, "Enkosi...thank you."
*Names have been changed to protect privacy