Kobojango, Botswana12 February 2002

Ntsalaka

I know it has been a while since I have written to you. How have you been? How is the UK? I am sure you are having the time of your life, especially seeing that I haven't heard from you in such a long time. How is med school? I bet you are enjoying yourself. If you are wondering, everybody is alright, your nephew Kabo is now talking. He will be a big man the next time you see him. When are you coming home anyway? We miss you a lot, Cuz.

Hey cuz, I know we have not talked in a while, but there is something I really have to tell you. A few months ago, I started getting little pimple-like things on my skin that would then rupture and become wounds. Apart from being very painful, they took forever to heal and the scars have totally deformed me. I got better at one point, after the doctor gave me the purple stuff grandma used to pour on our wounds when we were kids. Remember when we would graze our knees while playing football with the neighbourhood kids? Yah, that stuff, you would know the name, I suppose.

Grandma's purple stuff did cure my wounds. The thing is about a month later I started getting the wounds again. This time they were much bigger and more uncomfortable, but that's not all I had. I got tired really easy and even breathing was a task. I was taken to the hospital, and that bastard of a doctor did not even look at me before he said "I think it's the big disease." Is that how all doctors are, cuz? Is that what they teach you in the last year of med school, or is this guy just sick of his job? I am sure you will be a much better doc though; please promise me you will be better than that. Anyway, I was in and out of hospital for a while, and each time I was in I refused to get tested for HIV just to get back at that quack. I am not sure how that would help me get back at him, but I assure you, I did get some satisfaction from it.

In the end I agreed to the test, and somehow I was at ease to know that mine and everyone else's suspicion was confirmed. I am HIV positive. Don't worry, cuz, I have accepted it; it's a disease like any other. It was the way I got tested that I am not happy about. Yes, I was counselled, but that just made me more scared before and after the test, and I am not sure if the counsellor noticed it at all. The lady asked me what I would do if I tested positive. What could I possibly do? As far as I am concerned I am only as useful to this world as a statistic is now, after all I am one of the traitors that you have always talked about. You know, the ones that give sub-Saharan Africa a bad name? Sorry about that, Cuz.

Kobojango, Botswana8 June 2002

Ntsalaka

Thank you for your comforting letter, I cannot tell you how much it means to me to have the only "doctor" I trust in this world telling me that all will be fine. I hate to tell you that nothing is getting better though. They say I have TB now, "secondary" to the HIV. Oh, it gets worse, I have a lump in my neck that they sampled to test for cancer, and apparently if it is cancer then I will have much shorter to live. Why has nobody ever told me this would happen? Couldn't they have said so when I tested positive? You know I could have braced myself for it, cuz, you know how much I like to prepare for things like that! Oh well, such is life, I suppose.

It is very painful; it aches all over. It hurts even more when they take my bloods and when they "sample" my lumps. Oh, believe me, I am not talking about the pain from the needles and surgical knives. No, I am used to the needles now. I even use them on myself sometimes when the nurses are too disgusted to touch me or the many other HIV/AIDS patients in this ward. What really hurts is knowing that although they draw my blood and cut pieces off me I will not get better. They, however, will still have something scientific and intelligent to talk about during the long mid morning tea breaks that African doctors are so fond of. You know what I am talking about, don't you? You surely remember how it was to be a patient back here, don't you? How mighty and intelligent the doctors looked? Is that why you chose to be a doctor, cuz, or do you want your patients to come before your mid-morning tea breaks? I am sure you are in it for the better of the two; I know that you are better than that.

You asked me about antiretroviral drugs last time. Don't forget that this is Africa, or maybe it's the same over there as well, but I doubt that very much. Apparently my CD4 count should be below a certain level before I can have the privilege of antiretrovirals. This means that I have to be worse than I am right now, right? All I know is that if I get worse than I am right now I would never want to get better, I'd rather they let me go than keep me capable of having worse pain than I currently do. What would you do?

I don't mean to be rude, cuz, but I need to rest now. I look forward to your next letter; it makes me happy to know that you are doing much better than I am. Remember, you are living a dream that many would kill for. Keep well.

Your cousin

Kokobele

I like to believe that one of the toughest questions anybody can ever ask a medical student is why they chose medicine as a career. For me, it has always been the easiest. A simple answer about how I want to go back home and help the "situation"-works every time, and it usually also elicits showers of praise for my nobility and loyalty to my needy homeland.

However, this question coming from my own patient-cousin meant a completely different thing. It was more about whether I am going to cope with the harsh reality that is health in Africa, especially having trained in the comparative comfort of England. How far will the principles of good doctor-patient relations that have been drilled so hard into my head for the past few years take me in a system where the doctors are so frustrated and tired of trying? To be doctors in Africa, they surely must have started with very honourable reasons much similar to the ones I have now.

They are right you know, sometimes ignorance is bliss. Damn these letters.

By now I had decided that it was too late to stop, I went on to the next letter.~

Kobojango, Botswana19 November 2002

Ntsalaka

The end is near, I can feel it. I feel no pain anymore. I do not want to see a doctor of any sort anymore, forgive me, cuz, but it is true. Last month, Uncle Banki suggested we go and see a traditional doctor up north that a friend of his from work recommended. I know you are against this, but I had no choice, in desperation even the most ridiculous thing could make the greatest sense. What else was I to do; it is obvious that even your rational type of medicine cannot come up with a rational cure for a disease they claim to so rationally understand.

Anyway, the black cow my dad selected for the offering must have not been black enough to cure me. I wish I had refused to go; at least my siblings would have something left for them to eat after I pass on. Now that I think about it, all healers are the same, they love cutting. They take a sample of some sort and they try to do with it something only they understand. Either they mix it with stuff and add it to their statistics, or mix it with stuff and add it to their ancestral offerings. And then in the end you all want us to drink concoctions that taste so horrible and yet not make us even a bit better.

If I had the strength I would take my own life you know, I bet it would not hurt that much. After all I am just a pile of bones now; maybe that is why I don't feel much pain any more. Is that why, cuz? Do bones feel pain as much as flesh does? Who am I fooling, what use would that sort of knowledge be to me?

The priest comes to hold prayers everyday now, bless that old man. He does not care for the rotten smell of my diapers that revolts everyone-myself included. You should have become a priest, cuz; they do more healing with words than doctors do with their needles and scalpels. They bring peace to the soul. I regret not having faith during my more active days. I would not be writing you this letter today. Anyway, be good, cuz, and study hard. I told you before; you are going to be my family doctor some day.

Yours

Kokobele