Personal Space: A Privilege

I am not an overly warm and cuddly guy. One of the things I treasure is a sense of personal space. The unwritten rule in Minnesota (at least with everyone I know) is that everyone has a 3-foot buffer around their body at all times. You have to be invited into that space, and to breach it uninvited is just wrong. I clearly believe in that rule and follow it as often as I can. Clearly, though, people in the townships have never heard of that rule and I've had to adjust.

I'm not sure if it's cultural or a result of the living conditions; probably both. But, it's the norm to pack many people, without complaint, into what we would consider small spaces. Seven in a car, two on a chair, four around a desk, it's all an everyday event.

Privacy is also very different. Most township residents do not expect the level of privacy we're accustomed to in the U.S. I've mentioned before that people living in shacks and hostels do their bathing and dressing (and other things) within plain sight of other family members. At the clinic, people crowd around as they get their prescriptions, and everyone can see and hear what the other person's getting. I've even had women come into the men's room at the Centre when their stalls are full. They come in fast, so as not to embarrass anyone (them or me), but they come just the same. They'll even go into the stall in pairs. (I know women visit restrooms in groups, but that seems a little much to me.) It's just not a problem.

I had an experience in the extremes of personal space and privacy when I went to visit Rosie in the hospital this weekend. (By the way, I found out her real first name is Nokuzola. She is Sotho, from somewhere in the Free State.) She is in GF Jooste, the main hospital for Guguletu and all the surrounding areas. Jooste has four wards, each holding about 50-60 people. Two are for men and two for women, one each for surgical cases and one for medical cases. The wards are big rooms with partitions that divide them into 6- or 8-bed cubicles. The beds in the cubicles are about 3-4 feet apart, with only a curtain to separate them. The curtains are kept open so the nurses and aides can get a sense of what's happening.

As you can imagine, there is little to no privacy in Jooste. Even when there is an "emergency" going on, most everyone knows what's happening. It's worse during visiting hours - there must have been 20 visitors in Rosie's cubicle today, all standing around beds trying to have conversations. A group was holding a prayer service for a patient one cubicle over, but it may have been next door. It's hard not to see what's happening, from the woman eating ice cream to the one with the backless gown sitting without a cover on. Or the woman who just got sick all over her bed.

I also had another "white person privilege" experience. When I went to see Rosie yesterday it was because her daughter called me to come. Apparently Rosie had had enough and wanted to go home. She was also under the assumption that she needed to have an operation, because her doctor had told her she needed to go to Groote Schuur Hospital, the teaching hospital in Cape Town, for a consultation. I said my hellos to her family and spent a little time talking with her. I noticed her chart sitting on the bedside table, so I started to read it to see what was happening. I didn't get very far before the nursing sister told me that I wasn't allowed to do that, that only a doctor or nurse (her) could read the chart. I told her that I was a pharmacist at Brown's Farm Clinic and was trying to help Rosie understand what was happening. She said she or the doctor would come back and help me. And she said it 2-3 more times over the next 20 minutes.

Now, doctors don't round at Jooste on weekends. The only doctors in the hospital are interns who cover emergencies and new admissions. The intern on duty happened to be at the next bed helping a woman who was having an asthma attack. After he got that resolved, he did take some time to speak with me and we got everything sorted out (more on that in a minute). You had to be there, but I'm convinced if I wasn't a white guy, and probably a white American, that I wouldn't have seen anybody yesterday. I would have been brushed aside and had to have waited until Monday. I say that because no one had talked to Rosie's family at all, even though they had raised the same concerns. That's just wrong.

After a barrage of tests, it appears Rosie has tuberculosis (TB) and a bad pneumonia (PCP). She started on TB drugs last week and will be on them for at least 6 months. She also has TB in her abdomen (which is fairly common) and this has been the cause of her stomach problems. In addition, she has bad peripheral neuropathy, which is where the nerves in the feet (and sometimes the hands) get damaged resulting in numbness and pain. The TB drugs can cause the neuropathy, but she's had it for several weeks. So, that's why she's going to Groote Schuur, to go to the neurology clinic. She doesn't need an operation, and should be going home fairly soon. That's good, because she's not sleeping or eating well in the hospital.

In closing, let me also say I had one of my most difficult days on Thursday after I heard about the bridge collapse. It took me a little while to realize it, but I felt like I did on 9/11. I didn't directly know anyone affected by the disaster, but I knew that I wanted to be there to support those who were affected. It was especially hard because people here either didn't know about it or didn't make any connection between Minneapolis and me. I didn't have anyone to talk about it with, especially in the morning when I read Cindy's e-mail about it (because of the time difference). I now have a better sense of what real isolation means, even though I'm closely surrounded. My thoughts are with everyone there.

More to come.