The Lines That Divide Us All
January 3, 2006
Twenty-seven hours of flying has brought me to the other side of the earth. As the skyline of Johannesburg comes into view, discordant emotions collide in my chest. I’ve felt this before, when I’ve touched down in Mexico City or San Salvador that instantaneous question, “What am I doing here?” With South Africa having established democracy in 1994, apartheid still has a heavy presence. Although the Rainbow Nation is now free from the political violence that threatened to destroy it a decade ago, South Africans still must fight not only the injustices of their past, but also face the challenges of their future. South Africa reports the highest number of HIV positive individuals of any nation. In Swaziland, the average lifespan is 27 years as a result of AIDS. According to the South African Medical Research Council, one in two women here will be raped in her lifetime, and the number one cause of mortality in young men is gunshot wounds. The most recent unemployment rate is nearly 50%. Gauteng (how-teng), the small province that includes Johannesburg and Pretoria, accounts for 10% of the GDP of the entire African continent, considered home by corporate elite and destitute thousands. With eleven national languages and dozens of different ethnic groups, South Africa is a country of fantastic diversity, even if it is only just beginning to embrace this strength. Thoughts racing, I put on my stern tourist persona and walk out the doors of Johannesburg International Airport into the glaring African sun.
January 4, 2006
Early the next morning, with the pressured gait of one with much to see and limited time, I leave on a visit of the South Western Township (aka Soweto) and downtown Johannesburg, or Jo’burg. Never having participated in an organized tour, I find it awkward to be carted around with four other wide-eyed tourists. I counter this thought by reminding myself of the South African and American government warnings advising against any exploring of these regions without an experienced guide. Soweto was the center of resistance to apartheid, and one of the most violent of all the townships. (In the 1990s, it was considered to be one of the most dangerous places on earth.) Jo’burg’s violent nature, once an expression of resistance against an oppressive regime, has become a manifestation of the city’s poverty. Soweto was established as nonwhites were systematically moved out of the city to vacant plots of land without housing, water, electricity, or sewage. There, crime and poverty flourished while it continued to supply Jo’burg and Pretoria with cheap labor. We pass the houses of Nelson Mandela and Desmond Tutu, stopping for an hour at the Hector Pieterson Museum, named after one of the many children shot dead in 1976 by government police firing upon peaceful student protesters. In the ensuing Soweto uprising, over 200 students would be murdered. We stop again at Desmond Tutu’s Regina Mundi Church. During apartheid, nonwhites were not allowed to congregate in groups of more than two, except for at church. Not that the walls of the church ensured their safety, as evidenced by the multiple bullet holes on the inside and outside of Regina Mundi.
January 5, 2006
As you walk into the Apartheid Museum, you are given a card that classifies you as white, colored, or black. The arbitrariness of the card you receive is intended to mirror the wayward racial classification system experienced by South Africans. Ethnic distinctions permeated every aspect of people’s lives, and overt racial segregation has not been erased with South Africa’s embrace of democracy. As I walk into the heart of the museum, a temporary exhibit details parallels in the United States’ history of discriminatory practices, focusing on the Civil Rights Movement. Does tumultuous social upheaval unite people, or do we simply draw new divisions? Both South Africa and the United States have in many ways simply replaced racial segregation with economic divisions.
January 9, 2006
Mountains or sea surround Cape Town in every direction, a picturesque setting for a rapidly changing city. The mild summer weather complements the friendly atmosphere. I ride a minicab (an overcrowded VW van equipped with deafening sound system) to the Red Cross Children’s Hospital (RXH). Two hours later, I try to keep the sweat from dripping into my eyes as I assist in the operating room that is 33C. I wash the charred skin off of a two month-old baby whose mother had died two hours earlier. She had lain down in her bed, doused herself and the baby in flammable liquid, and lit herself on fire while holding the baby. Other burn surgery cases I witnessed: a child on a mattress that his brother set on fire while playing with matches, and a woman who accidentally threw the flaming oil from a kitchen fire onto the street and a passing toddler.
January 14, 2006
I spend the morning in the townships of Cape Town (corrugated metal shanty towns). We visit a local sheebeen (a makeshift pub), talk to the neighborhood goat head vendor over her pile of goat heads covered in flies (that are worth much more with the tongue intact), and chat with the medicine man (who sells unidentifiable animal products and herbs next to packs of condoms), all the while touring the “third world” neighborhoods where the majority of Capetonians make their homes. These scenes contrast with my afternoon trip to Camp’s Bay, a La Jolla-esque part of the city where people drive Range Rovers and sip martinis when they tire of baking in the sun. While the extremes of wealth and poverty seem more accentuated here in South Africa, I realize our communities in San Diego are no more integrated. How quickly I find myself nearly accustomed to the conspicuous racial segregation.
January 16, 2006
This three year old little boy is as happy as can be in his RXH room, playing with his sister, with just a small dot on his left forehead. I soon learn that this tiny mark is the entry point for the metal rod with which another child stabbed the patient in the head. And sure enough, later in the afternoon we drain 10 cc of purulent material from his large brain abscess. My attending shrugs and reminds me of the child who presented recently with scissors sticking out of his skull.
The faculty here is personable and professional. They exhibit that balance of family, career and self that so many preach but seldom live. Time in the OR is actually pleasant. People call each other by name, and there is no ducking of chucked instruments or responsibility. There is a focus on teaching not only the instruction of surgical skill, but also how to empathetically care for a sick child and his or her family. It is comfortable here while still challenging, technically and intellectually.
January 18, 2006
Without much going on in the OR this afternoon, I sneak out and make it to another one of South Africa’s many World Heritage Sites, Robben Island. Here Nelson Mandela spent eighteen of his twenty-seven years of incarceration. As I sit on the ferry, I try to imagine what the political prisoners traveling in this same direction several decades ago must have been thought. My tour of the prison is led by an ex-prisoner, who recounts with personal details his experience during his five-year sentence. He shows us where he slept, where he ate, and brings everyone to Nelson Mandela’s cell. This island for me has an eerie feel, but at times I feel the whole country is haunted. South Africans do not feel the same solemn reserve that I do visiting this place. They celebrate the end of Robben Island as it was once known. Now this site hosts New Year parties and dozens of weddings.
January 19, 2006
As I walk into the OR to help position our morning case, I hesitate. This five year old boy, operated on previously for a glioblastoma multiforme, is back for further resection. Locating the lesion is not difficult, as it is protruding out of his skull 7 cm and is at least that wide in diameter. We start to operate but we find we have to replace over 2.5 times his blood volume. The child is unstable, and the ever cool anesthesiologist in a flurry of vials and pacing does his best to keep the child alive. Having replaced the bone on his skull, we close and send the patient and family home to wait for the pressure of the now inwardly expanding tumor.
January 20, 2006
By now I have made my way through the tourist’s checklist of Cape Town: hideous baboons and hilarious penguins at Cape Point, the cable car to Table Mountain, concerts in Kirstenbosch National Botanical Gardens, a jazz festival at the Waterfront, and hikes up Lion’s head and through Constantia National Forest. I have spent nearly every night watching the Africa’s Cup on television with my friends from Zambia and Benin. We go out to a bar to watch a game, where two dozen avid fans yell, cry, and throw bar peanuts at the television screen. The next morning when I ask one of my colleagues if he had seen the game, he replies with a matter-of-fact tone, “White people don’t watch soccer.” The World Cup will be in South Africa in 2010.
January 24, 2006
When the mother carries her baby into the examination room, she unwraps the dressing from her 20 month-old baby’s head. Underneath, a 5 cm diameter portion of brain covered in a thin layer of skin and dripping CSF, protrudes from between her eyebrows. They have traveled three hours from a neighboring township for this visit. The mom politely asks my attending to fix her baby. She cannot take the child out of the house (and is therefore herself confined) for fear of judgment by her community.
January 28, 2006
It is my last weekend, and I am spending it with my South African friends on the western coast, two hours north of Cape Town. There is a lull, with each moment blending into the next without the haste and urgency I am accustomed to at home. We spend all day chatting, stirring pots and tending to the braii, which means “barbecue” in Afrikaans. My friend and I look out on the sunset together, a landscape that you could mistake for Baja if you didn’t know you were on the other side of the world. She turns to me and says, “You know, people have been telling us our whole lives that we’re not good enough, that our lives don’t mean anything. But you have a choice. You can believe them or you can live your life for you, knowing that you have value even if no one ever tells you so. This is the position we are all in.”