Preparing the Ground

08 December 2010

To every one’s relief, the rains have continued since the first, sharp showers of last month.  The previous few years have been dry years, with the rains coming late, or not at all.  After preparing the soil at the first sign of rain, people plant their land with food for the future.  If further rain does not follow swiftly, these seeds, planted with expectation and hope, will shrivel in the soil and yield nothing.  Late rain is, in some ways, as good as no rain at all.

There is a constant sense of sadness in the clinic for those patients who also arrive too late, when, despite our best efforts, they are past any help at all.  They come draped on blankets in wheelbarrows, fragile and barely conscious.  Unable to deny or resist any longer.  They come with desperate family members, who have probably watched their demise helplessly.  They arrive with a frail hope, but, perhaps, deep down, they also understand that coming too late is, in some ways, as good as not coming at all.

But, like the rains that are falling even as I write, not all patients arrive too late.  And when they come, in the same way that the rains revive the drought- weary land, we are also revived and refreshed and restored.  We are reminded that our work has value.  Because some of our patients come right on time.

Like the group of school leavers I met last week who came to be tested for HIV.  I held my breath whilst we waited for the results.  They were all negative.  They were all counselled on how they can stay negative.  These boys are just about to take their next step towards adulthood and independence and they arrived right on time.

There are other patients too.  Like the pregnant women who come to register for our programme to prevent mother-to-child transmission.  They know that if they come early and take the anti-retroviral drugs, they have the best chance of having a miraculously HIV negative baby.  Right on time.

Sadly, there are still many barriers to coming to the clinic, so many reasons to deny, delay and defer.  We’re trying to remove these barriers, one by one.  Cost is just one.  High unemployment and the poverty and insecurity that follows makes healthcare inaccessible for many.  Our clinics are free.  Travelling is a challenge in the rural communities we serve.  We are supporting isolated clinics so they can offer quality services to the same population we treat.  Stigma, sadly, remains another barrier, and, for me, the most painful.  Our community liaison officers seek to address this through education, and through the kind of openness that ignorance and falsehoods hate.

For the past few months, early in the morning, I have passed by fields full of people digging soil, moving rocks and sweating over the earth.  I have watched as wasteland is cleared and rich, dark soil is turned with backbreaking effort.  We can’t control the rain and make it fall on these hungry fields.  Likewise, we can’t force our patients to come and receive testing and treatment, however much we would like to sometimes.  All we can do is prepare the ground and wait with hopeful expectancy.  Often, like the rains, to our relief, they come.