The striped tents rose up every weekend, great red blemishes atop the green hillsides of KwaZulu, South Africa. In my morning runs through Maquadini Township, I would pass by Zulu men and women singing as they worked together to raise the tents’ brightly colored canvas sides into place. Every Friday, the tents rose and every Monday they disappeared. I assumed that they were for weddings.
Janet Giddy knew better. In each of the tents, she saw not a bride and a groom, but rather the thin shadow of a former patient lying in a small wooden box. And in the swelling numbers of tents that dotted the hillsides of the Kwa-Zulu/Natal, Janet saw the progress of AIDS as it cut a swift and deadly path through her homeland.
Janet Giddy practices medicine in one of the most beautiful stretches of land in all of South Africa, a region known as The Valley of a Thousand Hills. The beauty of the land’s dramatic topography is only surpassed by that of its people, several hundred thousand of whom turn to Janet as their only government-funded physician. The inhabitants of this blessed land are cursed with the one of the world’s highest rates of HIV infection. Nearly 40% of adults and 20% of newboms carry the virus that causes AIDS. Without any hope of recieving anti-retroviral therapy, they face the prospect of quickly having a tent raised in their honor.
After one of my morning runs through the tent-strewn hills, I arrive at Janet’s clinic to ask her a few questions. When I walked into the clinic’s outdoor waiting area, the number of patients waiting in the early-morning cold shocks me. Many had traveled hours to see a doctor, either on foot or in stuffed minibus taxis for her assistance. Most of the thin, coughing figures waiting on the wooden benches appeared to be in the end stages of AIDS. Many already knew that the doctor cannot provide them with medications for their illness, but her presence helps somehow. She gives them something worth the arduous journey and the hours of waiting: hope. And hope is in short supply on the frontlines of the battle against AIDS.
I walk past the queue of patients and knock on a door labeled “Dr. Janet Giddy.” “Come in,” her voice calls out from within. I open the door and walk inside. She is seeing a young Zulu mother and her child. They are already mid-way through the examination, and Janet asks the mother to open her mouth. The mother opens her mouth, revealing a thick white covering of thrush. She has AIDS, and the child in her arms is thin and crying. A lump starts to form in my throat, and I tell myself that the sentence need not be so severe. Only 50% of the children contract HIV through vertical transmission. Janet’s eyes, although red-rimmed from fatigued, do not convey a glimmer of shock at the thrush on the woman’s tongue. She sees this every day.
“How long have you been losing weight?” she asks in Zulu, sharp clicks alternating with soft hushing noises. “Were you losing weight before you became pregnant?” she continues. The woman nods and looks with worried eyes down at her daughter. “How long has your daughter been sick?” she asks, kindly.
“Oh, since she was a baby.” The woman replies, stroking the crying girl’s thin hair. As the child screams, Janet peeks between two rows of teeth at the girl’s tongue. She sees something.
Janet turns to me with a serious look on her face. “The baby has thrush.” She says and then starts speaking with the mother again. The calm, kind tone of her voice sets the mother at ease. I feel a sickness grow in my stomach as she scribbles something down on the baby’s chart. She is writing down three letters: ARC, AIDS-Related Complaint—three letters that will raise a tent in the child’s honor within a few years. I wonder how she can do this day after day without losing the hope that she gives to her patients.
That night she drives me to her home, picking up two of the six children who live with her and her husband. Four of the children are her own, one is a child of an Afrikaner doctor they know from their time spent at a rural hospital, the other child is the Zulu granddaughter of their friend and domestic servant. All are treated equally. Her home symbolizes the possibility of peaceful coexistence for a country so divided.
We arrive and the kids are lined up on the floor, English, Zulu, Afrikaner—the elusive rainbow nation in miniature, all watching a Disney cartoon. She, determined to enhance my medical education, sits me down in front of a pile of papers she has collected about the HIV/AIDS crisis in South Africa. One of them is a submission to the Truth and Reconciliation Commission, detailing her and her husband’s experiences as physicians in the Zulu homelands protesting apartheid. Another is a fiery editorial she wrote decrying the president’s refusal to admit that HIV causes AIDS.
“Do you think that we can beat AIDS in South Africa?” I ask.
“I never thought that I would live to see the end of apartheid, but here we are.” she says. I admire her hope and smile.
She goes to bed and I stare out of the back window at the burning sugarcane fields that weave between the hills of Zululand. I take in a deep breath and think about the years to come, and the clutter of voices that have told me that the spark of idealism dies with youth. I remember that Janet could have listened to these voices. A large percentage of her medical school classmates did, and now practice medicine far from South Africa. But she didn’t. She stayed to help her country through its problems, from apartheid to AIDS. Somehow she didn’t lose her spark, and now her fire bums as brightly as the sugarcane fields before me.
I can only hope that when I am faced with the choice in my medical career between taking flight from the world’s problems and walking the hard road to justice that I will have the strength to make Janet’s choice.
The Arnold P. Gold Foundation, Inc., is a public, not-for-profit organization founded in 1988 to nurture and sustain the time-honored tradition of caring throughout medical school and residency. Today, the Foundation has initiated or supports 26 diverse programs at 93% of our nation’s medical schools and at schools abroad. Its programs and projects are derived from the beliefs that: compassion and respect are essential to the practice of medicine and enhance the healing process, the habits of humanistic care can and should be taught, and medical role-model practitioners who embody humanistic values deserve support and recognition.
In 1999, the Gold Foundation instituted the annual Humanism in Medicine Essay Contest as a way to encourage medical students to reflect on their experiences in writing. Since the contest’s beginning, the Foundation has received over a thousand essays from more than 110 schools of medicine and osteopathy.
The theme for the 2002 Humanism in Medicine Essay Contest was “A Humanistic Role Model in My Medical Career.” Winning essays and honorable mentions were selected by a distinguished panel of judges. For the second year in a row, Academic Medicine is pleased to publish the top three winning essays from the 2002 contest; the essay by the first-prize winner was published in the October 2003 issue. The essay by the second-prize winner, Brent Savoie, appears here. The third-place essay will be published in the December issue.
Winning essays are also published on the Foundation’s Web site: www.humanism-in-medicine.org and in The Foundation’s DOC newsletter. For further information, please call The Arnold P. Gold Foundation at 201-567-7999 or email: 〈[email protected]〉.