On Thursday morning, we attended the weekly Kaposi Sarcoma (KS) Clinic. This clinic specializes in the care of patients with this vascular tumor, with epidemic (HIV-related) and endemic (non HIV-related) the most common types seen in this patient population. We worked first with the senior housestaff member and then with the attending. Roughly forty patients are seen in this clinic weekly, though previously, the numbers averaged between sixty and eighty.
Many patients are followed over several years, and return for follow up of quiescent disease. Others are referred from outside clinics and hospitals for initial evaluation and subsequent management of KS. Others are simply sick and complex, sent by their physicians with accompanying letters, asking for assistance. These are some of the strongest clinicians with whom I have had the privilege to work, both as general internists and as specialists. Their commitment to these patients and this disease also extends to highly relevant, translational clinical trials that provided ARVs as early as 2003, and others that tested different chemotherapy regimens while providing them at low to no cost to patients. Even now, patients with HIV infection and no chemotherapy in the past 3 months are eligible to enroll in a study with provides bronchoscopy for further testing and staging. One of the notable findings thus far has been the number of patients with AFB-negative sputum who then tested positive for tuberculosis on bronchoscopy.
Off hospital grounds, we seek opportunities to learn more about the Zimbabwean way of life. This is not an easy task, as even the Zimbabweans we know do not venture into the frenetic energy of the city center. Instead they convene in clusters of shops and restaurants sprinkled around the periphery of the city, satellites of light and movement that offer a look only at those who can afford edge-of-city living. Lack of sidewalks and streetlights make walking to these sites difficult. And private transport, like many other aspects of life here, is at least as expensive as in the United States.
Yet closed doors have opened others. I have discovered Petina Gappah, a Zimbabwean author whose collection of short stories, An Elegy for Easterly, has teemed my otherwise incomplete sight with rich characters that could easily be seated in front of me. A simple change of pronoun in a line from T.S. Eliot, and she evokes the President, setting the mood for the stories that follow: “He grows old, he grows old; he shall wear the bottoms of his trousers rolled.” I think of the story, “The Cracked, Pink Lips of Rosie’s Bridegroom” every time we meet a patient living with HIV, untreated for years. I learn about the tremendous cultural and familial ties that both bind people together and yet cut deep when fraught with financial and emotional burdens. In one story, the death of a loved one charges a family with the task of accommodating other members traveling from near and far. But how to feed in a time of need, and how to mourn the dead without family? And then the ultimate rift (and more sadly, the resulting ambivalence) that occurs despite one’s best intentions, in circumstances beyond one’s control (because how can we blame those closest to us for simply trying for a better life?): “I reached out too and we clung to the edges of the moving stairs, our hands passing without meeting. We laughed at our failure.”
Nearing the end of this first week, I find myself connected to this landscape in yet more unexpected ways. A woman running alongside me across a heavily trafficked street, both with umbrellas in tow, grabs my hand before I step into a gaping, muddied hole until we reach safety. In KS clinic, a senior housestaff member welcomes us with a wide grin before interjecting: “This whole Trump affair has led me to believe that you are not very different from us. It’s not politicking but politricking. For us at least it’s good living every five years but it never comes.”
Suddenly Inauguration Day is upon us. And there is Professor Chiratidzo Ellen Ndhlovu beside us, shouldering our internal weight the way she instructs us in patience—with calm and a mirthful wisdom. She introduces us to her husband’s cousin’s son, a young student of architecture who has been living with them. She shows us the small garden where lettuce, chilly peppers and herbs grow. She prepares two types of greens, muboora and munyemba, the first from a pumpkin plant and the other from a bean plant, to be served with sadza. Over the fire of the stove, she turns her wrist hundreds of times until the porridge, made with sorghum flour, takes on that perfect thickened lightness that unites flavors in the palm of one’s hand. Passing on the offer of fresh mopane worms (a local delicacy, the edible caterpillar of a species of emperor moth), we enter the living room where events in Washington D.C. unfold on the television screen. The words of the commentator mark a day with unknowable repercussion. We listen, we gasp, we shudder. But then we are brought back into the circle of family, sharing a meal, our plates resting in our laps on venda trays, made by hand by the Venda people, in a border town where she grew up.