Following on from International Women’s Day, I thought I’d reflect a little on some of the diverse encounters that I’ve had working with women here. Life brings particular challenges for many of our female patients, but their strength often shines through.
I was on call for New Years Day and saw 3 young women who had overdosed. One 18 year old took such a dangerous drug that she had several seizures and developed metabolic derangement in her blood requiring a few days of treatment on our high care unit. She was beaten by her brother, I’m not sure why, but he used a stick across her legs. Another girl was hit by her father. When I spoke with her the next day she was calm and intelligent with good conversational English. She told me she had been depressed for the last year because her father wouldn’t let her go to school. She had dreams of being a teacher, but she was being held back from completing her matriculation. In an act of rebellion she went to a New Years Eve party at the beach and this was what triggered the argument. The third lady was attacked by her boyfriend. She had tried to leave him several times and he had threatened to kill her. We talked about reporting him to the police but she was reluctant as he was linked with them through work.
Other injuries I have seen inflicted by partners are a broken jaw, bites to the face, burns and a deep laceration to the neck overlying the spine. Today I broke my own rule of not giving money to a patient so that a 22 year old could get herself and her 3 year old boy to hospital. She was pregnant and her boyfriend has been regularly violent towards her and their son. We are lucky to have a fantastic psychologist and team of social workers so we are able to offer some support to these women. The police are sometimes involved in cases of domestic violence also. Rates of interpersonal violence in general are high here and domestic violence is a frequent occurrence. I’m not sure I know enough about this culture and community yet to claim to understand the reasons why it happens. But meeting some of these young women who have no education, no employment and often young children I can see how it is difficult for them to leave an abusive relationship. If you can’t afford the bus to hospital then how are you going to facilitate living independently from your partner?
As sit in our monthly maternal and neonatal mortality meeting I feel proud of the work that is being done here. The room is full of senior midwives, nurses, doctors and students. Each case is discussed in sometimes painful detail with lessons learned extracted. We are in a setting of high teenage pregnancy, high HIV prevalence and reasonably high parity (number of pregnancies) so providing obstetric care is a challenge, but the expectation is of high standards. The presentation is led by a South African medical colleague and the senior midwives contribute to the discussions. Experienced and skilled, the midwives here are often fantastic and I think genuinely compassionate about the care they give to their patients. The local mums are lucky to have an educated, hardworking and sometimes slightly fierce bunch of women to fight for them. We have a regular stream of medical students here and many of our recent students have been female and Zulu. As more women from this community become educated and engage with tackling the challenges facing women here then I hope the outlook will start to change.
Out and about outside the hospital it is a treat connecting with other women. Once people realise that you work in a local hospital it seems to put them at ease and I find that people want to share stories with you. I had a lovely natter with Promise, one of the members of staff at a game park recently. She didn’t look much older than me but had 4 kids. Her oldest is 21 and she spoke proudly of him being an intelligent boy and doing well at university. She also has a 14 year old and is juggling childcare for her two little ones by her fiancé. The wedding is on hold chronically as there is always something more pressing to spend money on. As we chatted about family and relationships, she was quite open about the fact that her first son was the result of rape so there is no contact with is father. She shared this so matter-of-factly that I was taken aback. Sexual violence is prevalent here and I suspect many more of my patients are affected by it than I realise. Friends working in a small local hospital saw 8 rape cases on New Years Day after a party on the beach. Our psychologist also says that many of the young women with teenage pregnancies he works with have been in transactional relationships, whereby an older man buys them gifts such as food or a mobile phone in exchange for sex. It was powerful to see Promise juggling life as a Mum, partner and professional woman; and a survivor of sexual violence.
Meet the Gogos, some of my favourite patients. I’m not sure of the direct translation of the word ‘Gogo’ (pronounced Gawgaw, we get laughed at for our Anglicisation) but it seems to be applied to Grandma and also older women in general, often a term of endearment or respect. Our Zulu patients have physically demanding lives and age young – you might qualify as a gogo here when you would still be working full time back home. Often quiet and humble, they come to clinic wrapped in colourful aprons, carrying decorative walking sticks, usually ready for a chatter or laugh. I saw a 2 year old boy in clinic with his Gogo. He was meant to be on our high risk programme but had not been attending follow up, and was behind on his immunisations also. All of our children who have had severe acute malnutrition, and other presentations which are a cause for concern are linked into clinic-based follow up to try and detect new problems early. Gogo was concerned and caring but couldn’t answer many of my questions. As we spoke further, it transpired that she had not long taken over the care of her grandson. Her daughter had just left without explanation and she was now trying to pick up the pieces. I recently admitted a 60 year old Gogo who presented with seizures and signs of a severe stroke. Here prognosis was poor. She lived with her 6 grandchildren and was clearly the bedrock of her family. I’m not sure what will happen to the family structure now. One of the lovely old Gogos on my ward this week has dementia. She was unresponsive when she first came in, but has got her natter back on now. She has been trying to marry me off to her son – she said I would get 11 cattle, but I wasn’t very taken with the offer… Today in clinic a tiny wizened old lady and her robust 50 year old daughter came through the door. We had a funny moment as I was trying to get the old lady to sit in the patient’s chair and we were doing double takes. Actually she had brought her daughter to clinic. She had been suffering from epilepsy since she was a small child and had apparent learning disability also. As is often the case, her epilepsy was poorly controlled but with much scope for increasing her medication. I couldn’t help feeling amazed by the love and warmth shown by this lady who was clearly dedicated to her daughter but also concern for what will happen as she continues to age. We agreed she would see our social worker on her next visit to get some support. Women here seem to take the main responsibility for raising children and often 3 generations live together. Many children are raised by their Gogo – sometimes the mother is absent, sometimes deceased (usually due to HIV) and sometimes working or studying. Gogo’s pension may support 3 generations. In a setting where family can be fragmented, the Gogos seem to hold things together. To me they seem to have a spirit of quiet resilience and compassion with a sprinkle of humour and that’s why they are my favourites.