I see you

11/04/09

Siteki, Swaziland

8:45 am

The most common greeting you hear in Swaziland, is "Sawubona.'

It means "I see you".

There are many ways of seeing.

I remember during my student years, reading Foucault, an anthropologist who described 'the medical gaze'.

He postulated that when a health care worker meets a patient, the patient often becomes objectified. Dehumanised. That power resides with the health care worker and rarely with the patient.

I wish it were not the case but i know that in many, many parts of the world it is true.

It is not because health care workers are cruel. To the contrary the vast majority I have known are genuinely compassionate individuals with a commitment to the welfare of those whom they serve.

And yet there is just so much to do. So many patients to see. So little time for sleep, or food, or self care. So many agendas being thrust your way. Is it any wonder that the clinical gaze would be one which tried to be as efficent and detached as possible?

But there is more to healing than fixing a broken part.

Nowhere is that more apparent than here in Africa. I know many people who have taken a 'fast food' approach to Developing world Medicine. Their aim is to see as many patients as quickly as possible. And I know that to some degree this is required. In fact much of population health is based upon this principle... Do the most good, for the most people.

And yet if we truly want to create sustainable solutions to the crises facing the developing world, we need more.

In addition to much needed acute services such as outpatient departments and clinics that are able to see hundreds and hundreds of sick people each day. We need other services which can offer broader solutions to the complex problems which these people are facing.

Three or four days each week for the duration of my stay in Africa I will be going out with the home based care team at the Good Shepherd hospital. This wonderful team of nurses drives out along the red, dusty roads around the lebombo mountains and visits people who are known to have severe HIV infection/ or are unable to access the acute hospital because of lack of money or being too unwell to walk.

I have been asked to do some teaching for the team and offer ways of optimising the service.

Here are some of the suggestions I am making:

- No patient should be assessed on the back of a truck.

- The team should go into the hut, sit down with the patient, if possible at eye level, before making a medical assessment and prescribing medications.

- There needs to be an assessment of the needs of the family, of water supply, of sanitation. Do they have enough money to get to hospital? Are other family members sick? Are there orphans who need support services? Do they have access to food?

It might take longer. It will probably mean we see less people during the day.

But my hope is that whomever we do encounter will be 'seen'.

Some will criticise this approach as idealistic and impractical.

But i disagree.

Most of the patients seen by home based care have refractory AIDS and are going to die. It is the tragic reality of HIV and poverty in Africa. What these people need more than anything else is to be seen. To be heard. To have a thorough assessment of their physical and social needs so that further complications of their disease, like opportunistic infections, can be prevented. And so that their families will be supported and well looked after.

I say it over and over again, but when you have nothing, when you are dying a painful and solitary death - the smallest kindness, the most seemingly insignificant touch, the most cursory glance - means everything.

In truth, is this not a connecting thread that runs through the human condition?

The need for someone to look in your eyes and say simply, from the heart

"My brother, My sister,

I see you."

Sawubona,

Maithri