From Elective Reviews - South Africa - Mseleni Hospital, 2006 - John Greenall, medical elective
'The child's dead' says the nurse, as we stand over the motionless body covered by a blanket. My head's swimming, it just can't be true - I saw her only 5 minutes ago and she didn't look that ill! I look across to the parents, at least judging by the woman's age she's probably the grandmother… they don't look too upset… more resigned maybe… I pull back the blanket, calling frantically for one of the doctors as I do so, but by the time he arrives it is obvious that the nurse was right – I've just witnessed another child becoming a victim of the HIV epidemic that is tearing families apart in KwaZulu Natal, South Africa.
Looking at that lifeless body on my first afternoon in the outpatients department at Mseleni Hospital in the heart of Zululand is a moment I'll never forget. What I had just seen both angered and frustrated me and moved me to tears – too ill, too late, and too young –a story that was sadly going to be repeated many times during my stay. HIV and the often-accompanying TB is more prevalent here than anywhere else in the world. Patients presenting with a headache were more than likely to have some serious pathology, cryptococcal meningitis and TB meningitis top of the list. I saw serious pathology like this several times a day, which although interesting was also frustrating as better resources would help a great deal. It is especially difficult to take because South Africa is a country which has so many natural resources and first class services in its cities. However, what struck me more is that so much disease is caused by human behaviour. To witness the impact of sexual promiscuity on a people's health was incredible, and I have to admit it angered me intently as I realized that the choices people make which feel good at the time, lead to family break up and poor health, particularly in children, as a consequence.
I found out that there are many reasons why HIV prevalence is so high. One is that many young people are prevented from getting married because of the huge amount of money (the labola) that needs to be paid to the bride's parents, which most young men cannot afford. The high unemployment and lack of entertainment also go some way towards explaining the problem. However, as a Christian I am also aware that the bible is clear that God has created us for monogamous relationships where sexual intimacy is reserved for marriage alone. Looking at it like this I was struck by the fact that the HIV problem is in fact at heart a spiritual problem. Of course as a doctor I want to help those affected by HIV and implore people to avoid risky behaviour, and yet this will not ultimately stop the virus spreading; it is a change of heart that is needed. Whilst at Mseleni it was a privilege for me and my wife to talk to two youth groups about how God has been faithful to us in our relationship, how he enabled us to wait until we were married before we slept together and how he helped us keep ourselves for each other both before and now during marriage. One young man came up to us afterwards and thanked us for the advice we had shared saying, 'We need more people like you to give us advice on how to live lives that are pleasing to God'.
As a child one of my life's ambitions was to practice medicine in Africa. My grandparents were medical missionaries in Malawi and I remember deciding that one day I wanted to do the same thing. The decision to visit South Africa was therefore particularly motivated by the desire to experience not only medicine in Africa but to get a taste of what life is like as a medical missionary there. My trip has made me excited about being a doctor to people who have serious physical conditions but even more importantly I have realized that I am also a messenger of the Good News with the eternally significant role of introducing people to the Great Physician, Jesus Christ, who can heal people's broken relationship with God.
As well as being enthused and excited by this commission, the experience as a medical missionary was often challenging and sometimes frustrating. Every day was different, and there were many spiritual challenges. Having a constantly changing workforce limited in size means a small and constantly changing Christian community. My ideas about church were challenged, and the need to accept and love my brothers and sisters when living, working and fellowshipping with them was evident. I have also realized how isolated you must feel when abroad for a long time and noticed how those working there appreciated receiving letters and news from 'home'. It was also an eye opener to realize how different the Zulu people were to the English - the cultural differences, in particular the way we think, was hugely different and a real challenge to live with day by day. Thinking about this I was reminded that God made us all and he made us very different, and yet both Zulu and British culture struggle with the same vices – lust, immorality, alcoholism, gambling, greed and violence to name but a few. It is clear that the gospel is therefore relevant to everyone, to the Zulu people as much as to the English. I was reminded of the apostle Paul who said that he had 'become all things to all men so that by all possible means I might save some' (1 Corinthians 9:22). Never have I experienced so vividly the need to adapt my way of doing things as I desire to see people hear the gospel and be saved.
I also learnt the importance of having a wider perspective than just medicine. The doctors we worked with were not just doctors – they were teachers, preachers, builders and counselors as well. The needs of the community went beyond the boundaries of the hospital and I have become convinced that whilst I can't do everything (particularly the building bit!) I want to be available to God to do whatever He wants me to do. Indeed, it is quite probable that we will work in a developing world environment in the future. Jesus said that “the harvest is plentiful, but the workers are few” (Luke 10:2), clearly seen when you see the need for the gospel in the Mseleni area. And time is short – many of these people are dying before they reach their 40's, like the little girl I saw in my first half an hour in outpatients. May we be Christian doctors who serve God wherever he leads us, to be characterized by Christ-likeness and to be gripped by the urgency of the fact that people are dying before they hear the gospel. Amidst all the sorrow and the pain that I saw, looking into eyes that have seen great heartache and despair, I was reminded that God's word says that for those who have trusted Christ “He will wipe every tear from their eyes. There will be no more death or mourning or crying or pain…” (Revelation 21:4a). Until heaven, there is a world in need of the gospel and of Christ's compassion demonstrated to them.