First, do no harm. Lying underfoot, trodden by the feet of my province’s medical establishment, the Hippocratic Oath stands as a mythological document to many it seems. Though of course it was updated by Louis Lasagna in 1964 the essential remains to “never do harm” and to constantly remember one is dealing with a human being. But the fingers of compassion were prised loose in a spree of irrationality, as sick children and their families were turned away from hospitals to die.
The first story that was transmuted into bold black-and-white letters concerned one-year old Ubantu Mali. Ubantu had been discharged from the Red Cross Children’s Hospital, after being treated for gastroenteritis.
Gastroenteritis “is an inflammation of the lining of the intestines caused by a virus, bacteria or parasites.” It is one of the top 5 causes for deaths worldwide, and is especially a common death-dealer for infants in non-industrialised communities. Poor water and hygiene are, as usual, the primary reasons for this. It seems no fault that most hygiene specialists, when asked, “What is the best way to prevent sickness?”, usually reply: “Soap and water”.
Coming from an underprivileged community as Ubantu did, this does not make him a dirty child, or his parents filthy. What this means is that their surroundings are not catered for health or hygiene. It is only a stark reminder that whilst many of us have purified water, many of these people are forced through desperation to re-use water or partake of water that is completely unpurified. Sympathies should strike hard and for this reason I can not fathom the developement of this horrific story.
After being discharged, the family was told that if his symptoms arise again to take him to a local medical facility. The symptoms of course did arise again. Ubantu’s grandmother, Ntombizodwa Mali, then took him in an effort to save his life. Vomiting and diarrhea plagued Ubantu from the beginning to the, quite literal, end.
Ntombizodwa went to three different hospitals and was rejected three different times.
At the first, Nyanga clinic, they were told that the facility had reached its child quota for the day. This is utter nonsense, since the primary focus of the city’s policy is that no child is turned away if it is in severe distress. They were treated rudely by nurses and clerks, as they were shifted from section to section. Doors closed in their faces as soon as they approached, even when they pleaded and pointed to the dying child. Staff were simply dismissive, focusing instead on protocol and highlighting other patients.
Ntombizodwa said: ““There were so many people in front of us. They told us that their folders were with the doctor already and they were now queuing to see him. We sat there for a while and realised that we didn’t have a folder and therefore might not get help after all.”
Thus the retention of slips of cardboard became more important to the staff than the blatant suffering of a child. The human heart struggles to find fruition amidst the machine of bureaucracy. With Ubantu’s symptoms getting worse by the hour, Ntombizodwa decided to try KTC Hospital.
However, when they arrived they were rudely told that the facility did not cater for children. They decided to try anyway, given the desperate situation as sweat and fever rose in the tiny mangled form of the child. Entering, they were told by the receptionist that she was not there to answer stupid questions. In a Kafkaesque turn-around, she indicated she was only there to deal with people who had folders.
Finally they walked all the way to Gugulethu CHC. The rudeness abated somewhat but they still waited for two hours, being ignored by staff. Finally, they were told by staff to return home as the nurses had seen enough children for that day.
From all the travelling and personal attempts to keep Ubantu alive, Ntombizodwa had slowly depleted whatever small supply of money she had. She now found herself stranded, without any way to return home. The only way was to put one foot in front of the other, a trip that would be daunting for an old woman – one with no less than her dying grandchild on her back. Even Faulkner’s Bundren family, who carry the corpse of the dead matriarch in As I Lay Dying, were prepared for their necromarch.
When Ntombizodwa arrived home, she found her grandchild dead.
Cape Town was in uproar when this story was first reported. It shows that the inherent human need to help, care and convey compassion remains strong. I have never doubted this – the only problem is that human solidarity is replaced by atomised functioning, as machines based on paperwork trudge forward in an effort to work. But, as usual, lost amidst the cogs of that which we create – like economics for example – is the normal human drive to help.
And as the exemplar of reason is science and philosophy, so the pinnacle of compassion is medicine. Some might say that the medicine I am referring to is a purely “Western” one. Leaving aside the reason why we consider Western, or European, medicine the “medicine of the world” as Roy Porter calls it, is that it works. Praying and homeopathy, laying on hands and other quackery, simply are gateways for placebos. They work in the sense they make one feel better, but the evidence rests with medicine as taught in hospitals and medical schools, to actually “fight off” disease.
Leaving aside this asinine “debate”, we must reconsider what this means.
Head of City Health, Dr Ivan Bromfield, has reiterated the point, following this disgusting affront to human sensibilities, that the city’s policy didn’t allow staff to turn very sick patients away. A full investigation has been launched into why these sorts of incidents are occurring.
Why were the Mali family turned away, with the obvious lie that the staff had fulfilled its quota of children for the day? Or perhaps the nurses had seen enough children? It is not very obviously a lie but it certainly is an excuse to waylay those who suffer. As Sissela Bok has highlighted, telling the truth does not appear in the Hippocratic Oath. It underpins the debate in bioethics whether one should or should not lie to patients, in order to help them. Nonetheless, it is not required, then, to tell patients the truth according the oath.
Yet, one could also make the case that that only matters when the patient is actually being treated. As government officials, they are trusted with caring for the citizens. Quite literally, our lives are in their hands. Truth, compassion and respect should be primary – but of course, as we see here, it is not.
We are not slaves to the systems we create. We are its masters and we are the subject of its intentions to restore the lives we want to lead. These very real and so-called practical establishments, from medicine to engineering, all help us to maintain a straight path of least suffering. No one would be glad to have their lives filled with surgery but no one doubts its awesome power to save. The paradox then is whilst we should venerate things like medicine and its disciplines, no one actually wants to be anywhere near it. That indicates that ones straight path in life has veered and is in need of restoration. Ideally, we would want to live in a world without police, doctors, governments and farmers – because we would hope people would not commit crimes, get sick, require laws or get hungry. Since we are human, we do require machines of our own making to watch us. It seems no fault that we created idols in our past and then prayed to them. It reminds one of Montaigne’s line that “Man is certainly stark mad: he cannot make a worm, yet he will make gods by the dozen.”
We have long stripped ourselves of gods and idols (by definition, in a secular democracy). We have learnt where we stand. Now, if we are to recalibrate our source of compassion and direct it in ways which will benefit our fellow man, we must take harsh steps to do that. This story highlights the ultimate failing that can occur with the two-pronged sword of medicine: great ways to save, and horrid ways to die. A child’s life was lost because of maltreatment and disregard by talking apes who were more excited by folders then by human forms; this is a mistake.
Never, in all our creations of machines and gods, should we lose sight of the fact that what matters is human solidarity, compassion and respect. With medicine, this should be the overarching principle. When this fails, medicine, health, surgery, becomes nothing but brow-beating nomenclature toward compassion’s own destruction. Let us start again and focus on the foundation of it all: helping others. But first, do no harm.