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Karen Kiang, a medical doctor from Northcote in Victoria, has recently returned from southern China. It was her first mission with Médecins Sans Frontières (MSF) and she was working in Nanning, where MSF is providing free antiretroviral drugs to patients with HIV/AIDS. MSF also provides confidential, voluntary HIV testing, treatment of opportunistic infections and psychosocial counselling.
Beijing was my first destination, and I could barely see the ground as the plane touched down as the air was thick with brown smog. After a briefing, I flew out to Nanning, the capital city of Guangxi province in the south. Nanning is a city of 4 million people, and is considered by Chinese standards to be small compared to Beijing’s 15 million. It was uncomfortably muggy upon arrival (34°C highs felt like 41°C when coupled with the humidity), and I was thwarted by my first bout of Beijing belly within the first week.
I immediately bought a bicycle (upright, heavy steel, single gear, basket in front) for only $60AUD and joined the masses on the street. Pedestrians were clearly at the bottom of the traffic feeding chain, but bicycles were only one rung up. Drivers (the nouveau riche) relished their road rights, and actually seemed to delight in watching pedestrians flee when they turn on red.
I worked with two Chinese doctors in a rapidly growing 1000+ patient clinic, providing free antiretroviral drugs as well as free laboratory tests, medications/care for opportunistic infections, and hospitalisation. There were two other HIV/AIDS clinics in Nanning, both run by the government and both smaller than ours because the government could only supply the antiretroviral drugs (the costs of all other lab tests/meds/hospitalisation were shouldered by the patient). In addition, there continued to be strong stigma surrounding HIV, with most of our patients being infected either by intravenous drug use, involvement with prostitution, or MSM (men having sex with men), all of which are illegal in China. This created a terrible feeling of being trapped, and a horrible set of choices – seek care for a deadly disease, or avoid being arrested? Unfortunately, the prevalence of HIV in China has risen to the point that it has now spread to the general population and is no longer confined to these groups; I am hopeful, though not optimistic, that some of the stigma and its associated moral overtones will fade as this fact is recognised.
Wading through the alphabet soup of antiretroviral medications (AZT, 3TC, D4T, DDI, ABC, TFV, etc) was the easier part of my job. Sending people (grown men weighing 30kg) home to die was the hardest, because the range of HIV disease that I saw was vast; but unfortunately, half of it couldn’t be diagnosed due to lack of lab tests or lack of enthusiasm of the healthcare system to treat HIV patients. In addition, the Chinese healthcare system is a completely ‘user-pays’ system whereby nothing is provided by the government, making it extremely difficult for those who contact the disease.
The average cost of hospitalisation for an HIV-related illness is 1.2 times the annual income of a Nanning city-dweller, but almost five years of annual income for a peasant farmer. I saw too many peasants crying at my feet, heard too many stories of how they sold off all of their goats and cows, how they pulled their children out of school, how their family and friends wouldn’t pick up the phone anymore when they called; how terribly degrading it must have been to have to beg for help.
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| The team at the MSF information stall for World AIDS Day (1 December 2007). © Karen Kiang |
On a personal level, I had no reason to complain and we did not suffer from a lack of any creature comforts. Unlike MSF projects in Sudan, Kenya, Somalia, and so many others, security was not an issue (unless you were a bicycle or cell phone). We were able to find almost anything we wanted – good fruits and veggies, yogurt, fluffy white bread, good cheese and chocolate (at a price), pizza topped with veggies including peas and corn, and a Mexican burrito that took care of any craving for Tex-Mex.
The Field Coordinator [project manager] and I resided on the 20th floor of a sophisticated apartment complex, complete with a sit-down toilet. I felt terribly spoiled, having survival guilt knowing that my MSF colleagues were “roughing it” while I slummed it on my Manhattan balcony watching both the city lights and people practicing tai chi down below. My flatmate was a lovely French woman and nurse who has spent the last 15 years on-and-off in missions – 5 yrs (7 trips) total in Afghanistan alone, then Iran, Malawi, Tibet, etc. She was an example of pure manners – eating dessert with a small dessert spoon, offering biscuits and coffee/tea to anyone who comes to visit, setting the table before a meal and I think she found me a bit uncouth! There were two other expats here with us, a couple from Mumbai who were very experienced in HIV counselling and outreach, and we were all very fortunate that we really enjoyed each other’s company.
My Chinese steadily improved, and by the end I was able to take histories from patients and ask about their families. Of course, conversation is a dangerous one-way street – you can control what you say, but can’t control what comes back at you! I continue to be almost completely illiterate, which seriously limited my ability to function independently, like reading medical files and lab results, not to mention road signs, shop names, menus, etc. I was fully appreciative of our national staff and my medical translator in particular, without whom we could never have gotten anything done.
I came back two days before Christmas and didn’t fully realise how tired I was until I returned home. Despite the frustrations, our clinic continued to show spectacular growth and, more importantly, continued to keep alive the spirit and bodies of the people who came to us. That was the most satisfying of accomplishments.
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