Morris* (29) grimaces and pushes the hospital sheets away revealing a white dressing stained with a brown, murky fluid. ‘€œThey told me it was a simple appendix operation, that I would be out of here after a day or two,’€ he murmurs.

Two months after entering Bongani Hospital in Welkom , Morris’€™ life has changed irretrievably and his prospect of survival are slim. Lying in a single ward at the sprawling regional hospital, Morris has been diagnosed HIV positive and after three bouts of surgery, is confined to a hospital bed.

Had he been in any other province, his CD4 count of 42 would have ensured he was immediately started on antiretroviral medication. This would have boosted his immune system, allowing his appendix operation wound to heal. Currently his operation wounds are failing to heal and his bowel contents are leaking through the gaping wound , leaving him with an oozing hole in his abdomen.

His doctor shakes his head: ‘€œThere is no way you can complete his operation without ARVs. If given, he will heal. If not, he will die. If I want to get him onto treatment I will have to beg, steal or borrow and get into trouble later.’€

Ironically, Morris, an attractive man with shaved hair and a tall lanky body, is employed by a company which delivers ARVs to patients in the Northern Free State. They stopped paying his salary this month.

‘€œMy seven-year-old went to school this year. I am the breadwinner for my whole family. Now I don’€™t know what will happen. How we will pay for anything,’€ says Morris,

A few steps down a passage, 23-year-old electrical engineering student Paul*, is curled up on his side. Despite a lack of local anaesthetic,   a nurse at a secondary hospital administered a lumbar puncture (tapping spinal fluid with a needle in the back to diagnose meningitis) and doctors now suspect that a nerve was damaged in his back.

However, the young student’€™s problems are far greater than the pain from the botched procedure.

‘€œLast year I started coughing and my brother insisted that I go to the clinic to have it checked out. I was diagnosed with TB and decided to take an HIV test,’€ Paul recalls.

By September last year Paul had been diagnosed with HIV and was referred to Virginia Hospital for a blood test to establish his CD4 count. ‘€œAt Virginia Hospital they told me they are not going to take my blood. They said there was no need for a CD4 test as there were no ARVs. They gave me my TB medication and sent me home.’€

Earlier this month, the tall and gangly soon-to-be-father was admitted to Bongani Hospital complaining of headaches and double-vision. He has since been diagnosed with cryptococcal meningitis.

Now weighing less than 50 kilograms, he struggles to walk more than a couple of steps and can only sit for a few minutes before the excruciating pain in his back drives him back to bed.

With a CD4 count of 8, his doctor says it is hard to believe that he is still alive. ‘€œYou don’€™t need to be a doctor to see he needs ARVs,’€ the doctor nods.

A nurse lingering in the hospital’€™s corridor is terrified when asked to offer to her opinion, confirming the widespread belief that those who dare to speak out will be fired. However, she confirms that the hospital has shut two medical wards (60 beds) since the end of last year.

‘€œIn this 30-bed ward, we see between three and four deaths a day. It is terrorizing us. It really feels like we are going back to the bad old days before there were ARVs,’€ she says.

The doctor leads us outside the hospital and around the corner to a man skulking in the shade. ‘€œAh, here you are, I have been looking for you everywhere,’€ the doctor says, prompting the man to turn his face towards the light.

His face is a grotesque mishmash of swollen tissue, black spots and lumps the size of grapes. He peers at the doctor through slit eyes, a slight smile emanating behind his swollen lips.

He looks down when speaking to the doctor. ‘€œThey told me to go home,’€ he mutters.

The doctor shakes his head as he flips through the patient file. ‘€œHe has Karposi Sarcoma (a skin cancer often diagnosed in people with HIV who are in the end stages),’€ the doctor explains, urging the unemployed truck driver to share his story.

Ill-health forced Patrick* to stop working last January. He visited the Khutsong Clinic in Bothaville where he underwent an HIV test which revealed he was positive.

He then visited a private doctor who prescribed Bactrim, a pneumonia prophylaxis, and sent him home.

By October black spots started appearing on Patrick’€™s skin. Another private doctor told him it was ‘€œsores’€ and he was given tablets. By December skin lesions appeared and he went to see yet another private doctor who diagnosed Karposis Sarcoma and referred him to Bothaville Hospital in January.

‘€œThe doctor there confirmed to me that I had Karposis Sarcoma and needed ARVs urgently.’€

Patrick was again referred to another health care facility, this time Wesselsbron where there is an ARV treatment site.

‘€œThey told me I can’€™t get ARVs and sent me to Bongani Hospital,’€ says Patrick.

With a CD4 count of 162, the doctor confirms that Patrick should have been initiated on ARVs by now.

‘€œHe will die if we don’€™t start treating him, he’€™s in the end stages,’€ the doctor says. ‘€“ Health-e News.

*Names changed to protect their identities.


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