1. Wyss, Susi MPH, MA


An encounter with a nurse in Africa proves hard to forget.


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The village consisted of a couple dozen mud-brick, thatched-roof huts on either side of the dirt road. Scruffy chickens crossed from one side to the other, squawking and beating their wings as they narrowly missed the tires of our truck. A woman was selling gozo, chunks of fermented and dried cassava that had lost their white color thanks to dust stirred up by the occasional passing bus. Our driver pulled the truck up next to the health post-a shack with a faded red cross painted on the padlocked wooden door. Gawking children had already started to surround us, so we asked them to show us where the nurse lived.

Figure. Illustration... - Click to enlarge in new windowFigure. Illustration by Janet Hamlin.

We'd already guessed there was a problem at the health post-we hadn't received the last several monthly statistical reports. As a Peace Corps volunteer in the Central African Republic in the early 1990s, I reviewed these reports as part of my job at the regional health office. Another part of my job was to join a supervisory team as it traveled over dirt roads to check on health facilities from hospitals down to the village health posts staffed by a single nurse. A few months into my assignment, on our way to the provincial hospital, the team decided to stop by this particular health post to find out why we weren't receiving reports.


The children led us to an older woman who was pounding grain in a mortar in front of a hut slightly larger than the others. She told us that she was the nurse's mother. She put aside her pestle to shake our hands while holding her right elbow with her left hand-a sign of respect for her son's bosses-before she led us behind her home. There, a man lay on a foam mattress on a bamboo bed, shaded by the broad branches of a mango tree. Painfully thin and obviously weakened, unable to stand up and greet us, he reached out to shake our hands instead.


Although he wasn't in the most advanced stage of the disease, and didn't yet have the sunken eyes and skeletal look I'd seen in textbooks, there was something so resigned, so defeated in the nurse's demeanor, that it left no doubt in my mind of his illness-or of the fact that he knew he was dying.


I was glad my coworkers all shook his hand. Back then, all sorts of misunderstandings existed, even within the medical profession, about the transmission of HIV. Although the government had been quick to recognize the existence of AIDS, setting up a national office with strong leadership to address the problem, there was still enormous stigma around the disease. Antiretroviral drugs were unavailable-even now, only a fraction of those who need them in the Central African Republic have access to them-so on that day, not one of us spoke of what the nurse had. Instead, we sat under the mango tree and talked with almost surreal casualness about the weather and the continued delays in government payment of civil servant salaries.


It was the first time I'd seen an obvious case of AIDS. Though I would eventually lose Central African friends whom I knew much better, this nurse put a face to the epidemic for me. It wasn't just a disease in a textbook anymore. Twenty years later, I can't recall the name of the village or the nurse, but I can still see his features, his resigned expression. Meeting him drove home-in a way no textbook or statistical report could-how widespread the disease had become. Somehow, the virus had made its way to this tiny village in the heart of Africa.


I wondered how the nurse had become sick. A wife was nowhere to be seen, but a man of his stature would have one. Had she died already? Had she given the virus to him-or vice versa? But he could just as easily have been infected by a needlestick. At the time, infection prevention practices were poor in Africa, and postexposure prophylaxis was practically nonexistent-as it still is in many parts, particularly the rural areas. If he'd known the risks of contracting AIDS from his profession, would he still have opted to become a nurse?


On that day, our team leader took leave by explaining we still had a long road ahead of us. As we climbed back into the truck, I wondered if my colleagues had already known of the nurse's decline, had only come to confirm what they suspected. Were they thinking of other people they'd lost to the disease? Might they be reflecting on the possibility that they could be next? But I didn't ask, because I was learning that certain topics were too overwhelming, too devastating to be touched.