First day in the hospital

Today was the first day in the clinic... I want to share the day with you... Before I do, I want to say that it is another world in the hospital. Outside of the hospital, I have only been in the main area of the city (and once downtown)... Here, the people, the stores, the resources I use and see used, are all identical to those in Canada. As I mentioned, outside of the hospital, the only big difference I experience is the need to be street smart. Inside the malls, I feel like I am in Canada. It's a great place and I am having am amazing time. I have been told that the outskirts have a lot of poverty and are quite different, but I have yet to see it. I was in a public hospital today, which is free for the people in the area... having said that, here goes:
Where do I start? I feel like I was in the hospital for days... not because it was slow-moving, but because there was so much to see and do. It was the first day back after the public servant strike (which led to many, many deaths due to lack of treatment btw), so they were short-staffed... they were disappointed to see that we were just students, but many of the doctors were still eager to teach us. I was in the casualty unit, which is like our ER. Actually, not quite... patients are admitted by a nurse to see a doctor... the doctor then assesses the patient and either orders treatment by the nurses or another department, or referrs to another unit/ hospital. We were able to stay with 2 doctors that taught us about each case. This was a huge blessing because they spoke to all of the patients, and to eachother in Zulu. Not only that, but these doctors were amazing. They were 100% as educated as any of the doctors that I have been taught by, AND 2 of the 4 were GREAT teachers!!
Many of the patients did not speak english, so if we wanted to communicate with them, we would have to ask the doctors. Speaking of family, it was moving how essential the family support was for the patients. The nurses give the treatment in the unit, but they have no time for chatting or ANYTHING but treatment. One nurse (who I can honestly say had a kind heart), was running around, moving patients whose IVs would nearly rip out of their arms, and bumping beds causing patients pain.... she was just so busy! As sad as it was, she didn't speak to the patients. Nearly all of the patients that I saw had HIV, and most of them had late stage AIDS and were infected with TB and cryptococcus. These patients were in so much pain; physically, emotionally, mentally, spiritually??... it was devastating. However, the nurse didn't speak to any of them... they had NO comfort from the health care providers, whatsoever. If they did not have family, they were completely alone. I couldn't even grasp the pain that could cause.... I still haven't had time to digest it. Skin and bones, lying on a stretcher, coughing with the only energy they had, and groaning in pain... these patients FILLED the unit. Nearly every chart read "RVD" amongst a LONG list of other ailments, most of which were due to a deficient immune system. So why RVD? It stands for retro-viral disease... an alternative word for the life-shattering sound of "HIV." This email might sound scattered now and as I go on, but there is just so much to say and my mind is just a pool of thoughts right now too.
It's another world in the ward. There was an HIV clinic above us, which is partly the reason that so many of the patients that I saw had HIV (I would say 9/10 that I saw today)... they would send them down to the casualty unit for simple things like an IV for fluids after dehydration. I would like to learn more about the politics behind certain decisions, as one of the doctors began to talk about how awful this situation is (sending patients down for an IV line) because it is a waste of resources.. similarly, patients are being sent UP to the HIV clinic for things that require care in the trauma unit because some staff are afraid of treating the HIV-positive patients!
So far, most of the people I have mt have been friendly. There was one pateint's family member that was very rude to me... likely because I stand out, but possibly just because he was frustrated (he didn't know that I was just a student and not a doctor). I hated that everyone respected me just because I looked like a doctor in my white coat and stethescope... I guess I just hated it because I didn't deserve it at all... I wasn't helping anyone; I'm there to learn... just a student! I wished I could do something, but I couldn't.
I think that the number of patients that were there changed the dynamic of my experience. There were an uncountable number of patients with HIV and AIDs... When I would see a patient lying there, near death, I had no way of knowing who they were before this, or even if they had ever had a life before HIV. There were 2 girls around 20 who were in the late stages of AIDS, and I don't know how young they were when they contracted the virus. I wonder how the family members felt, seeing thier loved one.... did they see them as the same person? Either answer would have its own story behind it. When you meet one person with such a tragic history, it touches you and you can really empathize with them. When you see dozens of people, all with unique stories and all suffering from a merciless disease, it's too much to empathize with. I didn't even feel overwhelmed; I didn't cry. It was just so surreal. It's so common, but it's no less of a tragedy, each and every time!! I wonder, could it ever be perceived as a lesser tragedy due to sheer numbers??? I can't imagine why or how. Then again, I couldn't feel the tragedy of an individual today... only of a population. The other thing that keeps running through my mind is the news of a diagnosis. I wonder if the incidence being so high changes the devastation of a positive result. I don't mean that it is any less devastating, but it's so common! 1/4 adults have it; surely they know many people who are living with AIDS and dying of it too. Does this change how impossible it seems to swallow a diagnosis like that? I can't imagine that it would, and yet I suspect that it might... I have so much to learn and I hope that some of the things I am wondering about now will be answered slowly.
I hope I didn't overwhelm you with the length of this email. Today, can you please pray for all of the people in South Africa who are dying of AIDS, who do not have a family or another support network. For all of these precious soles who are all alone tonight, please pray that they will be comforted by the only one who knows their worries and their fears, their pain and their loss.