The nurse also told him that she would not take his CD4 count, that he must go to his local clinic for that. From now on, she told him, every aspect of the management of his illness, from support group to the initiation of treatment, must take place at his local clinic. She was abiding by one of the fundamental principles of the MSF program: the closer your site of treatment to your home, the more likely you are to adhere to your treatment.
The following day, Sizwe gave Xolela money for another taxi ride, this one to the local clinic, to have blood taken for a CD4 count. On his way home, Xolela stopped by Sizwe’s shop, asked to speak with him privately, and told him in all the detail he could remember what had happened at the clinic, from the precise words the nurse had used, to the counselors he had met and their names and the things they had said, to a description of the needle that had found his vein.
Sizwe has become Kate, I thought to myself. Or Xolela’s private Kate in any event. He is the one who mediates between Xolela and his treatment. When time comes for Xolela to take his pills, Sizwe will be the one to chew on them first, spit them out, and hand them over.
Xolela returned to the clinic the following week to get the results of his CD4 count. He got back to Ithanga just before dusk and went straight to Sizwe’s spaza shop. He stopped at the front door, looked over the heads of the drinkers, and found Sizwe’s eyes behind the counter. Sizwe nodded and stepped outside.
“He said that his CD4 count was 107,” Sizwe told me, “and I was so shocked I could say nothing for a long time. Okay, Xolela has been sick, but he is a strong man, much stronger than me. How can a man be so strong, and yet so close to dying? It made me worry about my niece, Thandeka. How long has she had the virus? What is her count? She looks healthy, but maybe she is nearly dead, too.”
“What did they tell Xolela at the clinic?” I asked.
“They told him he must go onto ARVs, but not yet. He must first attend the support group to learn about the drugs.”
“How’s he doing?” I asked.
“He is okay. He needs to talk a lot. Almost every day, he comes here to my place in the late afternoon, and we go somewhere quiet to talk. He needs to tell me everything that’s happening.”
XOLELA IS NOT the only one to whom Sizwe had decided to become a Kate Marrandi. A few days later, he told me another story, of a relative called Vuyiso, a man I had not met, from a village some distance away.
“It started with a skin disease,” he told me. “His skin went very dark, almost black. That cleared, but then he started getting a running stomach. He has had it over three weeks now. It seems it is permanent. He came to me a while ago. He wanted to talk about money. There was going to be a big ceremony for his daughter. We call it the bucket ceremony. When a daughter of the family is getting married, she is given many, many things that are put in a bucket, and she takes the bucket with her to her new home. Vuyiso asked me if he could borrow three thousand rand for the bucket ceremony. I gave him two thousand rand. The ceremony was last weekend. I arrived and Vuyiso was not there, at his daughter’s own ceremony, for which he had humbled himself to raise money. He was too sick to attend.”
“How do you know it is AIDS?” I asked.
“It is clearly AIDS,” he said cautiously. “The skin, the running stomach. All he has done is get medicine from the chemist. I said to him openly when he came to see me, ‘Maybe you must go and test for the virus.’ He said, ‘What can you do if you have AIDS? I don’t want to know.’
“Next week, I am going to take a day off and make a trip to his village. I will sit him down and urge him to test.”
“What will you tell him?”
“That having AIDS does not mean you are going to die. That you must go to test. It is like asthma. It is something you are sick with for a long time, but it is not death. You never get completely well. You are not quite right. But you do not die. You can live and you can work.”
“WHAT HAPPENED THAT made you change your views?” I asked.
“About what?”
From the tone of his voice it was clear that he knew what I had asked. He had taken my question as a criticism, as a call on his inconsistency.
We had come from visiting a relative of his in a district that was new to me. I had parked the car on a tall, narrow ridge, and we were leaning against the hood. The scene before us was unlike anything I had seen in the Transkei. In all directions, the land rolled away for miles. To the south, there were wide grasslands and forests and a blurred hint of the sea. To the north, a series of valleys disappeared over the horizon, lending the scene a hyperbolic sense of depth. Stand on almost any piece of ground in the Lusikisiki district and you feel that much of the world around you is hidden. Here, it seemed you could see everything.
“About AIDS,” I said, “when we met—”
“I know. When we met I was against even testing. And I did not believe that ARVs worked. You are right, I have changed my mind. It is for two reasons. First, I have seen four, maybe five people at Ithanga get very sick, and then get nearly better on ARVs. Also, the trips I have done with you—to Kate, with Dr. Hermann, with the nurses—I have seen the work the nurses do. But mainly it is the girls from Ithanga, the very sick girls who went onto ARVs and are well now.”
And yet the girls of whom Sizwe spoke went onto ARVs and started getting better some time before he and I met. They were among those who tested one Saturday morning when the counselors and the nurses came to the school at Ithanga, the day the entire community watched to see who went in, and who took a long time coming out. When Sizwe and I met, this day stood out in his mind as a warning against testing for HIV.
“So what changed? Did you speak to these girls about their ARVs?”
“No. They do not say they are on ARVs. But you see them getting into the taxis to go to the clinic, and you watch their health and you see that they are getting better. And people talk and you hear the rumors that they are on ARVs. You do not talk to them about it. You watch and you hear.”
I began to say something, but he interrupted me and began speaking of something else. He did not want to talk about why his views had changed.
I did not think it was the Ithanga girls who made him change his mind. I thought his views on the Ithanga girls changed because of the things he and I had seen together. That this was a source of discomfort for him troubled me. To my mind, the reasons for his shift were both obvious and unembarrassing. It came directly from an experience he and I shared.
The first thing I believed we grew to share was a bond between ourselves and the ill; it was something we brought back from our time with Kate Marrandi. She lifted our spirits, mine and Sizwe’s alike. At the end of each day that we were with her, we drove back to Ithanga feeling light and serene and nourished. We watched the sick ones surrender themselves to her care—the care of a faithful mother, plodding the footpaths in a calm and ceaseless search for the ill, never a judgment on her tongue. I think there were times both of us identified with her patients; I think we took part, vicariously, in their surrender to her. In those moments, the epidemic disentangled itself from the jeers and the whispers, and was enveloped in a gentle solidarity.
We also experienced something else together, something connected to the feelings we imbibed from Kate, but different.
Together we saw that the epidemic has no boundaries, that those who were ill were interchangeable with ourselves. Before our trip, the epidemic was contained: it resided in Jake, who was dead; in Sizwe’s niece, for whom he would one day surely find a healer with a cure; and in the girls who had been foolish enough to have their blood taken before the curious gaze of their community.
Indeed, the outing of the foolish girls had been a convenient foible, an illusory means to contain the virus. They allowed for the epidemic to be named and placed and pushed to one side. As they went about their business, silently watched but never openly confronted, the girls who had tested positive became the members of a parade to be jeered and pilloried. The audience,
by virtue of being the ones who jeered, were freed from the epidemic.
And that, indeed, is the heart of the poisonous work done by the virus’s strange twilight. These souls whom everyone knows but does not know are ill, gather the virus into one cage: a high fence is erected and the healthy affirm their health by staring in from the outside.
On our journeys, we saw too much for this illusion to hold. Wherever we went, the virus was in the healthy and the sick, in those who coughed and those who breathed freely, in those with the scars of a fungus on their faces and those with clear skins. That was precisely what Sizwe had been telling me throughout our journey: that the epidemic had lost its boundaries, that there was no caging it any longer.
Why was he so reticent to acknowledge that this experience had caused him to take stock? Why was his change of heart a cause for estrangement between us?
THE FOLLOWING DAY he offered an answer, albeit obliquely and cautiously.
“One of the things I have changed my mind about since my trips with you,” he said, “is the question of shingles. I thought this is something you should know, since clearly you are very interested in what changed my views.
“Previously, I did not think that shingles was a symptom of HIV. We used to associate HIV only with diarrhea, and with weight loss. Shingles we thought was witchcraft. It is caused by the ichanti or the umrulo. These are snakes sent to you by demons. They crawl on you in your sleep, and where they touch your skin you are left with shingles. I saw lots of people getting shingles. I think they all tested HIV-positive, and were too ashamed to tell people. So they let it be believed that they were bewitched. They would go to the inyangas, and the inyangas would say, ‘Yes, you have been bewitched. I can treat you.’ The inyangas treated them, and then they died.
“When I was traveling with you, I saw people with shingles. The nurses said this is a symptom of HIV. And I saw that some people with shingles did not die. They got better.”
I immediately remembered the first of Kate Marrandi’s patients we met, Nosiviwe, the water carrier with heavy marks on her skin. I remembered vividly how, on our second trip to Nomvalo, when we saw that she had gained weight and that her skin had cleared up, Sizwe had beamed at her and remarked on her skin. I recalled his joy well, but had no idea until now precisely what was at stake.
Throughout our journey he had been conducting these empirical tests in private. I wondered about the line that divided the things he shared easily with me and the things he kept to himself. About those who envy him and will see him destroyed, he was eager to confess and to share. But about the silent experiments he had been conducting on AIDS and its treatment, he was deeply reluctant.
I recalled that twice during our acquaintance, I had said things that he interpreted as a judgment on both himself and the entire milieu that had shaped him. The first was when I asked why falling ill with AIDS was a disgrace. “Is it not a disgrace where you come from?” he had asked with surprise and embarrassment. The second time was when I laughed at his account of the white conspiracy to win back political power by decimating blacks. “I am relieved that Kate told you what the people were saying about Dr. Hermann,” he had said. “I was worried that it was only Ithanga. When you laughed, I thought, Maybe I am telling Jonny some bullshit that only the people in Ithanga believe.”
At question in these encounters was the integrity of the local knowledge that had been bequeathed to him. The matter at stake was one of pride and humiliation. He knew that twentieth-century South Africa had gutted his world, leaving it without roads or lights or clinics, or decent jobs. Perhaps he also wondered whether it had left his world without wisdom.
I thought that the same was at stake when he compared inyangas and nurses on the question of shingles, and more broadly, when he decided to shepherd ill people to the clinics. That he had changed his mind on this question perhaps signaled a cultural defeat, a belittlement of his world. And thus an elevation of my world and a victory for me. It was a deeply unpleasant victory, one that was thrown in my lap while I was looking elsewhere.
Mabalane
On a Saturday in mid-July we attend a funeral some distance from Ithanga. I will only come to understand much later that the journey Sizwe maps for us today is intended to take back the victory I have won over him, that he is to put a wager on the superiority of Mpondo wisdom.
Sizwe never met the one who has died: she is of his clan, and the funeral tent is filled with clansmen and -women whom he knows only from rituals and ceremonies. The dead woman’s parents are Zionists, and the members of their congregation have assembled in the tent in their numbers. The women are in thickly starched red-and-white uniforms, while the men wear spectacular crimson robes on their bodies and expressions of austere religiosity on their faces. Each carries a chest-high staff. One of them wears a high, gold-embossed bishop’s hat and clutches a crucifix some seven or eight feet in length. They form a wide crescent around the coffin, the crucifix rising with some drama from their left flank. They sing and preach in turn, without interruption, for the duration of the morning. There is nothing mournful in their singing: it is frenzied and urgent, and it mobilizes in its members a blistering energy.
Sizwe gets up to leave the tent and invites me to join him. I shake my head and stay. This gaudy yet spare theater, lavishly camp but powerfully earnest, has me feeling both melancholy and mesmerized: the thought of getting up and walking out makes my legs feel heavy.
It is with this, I think to myself, that the support groups must compete when they descend on a funeral. Freedom songs and t-shirts versus bishop’s hats and staffs and a thunderous singing that evokes an ancient god. There is no mention this morning of the cause of the woman’s death. She was thirty-two and had been ill. That is all.
I remain in the tent for an hour or so, and then leave and look for Sizwe. I bump into him almost immediately.
“I was coming to call you,” he says. “There is someone you must meet.”
He leads me around the back of the tent. A number of young men are sitting in the sun on a long bench. Sizwe introduces me to one of them.
“This is a cousin of mine,” he says. “His name is Mabalane.”
He is perhaps thirty at most. He is dressed in creased blue overalls and he is very shy. He smiles at me nervously and looks away.
“He is an inyanga,” Sizwe says. “And he has been telling me about a cure he has developed for AIDS. He says he has cured many people.”
The young man glances at me quickly and nods, then bows his head and fiddles with a button on his overalls.
I look at Sizwe closely: there is urgency in his face, but I cannot read its source. Has he donned the role of the diligent research assistant, searching for interesting subject matter on my behalf? Or does he hope that he has found a cure for his niece Thandeka’s virus, that this business of spiriting the ill to and from the clinics for their blood tests and their drugs and their endless support group meetings can finally come to a close?
Of his thoughts about Thandeka’s illness and his plans to deal with it I have stopped questioning him long ago. It is not something he chooses to talk about. On the day he agreed to accompany me to the clinics as my interpreter, he said his primary motivation was to see whether ARVs might be for her. Since then, he has answered my questions about his quest in monosyllables. Talking of Thandeka, I guess, would mean talking of the private empirical tests he has been conducting for himself on the efficacy of ARVs; that is something he will only share with reluctance.
“I would like to see his place and his medicines,” Sizwe says. “It is not far from here. We can take your car.”
IT IS A ten- or fifteen-minute journey, much of it on overgrown pathways more suited to carrying pedestrians than cars. At times we move no faster than we would have had we gotten out and pushed.
I turn on my Dictaphone and we begin to ask Mabalane about his work.
“The ancestors started calling me when I was very young,” he says. “It was the 1980s.
I was a small boy. There was big fighting at that time. The young men’s associations were fighting wars against one another. And then there were other people who were struggling against the government. The ancestors came in my dreams and told me to do this and this and this. I went as far as Natal to get muthi for people to stop the bullets entering them.”
“What are the diseases you have learned to cure?” I ask.
“Any disease. If someone comes with an illness I cannot heal, I tell him to go. As soon as I go to sleep, all the ancestors come, even the ones I have not seen before.” He nods in Sizwe’s direction. “This one’s grandfather, whom I never met in life, my grandfather introduced him to me in my dream.”
“How do you recognize AIDS?”
“I need a card from the clinic. The patients must go to the clinic and come with the card saying they are HIV-positive. Then I give them two liters of medicines: they are herbs I have been told to fetch in my dreams. When the two liters are finished I tell them to go back and test again. The test will be negative. I don’t reduce the AIDS like the doctors. I kill the disease.” He pauses a moment, and then adds: “I charge two hundred rand for the two liters. But if the person doesn’t have the money, I give the muthi anyway, to save their life.”
“So many people have died from AIDS,” I say. “If the ancestors know how to cure it, why have they let so many people die?”
“The people only trust the doctors,” he says sorrowfully. “They don’t want traditional herbs. They trust Western doctors and they die.”
My thoughts turn immediately to Hermann Reuter and what he would say about this rival. I have tried to draw him out several times on the question of traditional healers. Always, he greets my inquiry with a long silence, then shrugs and begins speaking of something else.
Sizwe's Test: A Young Man's Journey Through Africa's AIDS Epidemic Page 24
