A Doctor, a Cat, and a Dose of Reality

So much has happened in the two weeks that I’ve been in South Africa, that it’s hard to know where to start. There are times when simple is best. It’s magic when a few sparse words, doled out Hemingway-style, can get across that feeling that comes with staring into the vast expanse of mountains and sky.  I never get tired of the views.

A picture is worth a thousand words.

However, I’ve found that nothing is that simple here. There is a delicate interplay between the Church of Scotland Hospital (COSH), the community, and the NGOs that conduct research within Tugela Ferry. To get my project going, I’ve had to establish working relationships with members in each organization and navigate past language and cultural barriers to get information. Each day is so surreal, so inspiring, and at times, so full of bleak moments that a simple description just won’t do. Instead, I’ll tell a story.

I live just down the road from COSH, the historic site where extensively drug resistant Tuberculosis (XDR-TB) was discovered, and where hundreds of South Africa’s poorest citizens receive treatment for everything ranging from HIV to workplace injury. It’s an overburdened, constantly buzzing place that’s dotted with adrenaline-fueled med students and visiting doctors, weaving in and out of the endless lines of Zulu patients. Last week, cats were added to the mix.

There are more than enough stray animals to go around in the area—any given night, I’m bound to hear the sounds of goats, roosters, and the occasional donkey. Cats, however, are a (relative) rarity. So when one stray stumbled upon the steps of the trailer right across from mine, it was an unusual sight. The trailer’s residents, two medical students and a hospital doctor, happily took him in. Here begins the impending tragedy: like many suffering in Tugela Ferry, the cat was ill, so very ill.

No one knew where he came from, but he picked the right home to settle. One of the most brilliant medical minds of South Africa lived in that trailer, and he quickly adopted the cat as his own. Soon we were being updated on the cat’s daily care and progress, as the medical students tended to his every need. Oral rehydration solution, antibiotics, a slow re-feeding program, and plenty of rest on a makeshift cat-bed probably as comfortable as my own mattress. Yet it wasn’t enough. The cat grew sicker.

No matter—these doctors deal with difficult cases all the time. If they can handle drug-resistant HIV/TB coinfections, they can handle anything. I was struck by how dedicated and they were—the loveliest thing about the doctors here is that they will go above and beyond to get things done, even for the tiniest of patients. The cat was given a name: Catiline. With a name (such a noble name!) he became eligible for a medical file. And with a medical file, Catiline became the first feline outpatient at COSH, ready to join the universal struggle for access to healthcare. At a hospital where novel HIV and TB interventions are piloted all the time, it was only fitting that Catiline became a pioneer. Other patients in the area have helped pave the way for policy changes as well, in XDR TB treatment, directly observed therapy (DOTs) programs, and isoniazid preventive therapy for HIV patients.

Just when I was getting used to daily Catiline updates and way too much talk about cat cuteness, he passed away. It might be that the outpouring of care and support stressed Catiline’s (already weak) heart. Perhaps he was yet another victim of the global tendency to overprescribe antibiotics, and succumbed to a viral infection gone unnoticed. Maybe if Catiline had been vaccinated against the measles…(there has to be a lesson in here somewhere).

In memoriam.

It’s been two weeks. Over that time I’ve learned one constant. In Tugela Ferry, despite everyone’s best efforts, death is always around the corner. This really makes all the epidemiological data we encounter, all the policy briefs we read and complain about writing during the school year, all the seminars we attend, seem that much more real. Even if it takes a cat story to describe it.

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*Some names changed/omitted to protect [cat] patient privacy

**This post is dedicated to the cat lovers who co-author this blog. You know who you are. While I am not very swayed by cute animals, and will forever be on Team Dog, I thought of you all while writing.