Because Jeff brought it up...

My 'worst thing I've seen' isn't what I saw, but rather what I heard.

A couple weeks ago Adi and I were waiting outside her apartment building waiting for her roommate so we could all walk to a Shabbat dinner. With open windows we heard this really loud cracking and clanking in her neighbor's second floor unit followed by screaming. We soon realized the dad was whipping a child with his belt in the room right above us. It was horrifying how long it went on for. We waited several minutes for her roommate and, with the beating still going on, left for our dinner.

I asked if we should call the police, and Adi was hesitant. She knew that the neighbors were Lebanese and because they helped Israel during the Lebanon War (2006), they were allowed to live in the country. Apparently abuse is common among this group - a stereotype, I know. While she wanted to help, she said that it can be dangerous for her to report them if they were to find out it was her, and decided that for her safety it would be best to ignore it. I should say too, Adi is a nurse, and incredibly compassionate... to me it spoke volumes about the complexity of this situation when she was reluctant to get involved. The neighborhood is a little rough, but clearly there are social, political, and cultural dynamics here that I don't understand.

This was by far my worst experience, the kind that challenges your being and leaves a knot in your stomach, and ironically it's something that I could just as easily experienced in Atlanta. It was a terrible feeling to know that a child was being relentlessly beaten, hearing the foreign shouting and piercing cries, and to not have the ability to do anything about it. I guess I'd like to think that if I were confronted with a similar situation in the US, I would feel safe enough to intervene... hopefully I'll never have to find out.

The worst thing I saw today

In the HIV section of a case report form “mom refused testing.” The child was one year old.

Most of the CRFs don’t have any extraneous writing, it is just boxes checked or lines filled in. Still, a lot is apparent about HIV testing in South Africa. People definitely are not testing when they should be. Stigma and denial must be huge factors, as well as worrying about having access to treatment if diagnosed.

I am only seeing cases with invasive pneumococcal disease, which is itself a warning sign about HIV status. Sometimes, a patient will have wasting and candidiasis or TB and candidiasis and the box is checked that they refused testing. Sometimes there is a CD4 count, which indicates the doc thought there was HIV and is going to try to treat the patient without acknowledging that they have HIV.

Sometimes I see a narrative through CRFs. Someone has the box checked for suspected HIV and they have AIDS defining illnesses but they refused testing. Then, three months later, there is another set of CRFs and they are positive.

Jeff