“The Lunchbox”
Gail Waltz
“Look at you!” Dr. Majubana* leaned forward in his chair to look at his patient, the small lines around his eyes disappearing as he opened his eyes wide, smiling. “You are beautiful!” The girl, maybe 5 years old, leaned back into her mother’s stomach, arms above her head, the edges of her closed lips turning up slightly. Fingering the polka-dotted bow in her hair, she couldn’t contain her pride.
Two other mothers sat with their children on the rickety wooden bench in the exam room. Just outside, nurses dressed in crisp blue and white uniforms tended to patients with minor symptoms: sniffles, scrapes, dehydration. Each morning, Dr. Majubana arrived at the clinic promptly at 8:30, arranged his blue lunchbox safely in his desk, and went outside to the waiting area. He handpicked his patients, weaving his way through the rows of plastic chairs, occasionally unwinding the stethoscope from around his neck to listen for wheezing, or lifting a shirt to check respiration. As we went, he narrated what he saw, often translating Zulu into English for me. “This child is in respiratory distress”; “The grandmother says the baby is not eating”; “He hurt his arm climbing a fence.”
The Madiba Community Health Centre* is one of the biggest government-run clinics in KwaZulu-Natal, South Africa. Nine doctors and countless nurses see over 500 patients a day, who often show up just before dawn to get a good place in line. I was assigned to shadow doctors in the childcare department for three weeks as part of a public health program; the goal of this placement, my academic director told me, was to “be a sponge—learn as much as you can.” Although the official purpose of the assignment was to learn about pediatric tuberculosis, my academic director told me that lots of previous students decided to go to medical school after their clinic placement.
I spent three weeks at Madiba watching Dr. Majubana chat jovially with patients, asking about their favorite colors and their symptoms simultaneously. He asked mothers about their boyfriends, teenagers about school. On several occasions, I saw him dig in his lunchbox and give away bits of the meal his wife had packed. Once, I saw a grandmother’s eyes well up with tears after Dr. Majubana gave her his sandwhich. She had been at the clinic since 4 that morning, and had done the same the day before. Her seven-year-old grandson hurt his knee and couldn’t walk; she carried him around on her back. She had spent half her month’s income on four taxi rides to the clinic. And a sandwich finally broke her down.
“Call the next patient in, won’t you?” Dr. Majubana asked me one day as he sat at his desk, filling out a prescription card. His work wardrobe a rotating collection of colorful scrubs and gray Crocs, he managed to strike a balance between authoritative doctor and respected elder. Though he fell short of the title of oldest doctor by about 20 years, he was the right-hand man to the clinic CEO, and many patients came to the clinic asking for him by name.
Outside the childcare trailer, patients in the doctor’s line waited to the left of the sagging metal steps. About thirty patients sat along the other side of the trailer, waiting to be seen by an available nurse. The tarps covering the open-air waiting area cast a blue light on the crowd. Infants lay in their grandmothers’ arms, swathed in fleece despite the sweltering heat. Children snacked on bags of potato chips, sold for 5 Rand at the stand just outside the clinic entrance. Babies cried; siblings waited.
Poking my head out the trailer door, I made eye contact with the next family in line: a man, perhaps a only a few years older than me, with a toddler between his knees. “The doctor’s ready for you,” I said, waving him inside in case he didn’t speak English. Nodding in understanding, he got up, taking the girl by the hand.
Back in the exam room, Dr. Majubana peeled away the paper exam table cover that was draped over the girl’s shoulders.
The skin on the left side of her back was gone, revealing tissue with patches of angry red. Her left eye was swollen shut; bubbles had formed down her arm, where her skin looked like melting wax.
Inspecting her burns, Dr. Majubana asked the man questions in Zulu. Nodding and writing, he explained to me what had happened. The day before, she had been opening a drawer for a piece of bread when a boiling pot of beans tipped off the cabinet, dousing her in a scalding mess.
“We don’t have strong enough painkillers here. I’m going to call for an ambulance to take her to the hospital. They can sedate her and clean out the wounds. I don’t want to try to clean them now, it would cause her too much pain.”
Sitting at the edge of Dr. Majubana’s desk, I recorded the patient information in the log. Female, age 4. Diagnosis: Burn involving special areas of the body, greater than 10% of skin involved. Treatment: refer to Mahatma Gandhi Memorial Hospital.
Just the week before, another young girl came in with a boiling water burn on her hand. Her skin had slid halfway down her fingers. Dr. Majubana saw burn victims all the time. “No one pays attention to safety codes in the informal settlements.” The exhaustion in his voice indicated that this was one of those public health problems that was urgent, yet not quite urgent enough to trump HIV or domestic violence.
Still, I could tell that Dr. Majubana’s usual breezy demeanor was gone. Once, after seeing an overbearing mother and her perfectly healthy son five days in a row, he joked, “Soon, we’ll have to get her a VIP card.”
Now, the girl stood whimpering under the paper, a vain attempt to protect her exposed wounds. Tears streamed from her closed eyes. No sobbing, no heaving, just soft, shy whimpers.
“Give this to her, won’t you?” Dr. Majubana reached for his lunchbox in the desk, pulling out a mini Chomp bar. He handed it to me, and I crossed the room to sit on the patient bench. Bending down to her eye level, I placed the candy in the girl’s unaffected hand. “Unjani?” I asked. “How are you?” Definitely a stupid question, one that needn’t be answered, but my Zulu vocabulary, restricted to basic conversational phrases, limited my options. “Ngiyaphila,” she sniffed, unintelligible had it not been the answer I was expecting. “I’m okay.”
I sat holding her hand for some time, smiling slightly, willing the words I couldn’t find, nor translate, to somehow find their way across the space between my eyes and hers.
When I first met Dr. Majubana, he said clinic administration had moved him from the adult practice to pediatrics. “I was taking too long to see each patient.” His thoroughness extended beyond medicine: get a full medical history, see what home life is like, and ask how school is going.
When I asked him about giving bits of his lunch to his patients, he just shrugged. “I sometimes pack a bit of extra candy for the children. It makes them stop crying, and they usually don’t get it at home.” Opening his desk, he removed his lunchbox and replaced it with his stethoscope, leaving me with a little pile of candy. “Give that out, won’t you? See you tomorrow.”
*Name has been changed
