Why you shouldn't ask about tattoos unless you really want to know the answer.

This article contains a trigger warning for miscarriage and graphic content.

"What a cute strawberry!" People often say. "It's a raspberry." I might reply if I'm feeling generous. "Ooooh so pretty. Why a raspberry?" is the common rhetoric. I usually shrug and say: "I really like raspberries" and leave it at that not caring if they think me weak-minded or superficial for randomly tattooing a fruit to my wrist.

On the 6 January 2013, 8 years ago, I found myself 8 weeks pregnant with an on/off fever and debilitating lower back pain. Concerned, primarily about my pregnancy, I called the local doctor after hours and asked him to see me. It was a Sunday morning. "I really don't feel well. Please help me." I said, guarding my abdomen with one hand and applying pressure to my lower back with the other. He did an HCG test (a pregnancy test that measures human growth hormone metabolites in urine) to appease me and declared that the dark pink double-line rendered me healthy. "Go home. You've nothing to be worried about" he said.

That Sunday evening, I was en route to an emergency room, dizzy with the amount of blood I'd lost. Praying. Begging: "I really don't feel well. Please help me." I leaned against a hospital wall for support, the hospital staff had no time to see me until I was gushing blood onto their casualty floor. They pulled me onto a gurney, yanked my legs apart with no word and out came a little baby I could hold in my palm. Translucent skin, eyes that could not yet close and little arms and feet, fingers and toes only just beginning to push out. A young female doctor, newly qualified, slid open the curtains, metallic hoops ringing in the rush, pushed and prodded the little thing back and forth with a gloved finger: "Nurse, please take this to the medical waste bin. The patient needs to be transferred to theatre stat." Words caught in my throat, I was in shock. In walked a suit-clad man with a clipboard asking me to sign a credit card form with a deposit of R20 000. I signed an AMA (against medical advice) form instead.

I escaped that casualty room to the news that my mother had died on her bathroom floor having suffered a seizure that so easily could have been reversed with IV sodium valproate. Or averted entirely through appropriate administration of chronic care. She was unemployed as a result of her epilepsy diagnosis and thus state dependent. She had been on a waiting list for months. I suppose what defines a tragedy as a tragedy is that they are usually preventable. A former foster youth, sex worker and drug addict. How many times had she said: "I really don't feel well. Please help me" and been looked upon with judgement instead of understanding and compassion. The last time we spoke was when I had called to let her know that she was going to be a grandmother. The baby was due on her birthday. They died 6 hours apart.

A few months later, I joined the same healthcare service that had mistreated me, as a junior paramedic thinking that I could heal my heart by giving to the world the care that I had so desperately needed. That my experiences as a patient would make me a more compassionate and educated practitioner. I thought I could be different. I thought I could be better. I found myself crushed by the system instead: 24-48 hour shifts with no sleep, below minimum wage pay, workplace bullying and sexual disinhibition accommodated by a culture of hierarchical, militarised power-imbalance. You keep your mouth shut if you want to keep your job. In Emergency Medical Services, reputation is everything. You don't want to be running into gang war zones with bullets flying over your head or into the trenches of Pollsmoor Prison with an ambulance partner that does not like you. It was this same culture that declared empathy a weakness. Mental health patients an inconvenience. Young mothers paranoid. And black, geriatric and economically disadvantaged patients immune to pain.

I made mistakes too. Or stood as accomplice to mistakes my seniors made. I still feel deep shame when the memories flashback at me. I cannot count the hours that I've stared with unblinking eyes into a dark abyss pushed back by my bedroom ceiling, unable to sleep, because of them. The systems of healthcare and education that we have designed to protect and progress us have failed the most vulnerable amongst us. Is it any surprise that people are suspicious of vaccines when their concerns are disregarded by healthcare professionals too sleep deprived and under-resourced to treat them with courtesy? It is not to place blame or shame on healthcare professionals for a system that serves neither them, demanding rather that they sacrifice their own wellbeing on the altar of so-called efficiency and excellence, nor their patients fobbed off through pipelines, protocols and the economics of privilege.

I'm in pandemic-induced lockdown today, listening from my desk, to ambulance sirens outside my bedroom window, driving back and forth, thinking about all the healthcare providers out there on the frontline and their patients who cannot breathe. Doctors and medics who are being retrenched or suffering pay-cuts, working thankless and unpaid overtime shifts, being issued written warnings every-time they make fatigue-induced mistakes and then contracting COVID themselves despite their best PPE (personal protection equipment) attempts. Patients queued outside hospital doors, burning chests, gasping for air, afraid for their lives. Not enough beds. Not enough doctors. Not enough medics. How much more do people have to suffer, how much louder do people need to scream: "I really don't feel well. Please help me!" Before we start realising the urgency of putting our minds and hearts together in order to develop healthcare and educational systems that place inclusive and sustainable human wellbeing and not profit, ego and exploitation at the forefront of service design?

Every week of my pregnancy, a moms-ed website would send me an email update detailing week-by-week foetal development and a growth chart by comparing the baby's size to a fruit. You start with a poppy seed and end off with a jackfruit. By 6 weeks, there's a heartbeat. By 7 weeks, fingers and toes. By 8 weeks, a name and a mother's dream: Ava, which means life / to breathe / to live. Fruit of the week? A raspberry.

A few weeks after miscarrying and burying my mother, I found myself at the grocery store doing things that normal people do: weekly shopping. I walked up and down the aisles like a zombie, carefully avoiding the baby care section, I landed up in the fruit section. Raspberries happened to be in season. I picked one out the fridge and held it in the palm of my hand. Later, I read that in ancient folklore, raspberries symbolise fertility and hope. On the 22 August 2013, the baby's due date and my mother's birthday: an artist drew with red ink and needle, a raspberry on my wrist. It lives there to remind me that hope lives even amidst unbearable suffering and grief. Hope will hold you. Hope will carry you. Hope will project you forward.

The entire direction of your life and everything that you think to be true can change in 1 year, 1 month, 1 hour, 1 minute. Our task, as human beings, living in communion with each other, is not to invalidate another's pain by saying: "oh it can't be that bad. It wasn't that long. Just get over it already" or "I can't see anything wrong. You don't look sick. It's all in your head. Stop being so dramatic." But to hold space for each other so that we can heal. It's better to show up imperfectly than not at all. We learn as we grow and we grow as we learn.

My hope is that one day, my children will be born into a world where if the time ever comes that they need to say: "I don't feel well. Please help me." The system of education that we have designed will have trained it's pupils in foundations of understanding, empathy and compassion. Inclusion and diversity. Not judgement and shame. And that the system of healthcare we have designed will be a safe place where all patients are seen as sentient, complex human beings worthy of love, care, respect and mindful attention while being administered to by healthcare professionals who are also seen as sentient, complex human beings deserving of rest, nutrition and support in order to offer the highest quality of care to absolutely anyone who walks through those doors saying: "I don't feel well. Please help me."

"What a cute strawberry!" People often say. "It's a raspberry." I reply. "Ooooh so pretty. Why a raspberry?" They ask. "Because I dream of a better world." I now say with confidence... "And I'm going to do everything in my power to help create it."

 

Kassie Paschke is Lead Researcher at Mylo. 8 years in Emergency Medicine as a paramedic kick started her career in Healthcare. During this time, she experienced first-hand the impact of systemic challenges on community health and set upon the path to finding proactive solutions over reactive measures. Community building, research (as formalised curiosity) and story-telling are the means by which she looks to drive progress forward. Her efforts are geared primarily towards Women’s Health inspired by Michelle Obama’s sentiment: “Communities and countries and ultimately the world are only as strong as the health of their women.