by Jesse Zink
She was leaning on the door of our clinic for support, weak, gaunt, and emaciated—the first time I laid eyes on Pakama I knew she had AIDS. Her collar bones poked through her shirt and she labored for breath. Pakama lived in Itipini, a shantytown community on a garbage dump outside Mthatha, South Africa, one of the poorest parts of a country that has more HIV-positive people than any country in the world. I was working at a community center in Itipini as a Young Adult Service Corps missionary of the Episcopal Church.
Pakama did, indeed, have AIDS, along with tuberculosis. She had come to our clinic for help in getting started on both the life-saving anti-retroviral drugs and the simultaneous treatment for her TB. Starting TB treatment was a relatively easy thing for our small clinic to do. Starting ARVs, however, is a complex process involving a labyrinthine health system, one nearly impossible to navigate for someone like Pakama whose health had deteriorated so far.
But it was not so impossible a process that we gave up hope. Even though there was a fairly substantial language barrier between the two of us—she spoke Xhosa and I was still barely functional in it—over the next several weeks, I helped Pakama get to the various appointments necessary to be given the ARVs—chest x-rays, blood work, counseling sessions. Taking ARVs is a significant commitment—patients take them every day for the rest of their life—and the appointments were to ensure she knew what she was getting herself into. But as the weeks passed her condition continued to worsen. She lost the energy to walk and I had to lift her in and out of the car and carry her to appointments. She lay in bed in her shack the rest of the day, complaining about the cold.
In the eight months I had been working in Itipini before I met Pakama, I had known many other patients with AIDS. All who had been as sick as Pakama had died before being given ARVs. Indeed, not two days before Pakama walked in the clinic the first time, another patient had died after a difficult—and unsuccessful—journey through the health system. The longer I worked with Pakama, the more I began to worry Pakama wouldn’t make it through the system in time. Each morning, as I drove to Itipini, I mentally prepared myself to hear the news that she had died the night before.
When it finally happened—in the midst of a busy day at the hospital from an overwhelmed doctor—receiving Pakama’s ARV prescription was somewhat anticlimactic. But we had it! We filled the prescription and headed back to Itipini. There was no sudden shift in her condition, however. She was still weak and thin—but alive. Soon, other patients in similar situations began to occupy my attention and I saw less of Pakama. Then, I was away for a few weeks. When I returned, the first thing I did was seek her out.
I found her in front of her shack washing clothes. She smiled broadly to see me again and asked how I was.
“I’m fine,” I said. “But I want to know how you are. Can you walk?”
“Yes,” she replied, clearly somewhat embarrassed to recall the time she had been so sick. As it was, she was supporting herself just fine washing the clothes. Still, I needed to see for myself.
“Show me,” I said.
She rolled her eyes and gave me a look that said, “What does he think? Of course I can walk by myself.” But she humored me. Without struggle or undue effort, she casually sashayed down one side of the shack and back to the door. She turned to look to see if I was satisfied. I was. She was like a whole new person.
That evening, I thought about Pakama’s improved health. As much as I had wanted her to get better, I actually hadn’t done all that much for her. I like to think I had been a supportive presence at times. I pointed her the right direction in the hospital at times but more often than not she could read the signs and knew where to go. Her sister and mother cared for her in her shack, not me. The fact is, Pakama and I were pretty different people. We spoke different languages, came from different cultural backgrounds, and a hugely different set of life experiences. If I had done anything, it was the only thing I could do: accompany Pakama on her journey from sickness to health.
Journey is one of the oldest metaphors for faith, and for good reason. Abraham set out for a land he did not know, Moses and the Israelites wandered into the desert, Jonah took off in the wrong direction, Naomi returned home after years away, Paul sailed around the Mediterranean. As I reflected on my time with Pakama, journey seemed an apt analogy as well. We had been on a journey together, her and I. When I knew the way, I took the lead. When she knew, she led. When both of us were lost, we moved forward together, confident in the knowledge that we were not alone.
In the months and years I spent in Itipini after first encountering Pakama, I accompanied many other people on journeys. Not all of them had nearly as successful outcomes and I can count more people I’ve known who’ve died of AIDS than are still alive. But I don’t consider myself a failure as a missionary. What makes the experience missional is our initial willingness to set out on the journey, to accompany someone who is different, to be converted by the experience.
The word mission is more and more a part of conversations about the future of the Episcopal Church. As I’ve watched the conversation unfold, I think back to my weeks driving Pakama to her never-ending string of appointments. Mission begins when difference is engaged—whether on a garbage dump in South Africa or just down the street. Where it ends up, we cannot control. But it is the fact that we are willing to render ourselves vulnerable to God’s guidance on a journey whose destination we may not know that makes our life as Christians missional. None of us will ever live to see the perfect peace of the kingdom of God on earth. But perhaps if we set out on the journey, we’ll find that the journey of mission truly is its destination.
Jesse Zink is author of Grace at the Garbage Dump: Making Sense of Mission in the Twenty-First Century (Wipf and Stock Publications, 2012), from which this essay is adapted, and is a deacon in the Diocese of Western Massachusetts. More information is at his blog.