AIDS 帰国支援
自分がこの4月から所属する、佐久総合病院 総合診療科の高山義浩先生があるMLに投稿
されていた内容を、許可をいただき転送します。
………………………………………………………………………
先週末、タイに行ってきました。未明に着いて1日活動し、翌朝に離陸とい
う忙しいスケジュールでしたが、エイズ発症患者を安全に航空搬送し、現地の
医療につなげるという任務は果たせました。私の働く佐久総合病院では年に一
人ぐらいのペースでこうした帰国支援症例が発生しています。
以下、患者個人の特定がなされないように配慮していますが、「たらい回し」
になりかけた自らの経験をもとに、今後の外国人診療の拡充を期待される御本
人の御意向もあり、事実関係の改変なく紹介したいと思います。
今回帰国させたのは、長野県内でセックスワーカーとして働いていた20代
の女性でした。スナックを訪れる客が希望すれば連れ出されます。休憩で2万
5千円、宿泊で3万5千円。そのうち1万円を店がとり、残金は彼女の借金が
減額される仕組みです。手配師により日本へ連れてこられる前に、彼女には死
んだ父親の借金がありました。私生児の2歳の男の子もいます。480万円で
身売りすることを自ら決意し、老いた母親に子供をゆだねたのです。これ以上、
借金を世代を越えた問題にしたくなかったのです。
2年間、死に物狂いで働いたと彼女は話します。当然ビザは切れ、パスポー
トも無効になっています。摘発されるまでの勝負ともいえます。前述のように
セックスワークの報酬は手元に残りませんから、スナックでの日当3千円が彼
女の生活費です。しかし、住居費と食費と称して店は月額6万円を請求しまし
た。よって、手元に残るのは月に2万円余。彼女はほとんど手をつけず、養育
費の足しにと母親に仕送りをしていたということです。
昨年の春頃から異変を感じていました。よく風邪をひき、下痢が長引くので
す。仕事をするのが辛かったですが、日本語のカラオケもひと通り覚えて、馴
染みの客もついてきました。まだ借金は200万円残っています。勝負はこれ
からです。しかし12月、突然、右手が動かなくなりました。整形外科医を受
診したところ、寝る姿勢が悪く末梢神経の圧迫によるものと診断され、ビタミ
ン剤を処方されました。下旬になると右足を引きずるようになりました。整形
外科医はビタミン剤を追加処方しました。ところが鍼灸師を受診したところ、
これは脳の病変だから画像診断を受けたほうがよいとアドバイスされました。
近隣の総合病院でCT検査を受けたのが12月末。多発性脳病変を認め、H
IV抗体検査陽性。「すぐに帰国して治療を受けなさい」と診断した医師に言
われました。さらに「それまでに何かあったら別の病院に行きなさい」と言わ
れ、紹介状を手渡されました。
そして日本は正月休みを迎えたのです。パスポートもビザも失効している彼
女に打つ手はありません。不安と戦いながらアパートでじっとしていました。
左の手足は完全に動きを失いました。嘔吐と頭痛。本当に久しぶりに4歳にな
る息子に電話をかけました。「ずっと帰れないかもしれないけど。お母さん元
気だからね。勉強いっぱいするのよ」と、最後の会話と彼女は覚悟していまし
た。
正月が明け、訪ねてきた友人により意識朦朧としているところを発見されま
す。友人は車をとばして都内の入国管理局とタイ大使館に連れてゆきました。
しかし、どちらも「こんな状態で帰国できるはずがない。地元で治療してから
にしなさい」とのこと。東京からの帰路において、ついに意識不明、呼吸状態
も不穏となりました。大使館にあらためて友人が対応を求めたところ、当院に
問い合わせあり、受け入れ決定ということになりました。
緊急で撮影したMRIをみて、私は慄然としました。多発する脳病変は大き
いもので5cm大。脳幹は圧排され、髄膜炎も伴っていました。脳外科と相談
してオペを施行し、最大のものについて生検目的を兼ねて隔出していただきま
した。生検結果はトキソプラズマ。その後、特異的治療に徹底した全身管理、
廃用防止リハを継続したところ、20代という若さにも助けられて徐々に回復
しました。そして2ヶ月が経過し、彼女の意識は完全に回復し、普通の食事が
可能なほど全身状態も良好となりました。ただし、残念ながら左半身の麻痺は
固定してしまいました。再度撮影したMRIでは、病変が圧迫していたからで
しょうか、脳梗塞を起こしていたことを示していました。
急性期を脱したいまは、帰国すべき段階と判断しました。正直なところ、す
でに500万円を越えている医療費も当院にとっては限界といえました。未収
金確実の医療費をこれ以上重ねることは難しい状況です。大使館とNGO
(シェア)と密な連絡を開始し、2月中旬の帰国日程を確定。現地の医療機関
とケースワーカー、地元NGOの紹介をいただきました。予測されたことでし
たが、搬送するタイ航空は医師同行を条件としました。ただし、6席を潰して
ストレッチャー搬送とすることに合意してくれました。
成田空港への道すがら、彼女は静かに信州、上州と移り変わる冬の日本を眺
めていました。どこかに観光に行ったことはあるかと聞くと、何もみることは
なかったと。日本はつらい思い出の国になっちゃった。がんばったんだけど
な・・・。お客さんはイヤだった? ううん、優しい人が多かったよ。コン
ドームを使ってと頼むと「俺を病気扱いするのか! お前の方がよっぽど汚い
くせに」と罵倒されてつらかった。それぐらい。だから、コンドームのことが
怖くて言えなくなっていった。借金返さなきゃいけなかったから、仕方なかっ
たのよ。
成田空港の出発ゲートまで車イスの彼女を押して歩くのは、たしかに奇妙な
ことでした。荷物もなく、ジャージ姿の半身麻痺の女性。両側ではきらびやか
なブランド商品と買い求める同世代の女性たち・・・。洗練された無臭の搾取
の情景。これが世界の日常なのです。
出発ゲートの隅に車イスを寄せると彼女はシクシクと泣き出しました。座位
が長すぎたかと思い、どこか痛むのかと私は聞きました。すると彼女は、子供
におみやげひとつも買ってやれないのがつらいと言いました。少し私は考え込
みました。チョコレートでも買ってきてあげた方がいいのかな・・・と。しか
し、搾取の現実に刹那の橋をかけたとして、それが何になると言うのでしょう。
おみやげは君自身だ。君の不自由な体だ。君が不自由な体をかかえながらも、
強く明るく生きてみせれば、君の子供にとって最高のプレゼントになる。強い
子がきっと育つ。がんばりなさい。
彼女は何も言わず、窓にひろがる薄曇の空を見上げていました。それは、越
えてゆくにはあまりに濃密な2月の空でした。
………………………………………………………………………
せっかくなので高山先生の著作も、紹介させていただきます。
・アジアスケッチ 目撃される文明
・ホワイトボックス 病院医療の現場から
(以下、小池の私見です)
Internationalってなんなのか、ときどき考え込みます。
日本を引きずって外国に身を置いて英語を話したりすることをInternationalと
いっているひとたちってけっこう多い気がしますが、そんなんじゃないんじゃな
いかと考えたりします。
文化とか、民族とか、言語とか、歴史とか。
そういったものをこえて生きるってことを共有する、ヒリヒリするような
Internationalが本来大切なものだと感じます。それって別に、国境をこえなく
ても、外国語をしゃべらなくってもいいことで。
日本国内すぐそこかしこにちらばるいろんなInternationalを無視して、目に見
えやすい、外国・外国語一辺倒では、どこか届かない気がします。
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