Ezokwelapha Zanamuhla—Zingafeza Okungakanani?

IZINGANE eziningi zafunda zisencane ukuthi: Ukuze zikhe i-apula eliphezulu esihlahleni, zigibela emahlombe omngane. Emkhakheni wezokwelapha, kuye kwenzeka into efanayo. Abacwaningi bezokwelapha baye bafinyelela emazingeni aphezulu ngokuma emahlombe odokotela abavelele bakuqala.

Phakathi kwalabo belaphi bakuqala kwakunamadoda aziwayo njengoHippocrates noPasteur, kanye namadoda anjengoVesalius noWilliam Morton—amagama abaningi abangawazi. Aba naliphi iqhaza kwezokwelapha zanamuhla?

Ezikhathini zasendulo umkhakha wokwelapha ngokuvamile wawungangeni ngaphansi kwesayensi kodwa wawuyisiko lokukholelwa ezeni nemicikilisho yenkolo. Incwadi ethi The Epic of Medicine, eyahlelwa uDkt. Felix Marti-Ibañez, ithi: “Ukuze balwe nezifo . . . abantu baseMesopotamiya babesebenzisa ingxube yemithi nenkolo, ngoba babekholelwa ukuthi izifo zaziyisijeziso esivela konkulunkulu.” Izinqubo zokwelapha zaseGibithe ezalandela ngokushesha, nazo zazinomsuka wenkolo. Ngakho-ke, kusukela ekuqaleni nje umelaphi wayehlonishwa ngokwenkolo.

Encwadini yakhe ethi The Clay Pedestal, uDkt. Thomas A. Preston uyaphawula: “Izinkolelo eziningi zabantu basendulo zaba nethonya elijulile kwezokwelapha elisekhona nanamuhla. Enye inkolelo enjalo yayiwukuthi isifo sasingaphezu kwamandla esiguli, futhi sasingaba nethemba lokusinda ngamandla omlingo enyanga kuphela.”

Ukubeka Izisekelo

Nokho, ngokuhamba kwesikhathi, ukwelapha kwaya ngokuya kuncika kuyisayensi. Umelaphi wakudala ovelele owayesebenzisa isayensi kwakunguHippocrates. Wazalwa cishe ngo-460 B.C.E. esiqhingini saseKos eGreece, futhi abaningi bambheka njengomsunguli wemithi yaseNtshonalanga. UHippocrates wabeka isisekelo sokwelapha ngemithi okunengqondo. Wawenqaba umqondo wokuthi izifo zaziyisijeziso esivela konkulunkulu, ethi zazinembangela engokwemvelo. Ngokwesibonelo, kwase kuyisikhathi eside isithuthwane sibizwa ngokuthi isifo esingcwele ngenxa yenkolelo yokuthi onkulunkulu kuphela ababengaselapha. Kodwa uHippocrates wabhala: “Mayelana nesifo esibizwa ngokuthi esiNgcwele: kimi kubonakala singabangelwa nakancane unkulunkulu futhi singengcwele kunezinye izifo, kodwa sinembangela engokwemvelo.” UHippocrates wayengumelaphi wokuqala owaziwayo owabona izimpawu zezifo ezihlukahlukene futhi wazibhala phansi ukuze zisetshenziswe esikhathini esizayo.

Emakhulwini eminyaka kamuva, uGalen, udokotela ongumGreki owazalwa ngo-129 C.E., naye wenza ucwaningo lwesayensi olusha. Esekela ekuhlukaniseni nasekuhlaziyeni izingxenye zomzimba wabantu nezilwane, uGalen wabhala incwadi echaza ukwakheka komzimba eyasetshenziswa odokotela amakhulu eminyaka! U-Andreas Vesalius, owazalelwa eBrussels ngo-1514, wabhala incwadi ethi On the Structure of the Human Body. Yaphikiswa ngoba yayingavumelani nokuningi okwashiwo uGalen, kodwa yabeka isisekelo sesayensi yokwakheka komzimba yanamuhla. Ngokwencwadi ethi Die Grossen (Abakhulu), uVesalius waba “omunye wabacwaningi bezokwelapha ababaluleké kakhulu kunabo bonke emlandweni.”

Izinkolelo-mbono zikaGalen ngenhliziyo nangokujikeleza kwegazi nazo zagumbuqelwa ngokuhamba kwesikhathi.a Udokotela oyiNgisi uWilliam Harvey wachitha iminyaka ehlukanisa izingxenye zomzimba wezilwane nezinyoni. Waphawula ukusebenza kwemithambo yenhliziyo, wakala umthamo wegazi egumbini ngalinye lenhliziyo, wabe eselinganisa umthamo wegazi elisemzimbeni. UHarvey wanyathelisa lokho akuthola ngo-1628 encwadini ethi On the Motion of the Heart and Blood in Animals. Wagxekwa, waphikiswa, wahlaselwa futhi wathukwa. Kodwa incwadi yakhe yabangela inguquko kwezokwelapha—isimiso somzimba semithambo yegazi sase sitholakele!

Ukusuka Ekugundeni Izinwele Kuya Ekuhlinzeni

Kwakwenziwa intuthuko enkulu nakwezokuhlinza. NgeNkathi Ephakathi, ukuhlinza kwakuvame ukuba umsebenzi wabagundi bezinwele. Yingakho abanye bethi umsunguli wendlela yanamuhla yokuhlinza kwakuyindoda engumFulentshi yangekhulu le-16 u-Ambroise Paré—umgundi owayeyingqalabutho kwezokuhlinza eyakhonza amakhosi amane aseFrance. UParé wasungula namathuluzi okuhlinza amaningana.

Enye yezinkinga ezinkulu ezazisekhona kwezokuhlinza ngekhulu le-19 kwakuwukungakwazi ukudambisa ubuhlungu bokuhlinzwa. Kodwa ngo-1846 udokotela wamazinyo uWilliam Morton wavula indlela yokusebenzisa imithi yokubulala izinzwa ekuhlinzeni osekwande kabanzi.b

Ngo-1895, ngesikhathi sihlola okuthile ngogesi, isazi se-physics saseJalimane uWilhelm Röntgen sabona imisebe idlula enyameni kodwa hhayi ethanjeni. Wayengawazi umsuka wale misebe, ngakho wayibiza ngokuthi ama-X ray, igama elisasetshenziswa nanamuhla esiNgisini. (AmaJalimane ayibiza ngokuthi ama-Röntgenstrahlen.) Ngokwencwadi ethi Die Großen Deutschen (AmaJalimane Amakhulu), uRöntgen watshela umkakhe: “Abantu bazothi: ‘URöntgen useyahlanya.’” Abanye basho nangempela. Kodwa lokho akuthola kwabangela izinguquko kwezokuhlinza. Odokotela abahlinzayo base bekwazi ukubona ngaphakathi emzimbeni womuntu ngaphandle kokumhlinza bawuvule.

Ukunqoba Izifo

Kuyo yonke iminyaka izifo ezithathelwanayo njengengxibongo bezilokhu zibuya futhi zande, zibangele usizi nokufa. U-Ar-Rāzī, umPheresiya wangekhulu lesi-9, abanye abathi wayengudokotela omkhulu kakhulu kumaSulumane ngaleso sikhathi, wabhala incazelo yengxibongo yokuqala enembile ngokwezokwelapha. Kodwa udokotela waseBrithani u-Edward Jenner waze wathola indlela yokuyelapha emakhulwini eminyaka kamuva. UJenner waphawula ukuthi uma umuntu ephethwe i-cowpox—isifo esingenangozi—wayengeke esangenwa ingxibongo. Ngokusekelwe kulokhu akubona, uJenner wasebenzisa izilonda ze-cowpox ukuze enze ikhambi lokwelapha ingxibongo. Lokho kwakungo-1796. Njengabanye abasungula ezinye izinto ngaphambi kwakhe, uJenner wagxekwa futhi waphikiswa. Kodwa lokho akuthola ngenqubo yokugoma ekugcineni kwasiqeda lesi sifo futhi kwaletha ithuluzi elisha elinamandla kwezokwelapha.

ULouis Pasteur waseFrance wasebenzisa umuthi wokugoma ukuze alwe namarabi nombendeni. Wabonisa nokuthi amagciwane anengxenye enkulu ekubangeleni izifo. Ngo-1882, uRobert Koch wathola igciwane elibangela isifo sofuba, esichazwa esinye isazi-mlando ngokuthi “isifo esingumbulali omkhulu ekhulwini le-19.” Cishe esikhathini esingangonyaka kamuva, uKoch wathola igciwane elibangela ikholera. Umagazini i-Life uthi: “Umsebenzi kaPasteur noKoch waqala isayensi yamagciwane abangela izifo futhi waholela entuthukweni kwezokugoma, ukukhucululwa kwendle nenhlanzeko okuye kwenza lukhulu ekwandiseni isikhathi sokuphila komuntu kunanoma iyiphi intuthuko yesayensi kule minyaka engu-1 000 edlule.”

Ezokwelapha Zekhulu Lamashumi Amabili

Ekuqaleni kwekhulu lama-20, ezokwelapha zazime emahlombe alab’ odokotela abahlakaniphile nabanye. Kusukela lapho, intuthuko yezokwelapha iye yashesha kakhulu—i-insulin yokwelapha isifo sikashukela, amakhemikhali okwelapha umdlavuza, ukwelashwa ngama-hormone uma unezifo zezindlala, imithi yesifo sofuba, i-chloroquine yezinhlobo ezithile zikamalaleveva ne-dialysis yezifo zezinso kanye nokuhlinzwa kwenhliziyo isashaya nokufakelwa kwezitho zomzimba ezithile, uma sibala nje ezimbalwa.

Kodwa manje njengoba sesisekuqaleni kwekhulu lama-21, ezokwelapha sezisondele kangakanani emgomweni wokuqinisekisa “izinga lempilo elamukelekayo kubo bonke abantu emhlabeni”?

Umgomo Ongafinyeleleki?

Izingane ziyafunda ukuthi ukugibela emahlombe omngane akuzenzi zifinyelele wonke ama-apula. Amanye ama-apula amnandi kakhulu aphezulu kakhulu esihlahleni, azifikeli. Ngendlela efanayo, ezokwelapha ziye zafeza izinto eziningi ngokulandelana, ziqhubeka zithuthuka. Kodwa umgomo oyigugu kakhulu—wokuba bonke abantu babe yimiqemane—usalokhu ungafinyeleleki.

Ngakho, nakuba ngo-1998 i-European Commission yabika ukuthi “abantu baseYurophu abakaze bajabulele ukuphila isikhathi eside beyimiqemane,” lo mbiko wanezela: “Umuntu oyedwa kwabahlanu uzofa ngaphambi kwesikhathi engakayihlanganisi iminyaka engu-65 ubudala. Abangu-40% bazobulawa umdlavuza, abangu-30% babulawe izifo zenhliziyo nemithambo yegazi . . . Kufanele kutholakale isivikelo esingcono ezintweni ezintsha ezisongela impilo.”

Ngo-November 1998 umagazini wezempilo waseJalimane i-Gesundheit wabika ukuthi izifo ezithathelwanayo njengekholera nesifo sofuba ziwusongo oluqhubekayo. Ngani? Imithi “iphelelwa amandla. Asemaningi amagciwane amelana okungenani nomuthi owodwa kwevamile; futhi empeleni, amaningi amelana neminingi.” Akukona nje kuphela ukuthi izifo ezindala ziyabuya, kodwa sekuvelé nezifo ezintsha njengengculaza. Incwadi yezemithi yaseJalimane i-Statistics ‘97 iyasikhumbuza: “Kuze kube manje alikho ikhambi lokwelapha ingxenye yesibili—engaba ngu-20 000—yazo zonke izifo ezaziwayo.”

Ingabe Ukwelapha Ngezakhi Zofuzo Kuyoletha Ikhambi?

Kuyavunywa, izindlela ezintsha zokwelapha ziyaqhubeka zisungulwa. Ngokwesibonelo, abaningi banomuzwa wokuthi ukushintsha izakhi zofuzo kungase kube isihluthulelo sempilo engcono. Ngemva kocwaningo e-United States ngawo-1990, olwenziwa odokotela abanjengoDkt. W. French Anderson, ukwelapha ngezakhi zofuzo kwachazwa ngokuthi “ingosi entsha edl’ ubhedu ocwaningweni lwezokwelapha.” Incwadi ethi Heilen mit Genen (Ukwelapha Ngezakhi Zofuzo) ithi ngokwelapha ngezakhi zofuzo, “kungenzeka isayensi yezokwelapha isonqenqemeni lokufinyelela isenzo esisha. Lokhu kunjalo ikakhulukazi ngokwelashwa kwezifo ebezilokhu zingelapheki kuze kube manje.”

Ngokuhamba kwesikhathi ososayensi banethemba lokukwazi ukwelapha izifo zofuzo umuntu azalwa nazo ngokujova isiguli ngezakhi zofuzo ezizokwelapha lezo zifo. Ngisho namangqamuzana alimazayo, njengamangqamuzana omdlavuza, mhlawumbe ayokwenziwa ukuba azibhubhise ngokwawo. Sebeyakwazi kakade ukuhlola izakhi zofuzo ukuze bathole ukuthambekela komuntu ezifweni ezithile. Abanye bathi intuthuko elandelayo kuzoba i-pharmacogenomics—ukuthaka imithi ngendlela yokuba ivumelane nezakhi zofuzo zesiguli. Omunye umcwaningi odumile usikisela ukuthi ngolunye usuku odokotela bayokwazi “ukuxilonga izifo zeziguli zabo futhi bazinike izingxenye ezifanele zezakhi zofuzo ukuze bazelaphe.”

Nokho, akubona bonke abantu abanelisekile ukuthi ukwelapha ngezakhi zofuzo kunikeza ‘ikhambi elisheshayo’ lesikhathi esizayo. Empeleni, ucwaningo lubonisa ukuthi abantu bangase bangafuni ngisho nokuba kuhlaziywe izakhi zabo zofuzo. Abaningi besaba nokuthi ukwelapha ngezakhi zofuzo kungase ngengozi kuphazamise imvelo.

Ngokuhamba kwesikhathi kuyobonakala ukuthi ukushintshwa kwezakhi zofuzo noma ezinye izindlela zobuchwepheshe bezokwelapha ziyozifeza yini izithembiso zazo ezinkulu noma cha. Nokho, kunesizathu sokugwema ukuba nethemba okungafanele. Incwadi ethi The Clay Pedestal, ichaza umjikelezo ovamile: “Kuvela ikhambi elisha, limenyezelwe emihlanganweni yezempilo nakomagazini bezobuchwepheshe. Abasunguli balo badume kulowo mkhakha, futhi abezindaba bahalalise ngale ntuthuko. Ngemva kwesasasa nokubhalwa phansi kobufakazi obusekela lelo khambi elimangalisayo, kuqala indumalo kancane kancane, ihlale izinyanga ezimbalwa kuya emashumini eminyaka ambalwa. Bese kutholakala elinye ikhambi elisha, cishe ngokushesha lithathe indawo yaleli elidala, elivele lilahlwe njengelingenamsebenzi.” Ngempela, amakhambi amaningi aye alahlwa odokotela abaningi njengangenamsebenzi, zolo lokhu abeyindlela yokwelapha esezingeni elikahle.

Nakuba odokotela namuhla bengasanikezwa isikhundla esingokwenkolo esasinikezwa abelaphi basendulo, abanye abantu basathambekele ekutheni bathi odokotela banamandla acishe afane nawawonkulunkulu futhi bacabanga ukuthi isayensi iyoliletha nakanjani ikhambi lazo zonke izifo zesintu. Kodwa lo mbono akuwona neze ongokoqobo. Encwadini yakhe ethi How and Why We Age, uDkt. Leonard Hayflick uyaphawula: “Ngo-1900, abantu abangamaphesenti angu-75 e-United States babefa bengakafiki eminyakeni engu-65. Namuhla, cishe lokhu sekushintshe ngokuphelele: abantu abangaba amaphesenti angu-70 bafa sebedlulile eminyakeni engu-65.” Yini eyabangela lokhu kwanda okungaka kwesikhathi sokuphila? UHayflick uyachaza ukuthi “ngokuyinhloko kwakungenxa yokuncishiswa kwezinga lokufa kwezinsana.” Manje ake sithi isayensi yezokwelapha ibingaqeda izimbangela eziyinhloko zokufa kwasebekhulile—isifo senhliziyo, umdlavuza nokufa uhlangothi. Ingabe lokho bekungaletha ukungafi? Lutho neze. UDkt. Hayflick uphawula ukuthi noma kunjalo, “abantu abaningi bebengaphila bagcine eminyakeni eyikhulu ubudala.” Uyanezela: “Laba bantu abaneminyaka eyikhulu bebesazokufa. Kodwa bebezobulawa yini? Bebezomane babe buthakathaka kancane kancane baze bafe.”

Naphezu kwemizamo etusekayo yesayensi yezokwelapha, ukuqeda ukufa kusengaphezu kwamandla ezokwelapha. Kungani kunjalo? Futhi ingabe umgomo wempilo engcono kubo bonke uyiphupho elingenakufezeka?

[Imibhalo yaphansi]

[Amazwi acashunwe esihlokweni ekhasini 4]

“Izinkolelo eziningi zabantu basendulo zaba nethonya elijulile kwezokwelapha elisekhona nanamuhla.”—The Clay Pedestal

[Izithombe ekhasini 4, 5]

UHippocrates, uGalen noVesalius babeka izisekelo zesayensi yezokwelapha yanamuhla

[Imithombo]

Kos Island, Greece

Courtesy National Library of Medicine

Woodcut by Jan Steven von Kalkar of A. Vesalius, taken from Meyer’s Encyclopedic Lexicon

[Izithombe ekhasini 6]

U-Ambroise Paré wayengumgundi owayeyingqalabutho kwezokuhlinza eyakhonza amakhosi amane aseFrance

Udokotela wasePheresiya u-Ar-Rāzī (kwesobunxele), nodokotela waseBrithani u-Edward Jenner (kwesokudla)

[Imithombo]

Paré and Ar-Rāzī: Courtesy National Library of Medicine

From the book Great Men and Famous Women

[Isithombe ekhasini 7]

ULouis Pasteur waseFrance wabonisa ukuthi amagciwane abanga izifo

[Umthombo]

© Institut Pasteur

[Izithombe ekhasini 8]

Ngisho noma kungaze kuqedwe izimbangela eziyinhloko zokufa, ukuguga bekusayophumela ekufeni