Day Four (July 6, 2006)

Not a great day. My energy and mood are low. There is not much here to elevate your mood on a down day and I would definitely not recommend Lesotho to anyone with a mood disorder. The first patient of the day was a 33 year old male who sat in the waiting room for 10 minutes in a wheelchair until one of the triage nurses recognized how gravely ill he was. Justina is all of 4′11” but very determined. She blasted open the door of the room I was in and insisted I see this one first. He made it to the door and on to the bed, carried by two of his relatives and then promptly died. Tuberculosis treatment was started yesterday followed by an urgent referral to Tsepong to assess his HIV and in the exam room, he died. After his body was removed I cleaned the rubber mattress he was on with baby wipes that I had brought from Canada. The scent of the wipes immediately stimulated an old memory of my newborn babies. The contrast between where I was physically and what I was doing at that moment and where my brain led me made me feel profoundly sad. There is very little innocence and sweetness left in this place.

So many questions. He and his family knew how ill he was but he did not seek treatment until last month. The distance, the price of gas, the lack of transportation the social stigma associated with HIV…. The district knows that Tsepong is here. They know what Tsepong can do but so many can’t or won’t access treatment. All the native staff at the hospital agree that they are dying in far greater numbers than those estimated by the World Health Organization.

As the day went on… I meet Memorena, born in 1959, she has seven living children, has been on ARV’s for 2 months with an initial CD4 of 20 and now is struggling for breath, a very poor prognosis to develop PCP while on HIV meds. She is a widow and will leave seven orphans alone in Lesotho. Mateboho, age 25, a widow with one son who is 8 and well. Her initial CD4 was 14, two months ago. She has rebounded tremendously on ARV’s. Her son reminds her to take her pills, each and every dose. He understands. Mathabibeng, age 22, and patient number 5032 at Tsepong (thirty new patients in three days). She is nine months pregnant with her second child. The first died at birth. She tested positive for HIV this week and her CD4 is 70. She looks very ill. We broke every rule today and started her on ARV’s and Bactrim. The pharmacist was in a state of fury. No one starts ARV’s at Tsepong until the patient has had an ARV counseling session which they must attend with a “buddy”. The next ARV session is in August. The HIV status of this newborn is dependent on the urgent initiation of meds today. If there was any miscommunication and the patient doesn’t take her meds before delivery, this child has a 50% chance of being born with HIV.

I said to her, “If you start taking these meds today, there is a good chance your baby will be born well”. Her response, “Do I have to pay?”. Luckily at Tsepong, she doesn’t.

Not a great day. The list lengthens. Africa weeps.

AM