Day Three (July 5, 2006)
Another beautiful day is Leribe. The sky is a constant blue. It was well below zero this morning and uncomfortable for sleeping but the temperature increased to 18 C by the middle of the day. The clinic was busy as usual.
There was an amazing time of prayer and praise this morning led by Montabesang. They danced and prayed and sang with such passion, everyone sick, everyone HIV positive. They moved me to tears.
I spent the day with Elizabeth again but assumed the doctor role. It was nice to bring my own style and humor to the relationship. The Besotho respond the same way as Canadian patients. Once they realize I am a bit of a nut, they relax and tease with me. Such beautiful people with such engaging eyes and spontaneous laughter. Most of the patients today were well on ARV’s and some were doing well not yet on ARV’s. I saw a few CD4’s that were above 400 today - the norm at the Masai Centre. The themes recur: mostly women, most in their 20’s and everyone has lost one or two children to HIV, usually their youngest children. The children between the ages of 8 and 14 are alive and well. Their parents and their younger siblings are dead or sick. They are about to become at risk sexually for HIV in a community where the incidence of HIV may be as high as 50%. How do we protect this generation? Is there enough time for public health and education, social reform and institution of law enforcement to protect human and particularly female rights to save this generation?
Elisabeth and I have engaged in many philosophical debates on the issues and how to resolve them. Is front-line treatment of those infected enough? It has to be or a country is lost.
The last patient of the day was an 8 year old brought in by his grandmother. He has two sisters, both parents are dead, presumably of HIV, and the grandmother is concerned about his weight loss and his cough. She is requesting that he be tested for HIV. As I was taking his history, Elizabeth took is respiratory rate. Sixty! The normal is 20. This child was gasping for breath at a rate of 1 breath/minute and when I spoke to him and shook his hand he beamed a spectacular smile. He had an x-ray with him. We diagnosed PCP pneumonia before his HIV test came back positive. An 8 year old with PCP pneumonia. He has less than 10 days to live without treatment and the only blessing for him would be how fast he would die. He was started on meds and we will see him next week. I think he will survive.
Hospital admission was not even an option. You cannot be admitted without a friend or relative to care for you in hospital. In most hospitals the relatives must make meals for the inpatient. No relative- no food and no care. Inpatients are lucky to receive the meds that have been ordered. This grandmother has two other grandchildren to care for and cannot be admitted with this child. In Canada he would have been a direct admit to a pediatric ICU with his own nurse and a wealth of treatment technology. In Lesotho, I sent him home.
This child had access to antibiotics that will likely make him feel considerably better within 48 hours. How many others are in rural areas at this moment, gasping for breath and soon to be another dreadful statistic?
We could and should be doing so much more.
The eve of day four…….
Anne-Marie
PS. Adam was offered a job today with the American Peace Core. He will start teaching high school students computers on Monday - a connection made at the internet cafe.