Day Two (July 4, 2006)

I spent the day with Elizabeth. She is a lovely, bright and wise French woman from Ottawa who will spend the next 10 months in Leribe working at Tsepong. She is a nurse practitioner with little HIV experience and a ton of courage. In the last month she has learned enough to train me, the next green team member at the clinic. Tomorrow I am on my own and really looking forward to it. I wish I spoke the language.

Today was much less difficult than I expected. Most of the patients we saw were children with their grandparents and most were well on treatment. Several were HIV positive pregnant women waiting to have their babies and hoping that their newborns will not have HIV. None were on treatment but all met the criteria for treatment in North America. There is such a fine line that is walked between allowing patients to become perilously close to severe illness and starting treatment. For most the only option is to wait, despite significant risk, until their lab work meets the criterion for HIV med initiation.

One patient was a 4 year old who has been HIV positive all his life. His chart reads, ” mother is dead, father has abandoned the family, grandmother is an alcoholic”. He is cared for and fed during the day by an elderly neighbor and sent home at night to sleep at his grandmother’s house. He has TB and is waiting for his TB treatment to be completed before starting ARV’s (HIV meds). He is seen monthly at Tsepong. The staff were thrilled to see his recent weight gain and praised this aging woman for the care she was providing to this child who was previously a stranger to her. She leaned over the desk at one point and handed me her file. She asked if her next appointment at Tseopng could be on the same day as this little boy’s. I looked at her with shock and dismay….she too has HIV. She is a saint. If she dies, so does this child. He has no one else in the world.

As the day went on, I began to take notes on the details of these patients’ lives. One page of hand writing says it all: their name, their sex (female), how close to death they were before treatment was started (CD4 usually well below 100), their marital status (usually widowed), the number of children they have lost to HIV and their age. Today not one of these women were over 30. Tsepong and many other clinics like it across Africa, is trying to save an entire generation of women and children.

I realized today that I am in my element. There is no where else in the world that I would rather be. I fall asleep at night wishing sleep was not necessary. Adam has matured a decade in the last 3 days. Today he spent the day with Justina at a filter clinic in Santa Rosa outside of Maseru. He stocked shelves, counted and sorted meds, toured the clinic and played piano for the nuns. He now believes nuns are terrible cooks. I guess lunch wasn’t so hot. The Tsepong staff are thrilled to have him and there is no task that he does not jump to cheerfully. Two staff have fought over him for tomorrow. It is 9:00 pm and he is out for the night. What an opportunity for both of us. It is a gift from God, and an honour and privilege to be here.

On to day three at Tsepong…

Anne-Marie