Current Issue
Spring 2014
BMM Current Issue
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FIELD NOTES
 
Under African Skies
The heartbreak and joy of treating children with HIV.
“My name is Masego, I am a solider. AIDS you CANNOT touch me. I will kill you, to the ground. My name is Thabo, I am a doctor. AIDS you CANNOT hurt me. I will inject you, to the ground. My name is Nametso, I am a lawyer. AIDS you CANNOT kill me. I will rule you, to the ground.”

Bashi, a 6-year-old HIV-positive boy made up and sang this song while running around our clinic in Botswana. He amazed us all with his knowledge and his joy in singing about his power over something that only a few years ago would have killed him.

I came to Botswana after finishing my pediatric residency last July, as a member of the Pediatric AIDS Corps (PAC), a program sponsored by Baylor College of Medicine in seven African countries. Much of what I found in Botswana surprised me: most of the country is serviced by tarred roads, the majority of houses have access to drinkable water, school is free (though book and uniform fees keep some children from attending), and health care (including free antiretrovirals for HIV) is provided for all citizens. The government is able to offer these services largely because of revenue from its diamond mines. Despite the relative wealth of the nation, the vast majority of citizens are poor, unemployment is around 18 percent, and an estimated 37 percent of 15-to-49-year-olds are HIV infected, leaving thousands of orphans and people requiring frequent and expensive medical care. There is also an incredible shortage of doctors, with 2.5 pediatricians/ 100,000 children versus 106/100,000 in the U.S. The PAC was established to help build pediatric capacity by training local medical officers and nurses in pediatric care.

The experience has been challenging, rewarding, and heartbreaking— sometimes all at the same time. Many patients will stick with me forever, including Neo. When I first met Neo she was 10 months old, HIV positive, and weighed 3.7 kg (six standard deviations below the mean). She had disappeared from clinic for two months and had run out of her medication, putting her at risk for developing drug resistance. I wanted to admit her to stabilize her nutritional status, but her mother was worried about her six other children. In Botswana, little children must be accompanied by a caregiver in the hospital; the nurses are not responsible for feeding or changing diapers. Given that the baby was not in significant distress, I agreed to close follow up. I involved the social worker, dietitian, and several nurses, and Neo’s mother agreed to return in two days for a recheck.



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