FROM THE COLLECTIONS
> Field Notes
Under African Skies
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Two days later, when she did not show up, we called the three phone numbers she had given us, but got no answer. We decided to do a home visit. A clinic driver, a nurse, and I set out to find her house. She was renting one room in the backyard of her landlord’s house. The room contained a 3/4 size bed, a small bureau, and a hot plate for cooking. There was one window, no electricity, and it was 100 degrees! Neo lived there with her mother, the mother’s boyfriend, and, on occasion, her siblings. Neo’s mother explained that she had not returned to clinic because she had gone to apply for a food basket (Botswana’s version of food stamps), a multiple-day process. After a long discussion, another home visit, and multiple social work interventions, we managed to get Neo admitted to the hospital and began the rehabilitation process for her malnutrition. After one week, during which she gained significant weight and her demeanor improved, her mother, frustrated with the hospital stay, took Neo home. One month later, we still have not found them.
As heartbreaking as this case is, thankfully it is the exception. Most of our patients adhere to their treatment and come regularly to clinic. This case made me realize that providing free medical care is not enough. The social stressors, extreme poverty, and poor educational attainment of many of our patients make it challenging for them to utilize the services they desperately need.
REASON TO HOPE
But for each of the distressing cases, there are many more children who surprise me with their tenacity and ability to smile and laugh in the face of adversity. I have never met children who light up so brightly when presented with a sticker or given a hug. There are hundreds of children who are positively thriving on antiretrovirals, when just nine years ago these medications were not available.
We have a blossoming Teen Club where HIV-positive teenagers get together one Saturday each month to have fun, see that they are not alone, and learn to deal with their HIV-positive status. At a recent event the teens created skits about disclosing their status to teachers, friends, and family members. They performed the skits in Setswana, but their skill and enthusiasm as actors conveyed their message even to non- Setswana speakers.
It is through these teenagers that I believe real change will be possible. We are working toward a new generation of healthy, happy, productive, HIV-positive children and teenagers, one of whom just might go on to find the cure for the illness that has shaped their lives.
Leah Scherzer will be in Botswana through 2010 and possibly into next year. She plans to combine U.S.-based practice with international work, and will continue to care for underserved children. Follow her at
Alpert Medical School