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Wednesday, October 24, 2007

A tale of two children

This is Kabugho, whose big searching eyes have reached my heart this week. I should see some reproach in them because I had pretty much given up on her, but instead I see the calm non-judgmental interest of a six month old. I first met Kabugho a few months ago when I heard that the staff wanted to use baby formula for someone whose mother was admitted on the female ward. We promote breast feeding, so I was wary of the request, and feeling protective of our supplies for nutrition I marched over to check out this story of a mother too sick to breast feed . . . And found this woman dying. Literally, she died while I stood there. It was pretty upsetting, she was a young mother, with TB and AIDS, and I had come to insist that she breastfeed her child only to watch her gasp her last breath. Her own mother had struggled alone to care for her, and kind relatives of other patients held the hungry baby while the staff wrapped up the body. I quickly supplied two cans of formula and told them to return when they finished burying, to get set up with a dairy goat from the Matiti project, and to start following the baby for treatment. Since then she had been seen a few times by various staff but sort of fell through the cracks until Costa, advocating for her, calmly said to me last week that he did not know what to do with this patient. I looked up to see the frail grandmother and the tiny baby, less than 8 pounds at age six months, deathly ill, gasping, bloodless eyes and peeling skin. I rushed them to the lab where her hemoglobin was 3.2 mg/dl, a value not compatible with many more hours of life. Her grandmother insisted that she had nothing with her, had come alone, and could not stay. I stood there with the staff trying to convince her to be admitted at first. But I looked at the baby and the grandmother and thought of the pain and loss she had already experienced, and how much worse it is culturally to die in the hospital than at home, and how marginal her chances were . . . And told her that if she really wanted to go she could. Thankfully she changed her mind and stayed. I did not expect her to live 24 hours. Now a week later she’s looking at me with those big eyes. Blood tranfusions, malaria medicine, antibiotics, skin creams, milk, TB therapy, some funds slipped into the grandmother’s hands for her own food . . . And the little life that was slipping away has returned. She’s going home soon, and though I don’t know how long she’ll live, I’m grateful for the lesson to not give up, to value the love the grandmother had for this child, to gaze into her patient little eyes and try.

The ART clinic today was full of stories, including a happy mother who showed me her baby’s negative test results, several fat little newborns whose status is still unknown, others waiting for medicine refills. But my other favorite patient of the day is a little boy who may be 5 or may be 7, they’ve told me both ages at different times. His mother died, and his uncle who is in charge rarely manages to come to clinic with him, so he is basically being cared for by his 12 year old brother. The two of them shyly stand in my exam room, silent, in tattered shirts, the younger barefoot and the older in mud-splattered school shoes and uniform. I offer them both candy which brings big smiles. No matter what I ask they nod and agree and rarely speak. It is nearly impossible to know how well his medicines are given at home. But today I got the results of his CD4 count back: in less than a year his absolute CD4 count has doubled and the percentage nearly tripled. So the two little boys must be doing something right. I pat them on the head and refill the prescription, praying he’ll keep improving.

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