homework

A massive rain storm swept in this afternoon, catching me at home between hospital rounds and chapel.  After half an hour of relentless pouring, I realized I was NOT going to make it to chapel.  So I embarked on lingering homework, updating the simple database of HIV exposed children that I try to keep.  These are the kids who come to clinic, or to Kwejuna Project quarterly gatherings, where we can follow-up their testing.  The denominator is problematic, because only the children who survive long enough to see me, or whose mothers are motivated to come regularly, are counted.  The sick kids are probably over-represented in those that seek care.  But I still found the big picture rather interesting.

There are 286 kids, from age 2 months to age 15 years.

73 are infected, which is 26% overall.

Of kids born in the last 3 years 30 of 216 are infected.  That is 14%.  (More reflective of PMTCT, the Prevention of Mother To Child Transmission, since the older kids are in our care because they are SICK not because their moms were screened).

PMTCT is supposed to cut transmission rates in half.  Again, the math is not perfect, but the general trend there looks good.

Of the 30 kids infected in the last three years, it struck me tonight that 10 were born in the time of ebola.  It looks like a 3X risk for infection between Nov 07 and Mar 08.  The health care system, particularly PMTCT, essentially stopped functioning in that time.  Our numbers are not high, but that's a pretty dramatic rise in risk in a very defined time period.

I keep the list so that when these kids show up on the ward or in the clinic, where the medical records are almost always NOT available, I can quickly find out their status.  It is a list for reference, but when you look at it for trends, I think it encourages me that the medical effort is accomplishing something.  Though there are also reminders of our failures.  At least 7 have died.  As I type in data I can see some toothy skinny smiles and some plumping-out cheeks in my mind, more than just names and test results, these are nearly 300 human beings who did not choose to have their existence defined by a struggle with AIDS.  

Never too old for homework.