Pivot point – Introducing Lizwi (2 of 10)
Lwizi is 6 months old.
Before he was born, his HIV+ mother received an antiretroviral called nevirapine to help prevent the transmission of the virus to the baby. The baby also received a dose after birth.
If given correctly, nevirapine reduces the likelihood of an HIV+ baby significantly. Without this intervention, 25-40% of newborns will be infected by mom.
Only about one in ten HIV+ pregnant women in Swaziland receive nevirapine.
To further reduce the risk of passing on the virus, Lizwi’s mother never breastfed the baby. Many Swazi mothers cannot afford formula (approximately USD$18 monthly), but Lizwi received it from birth.
Last month, Lizwi came to our clinic’s lab and, after a quick needle prick on the heel (like those done when testing blood sugar), our phlebotomist collected a few blood drops. They were dried and sent to a lab in South Africa where they were tested for the presence of HIV DNA.
Lizwi had tested positive for having HIV antibodies in his blood, but it was impossible to know if this was a result of his own infection or if they were mom’s antibodies, passed during pregnancy through the placenta.
I saw Lwizi in clinic yesterday. When I opened his chart, I felt a familiar adrenaline surge. It happens to me when I encounter medical tests results with mortal implications.
The results of Lwizi’s DNA test were back. My eyes scrolled down the page, looking for the word “POSITIVE” or “NEGATIVE” while the rest of me wondered what I was about to be telling the anxious mother in front of me.
Scenario #1 “The test results came back, and your baby is HIV POSITIVE. This is common among babies born to HIV+ mothers, and you did all you could to avoid transmission. Fortunately, this clinic and all who work here are dedicated to making sure that your baby receives high-quality medical care so that he can live to be a healthy old man.”
Scenario #2: “The test results came back, and your baby is HIV NEGATIVE. We will confirm this at 18 months of life to ensure that all of your antibodies have cleared, but in the mean time your baby should continue to grow and develop normally and can therefore follow-up with your nearest neighborhood health center.”
My eyes continued to scan the text in front of me. In caps print half way down the page, my eyes finally found the one word on which the life of Lizwi was to pivot.
I looked up at the baby.
He was contentedly chewing on my business card. An impressive quantity of drool was falling from the infant’s chin.
I confirmed his name, matched it to the lab result page, and gave the mom an improvised version of “scenario #2”.
There is an idiom that goes like this: “An ounce of prevention is worth a pound of cure.”
Life and death are difficult to measure, as are illness, wellness and drooling three month-olds.
But when I told Lizwi’s mom that her child was HIV free, the look on her face told me this: A healthy Lizwi is worth a heck of a lot to her.
It was a look of restrained exuberance, of gladness, of relief.
It was not the look of restrained sorrow and defeat that follows a “POSITIVE” result.
I sometimes wonder how much this sorrow would be amplified if the nearly 90% of HIV+ Swazi mothers who do not receive nevirapine knew that the drug costs a mere USD$1-2 per mother-child pair.
Less than a single British pound.
Lizwi, with my business card.
Labels: Patient encounters