Jabu’s mother - A patient encounter

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Jabu’s mother held the off-white white face cloth up to her eyes to hide her tears. Her husband died of AIDS and TB three days ago, and I had just told her that her HIV+ nine month old might have TB.

“Until we are sure that your daughter does not have TB, it is dangerous to start the ARVs,” I explained to her.

“But she needs ARVs,” the mom responded. She was absolutely right, and I told her this.

Jabu’s mother knew that if her husband had received ARVs earlier, she would not be a widow. She did not understand that starting ARVs in a child with an active TB infection is life-threatening.

Her mother-daughter family was now a family of two, and there is really no such thing as a family of one, so cutting corners was not an option. I explained this to the mother, and she understood.

Jabu’s mother supports her daughter by sewing in a clothing factory. She dressed the part, with an elegant pastel green blouse and flowing, floral-patterned black skirt. She wore a solemn, proud expression, even as she mourned the very recent loss of her husband. Every 15-20 seconds, she would move her small towel to her face to absorb tears and hide pain. She pressed the cloth firmly against her face with the index fingers of both hands.

Jabu is scheduled to get an x-ray tomorrow and come to clinic on Monday, after her father’s weekend funeral. If the film is clear, we will start ARVs that day. If it is not, she will receive TB treatment for 1-2 months and then start highly active antiretroviral therapy.

I reviewed this plan with the mother and gave her bus fare for the return trip to clinic, for funerals are expensive and running a sewing machine in Swaziland pays little, no matter how fashionable and valuable the product.

While it is not my practice to hand out money to patients, no mother should have to worry about how she is going to scrape together three and a half dollars while burying her husband.