Why I love my job - Quote 20 of 20

“He is gaining weight. He is eating too much. His stomach is too big!”

This was the response when I asked how Sinethemba’s mother how her son was doing.

His belly, medically speaking, was not actually “too big”; it was just no longer a concavity beneath his protruding ribs, as it had been before ARVs.

It now looked like a two year-old’s belly should look: convex.

Why I love my job - Quote 19 of 20

“Buya.”

“Buya,” loosely translated, means “come.”

The 2 year-old girl in pink who was supposed to "buya" was carrying a gigantic bag of puffed corn that, if empty, might be able to contain her. She was shoveling the junk food into her small mouth with noteworthy determination.


When her brother said this word, the girl protested but did not resist too vigorously, for fear of spilling. With some degree of effort, the boy, about 4 years old, managed to pick her up and carry her toward the phlebotomy room. (She did not know where she was heading, or perhaps she woud have deprioritized her prized salty snack.)

The brother would have had no chance of lifting her had her growth not been stunted by illness. Undersized children are all too commonplace in a pediatric HIV clinic.The family-sized bag of corn will no doubt add some plump. A mouthful may even make the blood draw hurt less.

Why I love my job - Quote 18 of 20

Sisana, 60yo grandmother of 4yo Sindiswa: “My right arm hurts.”

Me: “Where does it hurt?”

Sisana: “Here.” She ran her hand over her right arm, slowly, from shoulder to wrist.

Me: “When does it hurt?”

Sisana: “When I plow the family fields.”

--

For most all Swazis, Swaziland is not an easy place to live. Without the courage and vitality of Swaziland’s grandmothers, hope would wear thin.

See also these previously posted narratives featuring this admirable group of women:
Ticklish - A patient encounter
Broth, no bread – A patient encounter
An old woman is looking for you – A patient encounter
Happy Mothers’ Day from Swaziland, with love

Swazi HIV Awareness Poster Series - (20 of 20)

Why I love my job - Quote 17 of 20

"Hey! I am so happy."

- 32yo Mr. Sibandze when I told him that his CD4 had gone from 45 to 206 after a few months on ARVs.

I was also happy for Mr. Sibandze.

Why I love my job - Quote 16 of 20

"I am interested in doing everything that you say. I want my baby to be safe. I am here to get pills to protect my baby."

- 27 year-old Lydia during her first visit to the Baylor clinic here in Swaziland. She is HIV+ and 28 weeks pregnant.

--

The prevention of maternal to child transmission (PMTCT) of the HIV virus is cheap and really quite simple. Essentially all babies born to HIV+ mothers can potentially be born without the virus. While such prevention is the norm in the USA and Europe, PMTCT is the exception here Africa.

For want of a few pills, baby human beings are unnecessarily infected with a preventable and deadly disease on their way into the world, many before the first breath.

When I think about this, I do not feel proud. I feel embarrassed and ashamed.

Swazi HIV Awareness Poster Series - (19 of 20)

Swazi HIV Awareness Poster Series (17-18 of 20)

Why I love my job - Quote 14 and 15 of 20

Romanian patient with bilateral parotid enlargement due to HIV.
(www.bayloraids.org/atlas/)

“He was so big here.”

-Mother of 7 year-old Zinhle. As she made this statement, she held her hands up to her ears like earmuffs. She was referring to the child’s parotid glands, which had been enlarged prior to starting ARVs in September 2006. (An example of this is shown in the photo above.) Now, no earmuffs.

“He spoke nothing before. Now he is starting to speak.”

-Mother of two year-old Siphiwe, who started ARVs in June 2007. This is the third patient I have had this week alone whose language skills advanced dramatically after ARVs.

(See quotes 12 and 13 for the other two.)

Why I love my job - Quote 12 and 13 of 20

“The first time I came here…eeesh…it was a problem. He couldn’t talk at all.”

A mother explaining how her 8 year-old began to learn how to speak after starting ARVs at age 7.

--

“She tells me in SiSwati when she poops herself.”

A mother marveling at the fact that her nearly three year-old daughter has begun to use words after starting ARVs a few months ago. She never spoke prior to starting the medicines. (She also knows several other words besides "poop".)

--

You see, HIV, when allowed to replicate freely, is very hard on the developing brain.

Why I love my job - Quote 11 of 20

“I have got a little doctor behind me.”

– Vusi (a proud father) commenting on Siphesihle (his 6 year-old daughter) playfully listening to his back with an imaginary stethoscope, shortly after I did so with an actual one.

Siphesihle is thriving on ARVs.

For quotes 1-10, click here.

Why I love my job – Quote 10 of 10

www.worldhope.ca

“The number of HIV-positive people in developing countries with access to antiretroviral therapy increased 54% to two million people in 2006.” -UNAIDS

BIPAI was a major contributor to this number, especially among children.

Save your pats on the back for later; according to a report released last Tuesday by UNAIDS (where the above excerpt originated), 380,000 children died of AIDS-related illnesses in 2006.

Three hundred and eighty thousand...

...due to a lack of access to existing drugs.

A few pills or syrup teaspoons a day equals undead kids, healthy kids.

Smiling, playing kids.

--

Only 15% of the 780,000 children in need of antiretroviral drugs had access to treatment by the end of last year.

Only 4% of HIV-positive children received the antibiotic co-trimoxazole, recommended by WHO for HIV-positive children and infants who contracted the virus from their mothers during birth.

Children account for 14% of those in need of antiretroviral treatment in the region but only 6% are on such treatment regimens, according to the above report.

Because numbers such as these tend to underwhelm or overwhelm (for being too abstract or too big, respectively), I am going to begin a series of mini-biographies of some of these children tomorrow.

For abstract of report cited above: Antiretroviral Therapy Access Increases In Developing Countries, Hundreds Of Thousands Of Child Deaths Preventable, U.N. Report Says

Why I love my job - Quote 9 of 10

The first child to receive ARVs at Lomahasha clinic.

“The first pediatric patients on ARVs have been rolled out and were seen on site by the outreach team and a nurse of Lomahasha clinic...It was a very special moment, because Lomahasha is the first site for roll out and is hopefully serving [as an example] for many other clinics that will follow in the future.”


This is a segment from an email from Helga Loeffler, a colleague of mine here in Swaziland.


We are working toward the decentralization of pediatric HIV care throughout Swaziland, and the Lomahasha clinic, previously ill-equipped for such care, is now dispensing ARVs to children.


A 'special moment', indeed.

Why I love my job - Quote 8 of 10

"But I have promises to keep. And miles to go before I sleep, And miles to go before I sleep."

Okay, so this is not actually a recent quote, but rather the end of a oft-cited 1923 Robert Frost poem titled, "Stopping by woods on a snowy evening."

There are no snowy evenings in Swaziland, but, as you can see below, there are many miles to go, indeed.

Why I love my job - Quote 7 of 10

“We are trying to have a sharing of experience.”

This quote came from a speaker phone sitting on the desk of our clinic’s executive director, Busi. We were having a conference call to discuss a new training collaboration between Baylor International Pediatric AIDS Initiative, Swaziland and Elisabeth Glaser Pediatric AIDS Foundation, Mozambique.

D.C., Houston, Mozambique, and Swaziland representatives of BIPAI and EGPAF were on the line.

I haven’t met the owner of the quoted voice (from the EGPAF Maputo office, I believe), but he spoke with authority and a French accent. From what I can gather, is quite excited about the undertaking, as am I.

The plan is to bring eight Mozambican physicians to our clinic (over 3-4 months) and introduce them to our pediatric HIV care and treatment program, while also learning about the challenges that they face in Mozambique.

For me, it is an opportunity to speak Portuguese, share the Baylor experience, and learn what it is like to do similar work in Mozambique.

The first visiting docs are scheduled to come in July.

Plenty of bloggable material will come of this, I am sure.

By the way, we saw 166 patients in clinic today, nine shy of yesterday’s all-time record. I need to go eat something, but will try to post a few more substantial entries soon.

Why I love my job - Quote 6 of 10

“One hundred and seventy five.”

Sibongile said this as she looked at today's patient roster. It is a new clinic record for most patients seen in a single day.

While 175 is a small number in the grand scheme of this epidemic, it is a number that certainly keeps a pediatric HIV clinic bustling.

The more, the merrier, I say...or perhaps, the more, the healthier.

In any case, it is seven thirty, and I still have to do my taxes. I will try to post more tomorrow.

Why I love my job - Quote 5 of 10

"[BIPAI's] become a model for the global pediatric AIDS community. This is a model that works."

Quote by Texas Children's Hospital President and CEO Mark A. Wallace, printed in an article in the Houston Chronicle describing the growing partnership between Texas Children's Hospital and the Baylor International Pediatric AIDS Initiative, worth up to USD$10 million.

The funds "will allow BIPAI to open at least 20 new African clinics and intensify its focus on preventing mother-to-child transmission of the AIDS virus."

Why I love my job – Quote 4 of 10

“Lomtfwana ubukeka amuhle.”

She looked me straight in the eye as the said this, and chuckled as the SiSwati words rushed from her mouth. Her face was creased as smiling faces sometimes crease when skin bunches around the nose, eyes and forehead. Her words were dripping with gladness. Her handshake whitened my knuckles.

“What did she say?” I asked my translator, Thembi, after the old lady left the room.

“She said that she is happy. The gogo is very happy that the child is looking good now.”

The child is a 6 year-old named Phumile, and she started ARVs two years ago. Her previous health dossier included herpes zoster, chronic upper respiratory tract infections, pulmonary TB, pruritic papular eruption, and other things that nobody wants on his or her health dossier.

Translated directly, the quote means "the child is looking good now."

Indeed, she was.

(I sometimes find it hard to believe that I actually get paid to watch sick children look better and better.)

Why I love my job - Quote 3 of 10

“La la…la la..…la la la la…….la la.”

This quotation is attributable to an 18 month-old patient, named Khayalethu, on her way down the COE hallway to my exam room today.

She was started on treatment for extrapulmonary TB in February, 2006, initiated on ARVs in June, 2006, and singing on this 3rd day of April, 2007.

She sings for good reason…her TB is cured and her CD4 count has nearly tripled.

Why I love my job - Quote 2 of 10

“I have noticed that maybe there is an effect on growth. He is growing faster since the medicines. He plays football with the others, plays moto, runs, does everything. Everything with the others.”

I asked the grandmother what she meant by “moto”, and she explained that “moto” is a type of contest where the children build cars out of wire and see which one is the fastest, biggest, fanciest, and so on.

I have seen these cars. There are many varieties, but they have one commonality: they are toys made from common materials, often scrap metal and leftover jugs, bottles, tubes, etc.

I once saw one equipped with battery-powered FM radio. (I think I have a photo of it somewhere.)

Until I unbury it, I offer the following examples from the internet:

www.junglephotos.com

www.synesthete.com

www.askadavid.org