Reflections

Just now I got back from dinner with friends, at one of the few places to actually go out in Mbabane. We were having a good-bye party; we have regular goings and comings around here and its always fun to be well wishers and also to greet new folks, wide-eyed to explore Africa. In anycase, I'll just share a brief conversation.
My friend asked me how work was today. My response was, to me, quite ordinary. "It was a good day today. No one died today. I went to the hospital to see the children, and no one was even listed in the death book. None of our patients died since I was last there, on Thursday." My friend Neal stared at me and after a few pauses just questioned, "A death book? No one died?" This conversation would have been foreign to me a year ago as well, and I often forget to tailor my response for my non-medical friends. In fact, I chose pediatrics because it is a happy field. No one is SUPPOSED to die. Unless of course they have HIV and malnutrition and perhaps TB as well as food insecurity and come from poverty. So, I'll confess, it wasn't a great day. I had to tell a mother her child is HIV positive. That is pretty routine for me. But in doing so today, I had to pull her away from her child, who was severely dehydrated, weak and lethargic. We have given her IV fluids, treated her for a pneumonia, treated her for gastroenteritis, and she is not getting better. I told her my plan for her child, to start TB medicines now and ARV medicines in two weeks. She knows her time with her daughter may be limited; she wants the ARV medicines today. I explained to her they don't work overnight, and will make matters worse if her daughter is acutely ill. We must solve the acute issues before battling the chronic issues. She nodded acceptance and returned to the bedside. I continued on my day, repeating the advice multiple times throughout the day. That was my day today.