The patients come in and out of my clinic doors. Many are stable patients on ARVs with only minor complaints and needing refills for another 2 months. Yet others arrive, sit down and wait for me to proceed. I quickly glance at the child's medical chart as I look around the room. I realize I am looking at the faces of HIV/AIDS. Sitting in front of me is a 12-year-old girl, dressed in a nice pink sundress with a coat on top; hardly the appropriate attire for the 45 degree weather outside. Sitting next to her is her grandfather; I read her medical record and learn that we have asked him to come 3 times, and today he finally arrived. I better make this visit count. Sitting on the other side of her I see a treatment supporter, someone who will help her take her medicines. This child is a double-orphan, living with her grandfather and 14 other siblings. Does she get food? Where does she get her clothes? Will she take her medicines? She has had many HIV staging illnesses. Her CD4 has just dropped below our threshold for ARV initiation. I ask her why she needs medicines. “To make her body strong” she responds. Does she know why she is sick. “No” she responds. She is twelve years old yet does not know what disease she has. Am I truly “doing no harm” as I write out the prescription for her first doses of ARVs, medicines she will take for the rest of her life. Will these magic pills work despite food insecurity, poor adult supervision, poverty, and lack of knowledge about one’s own illness? I give her the prescription and usher her to the pharmacy, wondering if she will return for her follow-up appointment in 2 weeks.
1 comment:
Stephanie, it seems to me there is not a clear better path. If everyone in her family and in so many other families is dying of AIDS, then surely the first thing to address is the AIDS, since that is the root cause of the malnutrition and poor adult supervision. To try to address the cultural problem of her not knowing why she is sick--that would be patronizing. You followed her grandfathers wishes because you are a stranger to this girl and you have to trust her guardian to make the best decision he can.
I am struck by the media coverage here lately about Haiti pre and post-earthquake. I heard a lot about how Haiti was run almost entirely by NGOs before the earthquake because the government was so dysfunctional. NGOs were providing food and clinical aid, education, etc. Experts said that was creating a dependency that inhibited the government's appropriate development. I guess we haven't yet found the magic touch of how to intercede appropriately. Anyway, I think you're taking the best path available to you.
By the way, I'm hoping to see you in August!
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