African Adventure Installment EIGHT

As part of our trip to Lesotho, I very much wanted to visit JoAnna's clinic in Maseru where she is one of several pediatrician working with HIV positive children. The number of challenges that JoAnna and her colleagues face are many. Very many.

Let's start out with some sobering data. The "Top Ten List" of countries with the highest prevalence of HIV/AIDS is listed below. You don't want to see your country's name on this list. Not surprisingly, the poorest of the poor are on this list....do you see why I am on my soapbox? By the way, this list includes only adults....NOT children.

Adult HIV prevalence
		2003
Swaziland		38.8%
Botswana		37.3%
Lesotho		28.9%
Zimbabwe		24.6%
Namibia		21.3%
South Africa		21.5%
Zambia		16.5%
Malawi		14.2%
Central African Republic		13.5%
Mozambique		12.2%

Quite honestly, I wish JoAnna was out of work...(sorry Joey I know you love your job and you're very good at it) but quite frankly if there weren't such an urgent need - if HIV weren't overwhelming so much of the world's population, JoAnna wouldn't have a job. Now, wouldn't it be wonderful if we could put JoAnna out of work? I think she'd like it too...and not just because she'd get to enjoy the company of her husband and dogs more often, but because it would mean that fewer children (who grow into adults...we hope) would be ill as well.

So - we went to JoAnna's clinic. She'd told us how impressive it was - very state of the art, fancy conference room, high-tech computers, but she'd also told us how many problems they'd experienced. I won't elaborate on this because it isn't my place. The bottom line is that despite best efforts, lots of money, and good intentions, there are still problems that are difficult to solve when you apply the workings of a wealthy nation to that of a developing nation. (This is not to say that wealthy nations should not help....but rather that even the best intentions and best laid plans will have faults and mistakes)

She was right - it was impressive. The building is beautiful and new, filled with local artwork and a sense of pride.

The front of the clinic

Artwork in every exam room - the AIDS ribbon made from aluminum cans

"Life is a Rollercoaster" - artwork by a local child

This is NOT artwork...but rather a confirmation that the child who made
"Life is a Rollercoaster" was correct.
This is a receptacle for needles and other such items - the text on the bottom reads
"HIV/AIDS Kills - Be Safe.
It hung across the room from "Life is a Rollercoaster". Sadly ironic.

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And, whether or not it was good for us, it was probably bad for others that there were very few people in the waiting room that day. Now, you might think that this is a good thing.....that only two people in the waiting area is good. But it probably means the following:

1) There are people who should be in the waiting area and are not. WHY?

• They're too afraid to get their children tested because of:
• stigma
• implications of health care
• fear

• They think HIV is a conspiracy of the government:
• People always died before... HIV is just a new thing to blame...it must be made up
• Misinformation has spread like wildfire....herbal remedies will cure you
• The wealthy and educated are always trying to bring down the lower ranks of society....HIV must be made up or intentional.

2) The lack of people in the waiting area makes the gravity of the situation more real

• one file in JoAnna's "inbox" = one boy in the waiting area
• this one boy is HIV positive
• what does his future hold?
  

So, with one lone child (accompanied by his uncle - presumably because his parents are already dead from HIV-related illnesses) in the waiting area and one solitary medical file in JoAnna's arms, the brevity of HIV in Lesotho hit me. (Think of it this way...roughly 30% of the adult population are HIV positive. To put it into perspective in your own life you simply think about the next time you go to a movie theater and break the group into 1/3....they're HIV positive. Or take it closer to home and imagine 30% of your coworkers being HIV positive. Even more scary, imagine 30% of your family having contracted HIV. yah - that's scary stuff.)

I was in the midst of a beautiful clinic with well trained staff, the best computers for miles, and a devoted doctor with a degree from Harvard University. But this one boy stood out- for many minutes he held the weight of the world, the weight of millions who have perished in the clutches of HIV, and millions who will follow. I couldn't take it.

Quite unexpectedly I was unable to bear the thoughts of this small boy, maybe 10 or 11, perishing like the others. I was unable to stand the thought that this child was just another number among millions. And I was pained by the thought that in many ways, he means nothing to anyone in the US, but he means the world to those of his family and friends who remain, see him running and playing every day.

I exited the waiting area knowing that it would be incredibly offensive if I were to break down into tears in front of staff, but more importantly in front of this child. Ryan walked me up to JoAnna's office where I struggled to regain my composure - my heart bruised and open to the filth of the world and its tragedies.

After her exam with the boy, JoAnna returned to her office - her composure containing elements of hope. She really wished we'd been able to sit in on the exam.

One of the things that the doctors ask about is the regularity with which the children are taking their medications. This boy had it "down cold"....he knew which pill to take at exactly the right time. He had been taking his medication with regularity and showed great promise that he would continue. This is a VERY GOOD sign.

The way Antiretroviral (ARV) medications work is rather complex in my opinion. The short of it is however, that if you miss your medications or fail to follow the instructions, you become immune to them.

This is not such a problem in the US because we have many medications available to us...so if you become immune you still have other options with different drugs. This is not the case in Lesotho, however. If you blow it, you don't have other medications readily available. (see note below for information on a 2nd option of ARV medications) You get one chance. You have only one chance. Remember those 30% you imagined a few minutes ago...if they're in Lesotho, they have one shot. If they blow it they're done...and again, this 30% are comprised of adults - NOT kids!

This is the stuff that worries me - the inequalities of our world...that one country is unable to provide the medications needed for their children and adults to combat HIV. There are plenty of related things to worry about as well...drinking water, literacy, malnutrition. The list could go on and the list is VERY real every hour of every day.

I run the risk of sounding like one of those "Save the Children" commercials with Sally Struthers, but the bottom line is that there is a lot of saving that needs to be done. I'm still trying to figure out how to help.


As a final and concluding note to this post, I will say that JoAnna has shared that there has been an increase in the number of people being tested at her clinic (over 600 patients last month) and that there is a second line of ARVs available, however the cost (roughly 20 times more expensive than that of the "first line" ARVs) makes them a difficult and unsustainable option for those living in a country where 49% of the population live below poverty level and the average per capita is $2,500/year .



Next post will be a glimpse of our morning at the orphanage preschool. Many photos to come! As always, thanks for reading, but more importantly, thank you for reflecting on some of this difficult information - I know it can be tough to read about a reality that seems so desperate.

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