Three children

Clinic is getting busier by the day now - which is great. Friday was the first day that we really could have used 2 rooms; the renovation and expanded space will be very welcome when they're ready.

Three kids this week demonstrated why I'm here...

The first is a 6.5kg 2 year old orphan... now, for you non medical types, the average 2 year old weighs 12kg. She was admitted and diagnosed with HIV this week. When we brought her some medicine on Friday afternoon, she looked at us with huge bright eyes and smiled, and offered her hand to shake like a polite Burkinabe child. But she was so skinny, its hard to imagine her being able to walk; she gives a new definition to "skin and bones". Thats where they sometimes start.

We also saw a 10 month old with thrush (which you shouldn't see after the first few months of life); but growing well, developing normally who needs to start treatment. His mom was treated in pregnancy but just took a few doses here and there... so adherence will be a challenge. When we talked to her about the medicines & reasons for them, it seemed like all the information was new to her... either she didn't know, didn't understand, forgot. She feels unable to tell her husband about her HIV status and that is another barrier to successful treatment.

That's common here; women fear being beaten, turned out of the house, ostracised. So many women feel unable to tell their husbands about their infection. Hiding the infection, and the drugs, makes it really hard to ensure compliance.

The last kid, 1 year old, was brought in by an educated mother who had been tested in pregnancy and found to be positive. Despite starting on triple therapy to prevent transmission, the baby was infected and has been chronically ill from the beginning. Started on ARVs at the age of 6 months, and clinically is doing poorly; malnourished, chronic thrush, can't even hold up his head or sit up unassisted. Basically, is clinically failing and will need second line drugs that we don't yet have.

All three of these cases give different management challenges. Social challenges - not enough food, literacy, violence against women, HIV related stigma. Medical challenges - how to manage things with few resources for testing and only a limited selection of drugs.

But I have to say the other reason we're here is this: the kids who do well on therapy, who go from deaths door to being normal, healthy kids. We are also doing followup visits for kids who are doing well on ARV therapy; and they are healthy, smiling (unless the white doctor gets too close), normal kids. That part is great and gives us hope for the first three kids. I'm looking forward to when a few of the kids we start on ARVs start rebounding like that.