Milja's Story
Life at Canzibe Hospital
Milja Sheer is a Dutch doctor working at Canzibe hospital near the Mdumbi community. She tells us about a day in her life there.
In the corridor leading to the doctors’ consultancy rooms, many people have gathered, waiting to be seen. Some are bored of waiting. Some are excited, talking to each other, playing with children. Some are eating - chicken feet and necks - the cheapest meat. Some are wearing shoes, most have bare feet. Some of the people here are very ill, in wheelchairs, pale, thin, breathing heavily and coughing. I know they will surely have tuberculosis or AIDS.
In the crowd I recognise a young woman who stayed with her child at our malnutrition centre, Nokuphila (‘good life’), some months ago. She had left a strong impression on me for many reasons. One was that her husband visited many times during her stay at Nokuphila – something very unusual in the Xhosa culture. They were a young couple, in their twenties, and had two children. All of them were HIV positive.
The daughter she had brought to Nokuphila was one-year-old girl, Thandi. A beautiful child, but far too thin and small for her age. Her mother was very dedicated, sitting for hours by her bedside caring for her. Gradually Thandi gained some weight, started smiling again and regained her appetite. We started preparing her for ARV’s, medication to slow down HIV.
Then one day I came to Nokuphila and found that Nozukile was not there - and neither was Thandi. The village health workers told me she had become ill and was send to the paediatric ward. When I arrived there, I did not find Thandi, but in the corner of the room I saw a small bed, with a baby who looked about six months in it. Totally covered in blisters, oozing watery fluid from the red, broken skin, no normal skin left at all. Suddenly I got a shock, I felt sick - this was indeed Thandi.
What had happened to her? I had never seen this in my life before. Was she burned by fire? Why so many burn wounds on her? I found Nozukile in the room next door, and asked her what had happened, she cried and said nothing happened - the blisters just came like that. Then I remembered from my dermatology lessons a syndrome in which the whole skin is ‘eaten’ by bacteria - staphylococcal scalded skin syndrome. This baby, with such a low immune system could not fight the bacteria, and so her skin was being totally destroyed. Thandi was half asleep, half awake, dehydrated by all the fluid loss through her broken skin. She did not smile anymore, neither did she cry. There was no child left inside her.
I could not handle it, but walked to the cupboard and started preparing things to put up a drip for Thandi, with fluid to rehydrate her, and strong antibiotics to help fight the bacteria. It was all we could do for her. The next day Thandi’s bed was empty. As I had expected, another AIDS baby had lost her struggle for life. And now, at least half a year later, I saw Nozukile in the corridor, waiting for me...
I called her and closed the door of the room behind us. She came to see me to show me her CD4 count results, an indicator saying how good or bad the HIV in the blood is. It was bad, her CD4 count had dropped and she needed to be put on ARVs.
Then I remembered that I still had a picture of Thandi on my computer. I asked her if she had any pictures of the daughter she had lost, and she said no, so later I went home and printed Thandi’s picture. Though it was not a good quality image, it was so clearly Thandi - with her big eyes, taken when she was in her cheerful times at Nokuphila.
When I gave it to Nozukile she was quiet, tears welling up in her eyes, ’I loved her so much’ she said. I wanted to console her, but knew my words would never heal any of the pain of her lost child. So I started to ask about her other child: she looked at me: ‘It also died...’ Then I asked her how her husband was, he had looked so healthy and beautiful when he came to visit them at Nokuphila some months back. She looked down and whispered: he died last week.
Here I was, sitting behind my doctor’s desk, having to bring the news to Nozukile that her blood values had gone down, that her HIV was getting worse, and that she was in need of medication urgently to help her stay healthy and not die, while all her loved ones had already died - two children below the age of three and her young husband.
She carefully wraps the picture of Thandi in a plastic bag and after I tell her where she can find the ARV clinic, she leaves my room. The door opens again: next patient. My next patient is a happy child, with only a small bruise on the elbow, he fell while he was bringing the cows home. I give him something for pain, and a balloon, and his smile helps me balance my emotions.
My account is real, only the names have been changed. It is one of my many encounters with HIV and AIDS. In my district one in four people is HIV positive and one in three babies of HIV positive women are also HIV positive.
What we do have now is supply medication to help fight this disease and I am thankful for this - many people can be saved. But the first step for them is to acknowledge they have HIV. They need to be tested. What we need here is HIV/AIDS awareness and education. Let the people know about HIV and AIDS, let them talk about it, let them speak about their fears, their anger, their needs. Let them find a way out of their loneliness.
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