My Final Week

I just cannot believe that this is my last week here. I've spent so long looking towards this trip. I'm concerned how I'll feel once I get home and no longer have this in my future. I guess this is just to say, I'd really like to return.
I'm here now with Sheldon, a nurse who is also a Professor at the University of Rochester, among many many other things, and Kevin, also a nurse, who is a Professor at Georgetown and is one of those running this program. I like them very much and we've actually been having a lot of laughs. Kevin got in on Saturday night and on Sunday he and I went to Phophonyane Falls and hiked around in the off and on rain. It was so beautiful and I'm frustrated that I neglected to bring my camera. Sheldon got in Sunday afternoon. Yesterday was spent orienting him to where we're working and formulating a plan for the week. Betty would have been so happy and I really missed her. They seem to have turned a corner and, now, all the work we wanted to sink our teeth into for the past 3 weeks is available for us to do just that. This makes it doubly frustrating that I'm leaving soon. I want one more month. Ah well. Maybe next year?

Today, Sheldon and I went with the HIV Task Force to a support group for HIV+ people. It was a wonderful group which was actually being interviewed by a related agency. I was able to ask questions of the group members about the difficulties they encounter adhering to medications. The main obstacles they face begin with a severe lack of food, followed by lack of access. They have to go so far, most often on foot, in order to get to a clinic. These long distances make keeping up with medications almost impossible. Lastly, superstition was reported as a problem for some people, although not members of this group. The belief that the medicines don't work or are poison is very common. It was a great group to be a part of. After that, we all piled into cars and vans and we were shown "The Garden Project", a community garden created with outside funds. It was beautiful, although right now its main crop is potatoes.
And finally, we went on a home visit to a mother with newborn twins. This was when I wanted to scream about leaving in a few days. There is so much more work I could be doing. She had done such a wonderful job staying adherent to her meds, increasing the likelihood that her children will have been born uninfected. I praised her for what a wonderful mother she is and when we left her hut the woman running this program said "She shouldn't be having babies". She didn't seem to have any idea how not helpful a statement like that is. Exclusive (meaning no water or food at all) breast feeding for the first 6 months is the best thing for an HIV+ mother to do when there is no clean water available for mixing with formula (never mind the risk of watering down formula when there isn't enough money). I asked if this mother is breastfeeding and the woman running the program (let's call her Mary) said that she had told the mom to exclusively breast feed one child and to formula feed the other!@#$@! I, calmly, asked why. Mary said, "because I don't think she can handle breast feeding both of them". And I'm thinking, "so which child is she going to choose?" Which one will have a higher risk of death by diarrhea? I talked about how helping the mom get food for herself, rather than formula, would make her better able to exclusively breast feed both kids, decreasing the risk of HIV infection for both and for intestinal disease for one. If she's unable, then you could start formula, which you would then have to stick with so as not to risk HIV infection with reintroduction of breast milk. I don't think she really thought much about what I said. I hope to be going out with the HIV Task Force again on Thursday. Perhaps I'll have an opportunity to readdress this topic. Although it will be too late for this mother and at least one of her children. I hope so much that they stay well. I will have to provide "Mary" with lots of information to give them about how to disinfect water. I wish so much I could visit that family again. I know I won't forget them.