Happy/Sad

Today, back at work.  So happy to see my friends.  They greet me with such love.  A very busy day.  First the mamas about to burst, 36+ weeks, then the “new” moms.  Victoria came back to help we were so busy.  I’m not sure I’ve talked about her.  She is a pre-med student who has been here already for 3 months.  She is from Montana.  A super girl, and now a new friend.  She loves Africa.  And she fits in and communicates like a native.  I so much want to be like her by the time I leave.

I have put up a “cheat sheet” for me for words I use all the time on the wall.  Alodia thinks its funny.

But the happy thing!  A young mother came back that we had examined prior!  And with twins!  Two sweet little baby girls.  So very tiny, but very healthy.

That was a happy, happy time.

But then, the sad thing:  My last mama of the day.  With our new moms (Not that this is their first pregnancy, it is that they are new to us.  The percentage of mothers actually coming into the hospital is very low.)  we always do 3 blood tests.  HIV, syphillis, Malaria.  We actually ran out of the syphillis tests last Friday.  But, luckily they were restocked today.

Anyway, these tests are immediate tests,  I just prick the mama’s finger and apply the blood to the testing strips.  And yes!  I wear gloves!  I then apply the reagent to the strips.  Within 5-15 minutes we have the answer.  Very much like a pregnancy test.  One stripe you’re negative.  Two stripes, positive.  (Although I believe that’s reversed on the pregnancy tests?)

I do the tests as soon as the mama comes in the exam room.  After I finish starting the strips,  I proceed on with the physical exam, measuring the bellies, palpating to see baby placement, and listening to fetal heartbeat.  This allows the time for the tests to process.  By the end of the exam, I give the mama her tetanus shot, then whatever pills we have available. (Still out of the malaria tablets) .  I then can glance back at the strips on the table, and give the mothers the results.

All afternoon, each test was negative for all the mamas.  I had seen 9 mothers so far.  Yay!  One line on the testing strips.  No HIV!  I could tell the mama, “Omnamatata” (All is good!)  They would smile, and say, “Asante.”  (Thank you)

But my last mama.   As I turned to look at the strip on the table, my heart fell.  Two stripes.  Two ugly glaring stripes.  HIV positive.  Darn it!

I tried to keep my face unemotional, I smiled at the mother, said “Kusibiri” (Wait) And took the tray into Alodia in the other room.  I didn’t have to say anything, just show the tray to her.  She was busy with another patient, but glanced down into the tray.  Her face also dropped.  And she let out a deep, deep sigh.  She then got up, and we went back into my exam room where my new mother was waiting quietly and patiently.

There is another second test you give to verify if the first test is positive.  We did that, and yes, it was positive.  Alodia then very quietly and gently told the mother.  My Swahili isn’t good enough to understand everything Alodia said, but I got the gist of it.

The mother’s reaction was very African.  She smiled softly, and just said. “Asante”  No crying, no hysterics, nothing.  I asked Alodia later if she thought the mother already knew, and that why hardly any reaction.   Alodia said, likely not.  This is just very African.  Stoic.  Brave.  Taking life as life hands it out.  Not showing sad emotions on the outside.

We then took the mother over to the CDC department located in the HIV outpatient building so she could get started with her meds.  She is early enough there likely won’t be any transference to the baby.  One good thing is the mother actually came into the hospital.  She can get treated, and so can her unborn child.

I had seen 9 new moms that afternoon prior to my last one.  All negative.  And this last mother positive, 1 out of 10, so 10% HIV positive rate.  I asked Alodia if that was a good number, a good day.  Alodia said, and this struck me to the core.  “The only good number is 0”

This mother has 4 other children at home.  The father and last baby will need to come in to be tested too.  The truth of the matter is, many mothers do not even come into the hospital to have their babies, they have them at home, alone, or accompanied by a family member, so are not even being tested.  So, of course, not getting any HIV medications.  And HIV spreads.  On and on and on.

HIV is rampant here.  The reported numbers likely aren’t accurate.  You hear from 10-45%.  My personal anecdotal day today was 10% of mothers that come in to the hospital that is.  But who knows what the numbers really are?  Wednesdays are our HIV mother day.  And all I can say is, the waiting room is full to overflowing.  And mothers waiting outside in line wrapping around our little building.   Breaks my heart.

But this is life in Africa.  And life for me at St. Elizabeth.