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This lack of basic rights trickles down to the children who are often under women's care. "I saw a nine-year-old girl, who had just tested HIV-positive two weeks ago," continues Kim. "I had never seen a CD4 count so low; I could not believe she was still walking without blatant evidence of infection. I tried to impress upon her father the urgency of the situation, the full import of such an immunocompromised state, the dire need for ARVS, urging him to return as soon as possible for adherence counseling with a second caregiver. His response and reply shocked me. There is no hurry, he tells me. I need to wait. He will return when he is ready. There is no emergency. I was sensing defiance in the tone of his voice that he is the father, and he will be the one to call the shots. I have not seen her again. For some patients, we are too late."
Dealing with the still rampant stigma over HIV remains a challenge as well. "The nurses scold me for 'talking too loud about HIV' while I'm [on rounds seeing patients]," Sarah Kim writes a month after arriving in Lesotho. "Sometimes I feel like saying, 'well the majority of this ward is positive so we have to talk about it!' But I realize that I shouldn't."
Not having the basic medical equipment and medications that Western doctors take for granted is another adjustment. Even in the Centers of Excellence, which represent the higher end of medical care available in Africa, supply chains aren't always reliable. "There are still many challenges here with labs and medicine not ARVS but things like iron supplements or antibiotics like penicillin that are not consistently available," Megan Harkless e-mailed last week from Botswana. "There is still stigma and fear, and families that are financially very limited with no [electrical] power and therefore no refrigerator. Some patients have to travel for several hours or even an full day to come to Gabarone for clinic visits, many are struggling just to have enough nutritious food to eat."
In spite of or perhaps because of all the obstacles, the American doctors relish any small victory that validates their presence. Annu Goel, who is working in Lesotho with her husband, writes about a six-year-old boy who was brought to her at the most advanced stage of AIDS. "He was malnourished, had pneumonia, a big belly he looked sick," she writes. "But mainly, what stands out is that he is sad. He is ALWAYS sad. One of the doctors here said she did not have a good feeling that he will make it. He has had side effects to a log of the meds. When I first saw him, I told him and his father that he will play and have fun again. I had my doubts until last week. [After being on a different combination of drugs], his CD4 count shot up and his family and I have hope. He still hasn't smiled, but I have hope."
And that, after all, is a big part of what these patients so desperately need and what these doctors provide.
To learn more about the Pediatric AIDS Corps, visit bayloraids.org