8 months old is the most delicious age. Chubby little arms and legs, the desperate start of an uncoordinated crawl. The first “mamas” and “dadas”, little fingers finally victorious at picking up tiny objects.
Ava came to us at 8 months of age. But instead of roly poly deliciousness, she was skeletal – 3.5kg, gaunt cheekbones in a garish caricature of how a baby face should be. Ribs clearly visible, arms no thicker than your own big toe – a shell of a baby, her appearance reminiscent of a Holocaust victim. Vacant eyes, devoid of hope.
We tested Ava, pretty sure of the result before it even came back – both Ava and her parents were HIV positive. Her immune system destroyed by a vicious virus, she came to us malnourished, with thrush, aggressive pneumonia, TB, and probably a blood infection with possibly more. Her desperate body trying to fight too many battles at once, and losing.
The night after Ava arrived, she started to gasp, and she was taken to intensive care and put on a ventilator until she spat out her breathing tube. The next morning I saw her and had to have one of the hardest conversations I’ve ever had with a mother.
I told her that Ava was going to die, and that she was going to probably die that day. And that spending her time in intensive care was not going to help her – that she should be made comfortable back on the pediatric ward, but that if she stopped breathing there was nothing we could do.
I made sure that Mum understood her and her husband’s HIV status, and she did. They wanted to wait a couple of weeks and pray for healing before starting HIV treatment.
I made sure that Mum understood that if she was treated, and had more children, that the virus may not be passed on to them, that future children wouldn’t have to suffer like Ava had done.
She turned to me with a weariness in her eyes that I haven’t seen before. She asked me – is there a way I can not have any more babies, and my husband not find out?
It took me a minute or two to find words.
I gently explained that a permanent solution requires surgery, and that she would need to come to the hospital for that.
She looked away, defeated, no further conversation desired.
This mum has 5 other children, the youngest 8 years old. None of whom are HIV positive. It is likely that she or her husband acquired the infection some time in the last 8 years, and had infected the other. And neither one has been admitted to hospital for a contaminated blood transfusion.
A marriage in which one of the partners has acquired HIV/AIDS.
A marriage in which no discussion can be had about options for childbearing.
A marriage in which irreparable destruction has been wreaked on each other and their youngest child.
An avalanche of multigenerational grief.
Ava died that night. Her mother sat at her side, knowing what was to come and powerless to intervene.
This mother comes from a tribal group in Kenya in which only 48 percent of girls enroll in school, and only 5 percent of those who enroll reach the secondary school level. Many girls are circumcised at a young age and married before the age of 15 to men chosen by their fathers. Nicholas Kristof, a respected journalist who has won many awards for his thoughtful commentary on the invisible and marginalised, noted in his book “Half the Sky” that there’s no silver bullet for justice and aid work in the under-resourced world, but educating and empowering a woman is about as close as you can come to one. Many others agree with him when he says:
“.. girls’ education may be the single most cost-effective kind of aid work. It’s cheap, it opens minds, it gives girls new career opportunities and ways to generate cash, it leads them to have fewer children and invest more in those children, and it tends to bring women from the shadows into the formal economy and society.”
The practice of medicine is important – health is important, and I’m glad to do what I do. But it’s only one thread in what should be a rich tapestry of a fulfilling and meaningful life, in which education, nutrition and freedom to choose play a part.
Let us keep striving, each in our own way, to participate in bringing God’s kingdom to earth. To render this tapestry a beautiful work, in which each thread is long and none is cut meaninglessly short.