Skip to main content

Disclosure

The waiting area is full. Children are running up and down between the benches, their mothers (and some fathers) watching them as they wait to be called into a consulting room to see a nurse or counsellor. A woman stands in front of them talking loudly in Xhosa. She bangs her palm with the edge of the other hand, as if emphasising her point. She appears to be delivering a lecture. As I get closer I recognise her as the sister in charge of the HIV clinic.

I slip into one of the consulting rooms used by one of the clinic Sisters. “Molo Sister Sibisi”

“Molo Doctor. Ninjani?” She has just given a vaccination to one of the anti-retroviral patients – a flu jab. She applies a dressing, and the man thanks her and slips out.

“Sikhona,” I exhaust my meagre Xhosa. “What is Matron talking about out there Sister?”

“She is giving them a talk on disclosure.”

“Disclosure to their friends?”

“No doctor, to their children. This is parent-child clinic day so the HIV positive parent comes with their positive child and we see both at the same time. The thing is, many of these parents do not tell the child that they are positive.”

“That the parent is positive?”

“No doctor, they do not tell the child that the CHILD is positive for HIV.”

“But how?! The child is on tablets and has been coming to clinic for years.” Most of the children here will have become HIV positive as a result of infection during, or shortly after, birth. Whilst there are treatment regimes that can reduce the rate of infection in pregnancy dramatically the mother needs to know she is positive (and many do not - or do not act on the result) and drugs need to be available at the right time.

She shakes her head sorrowfully. “Yes doctor, but there is a lot of stigma still. And they tell the child that they are taking the tablets for flu. And then one day when the child is 11 or 12 they want to know why do they take the tablets when their friends do not. And then it is very bad, because when the child finds out they often get very cross, and they stop taking their tablets, and then the virus comes back and they can get very sick. So Matron is telling the parents they must tell the children they are positive.”

“But that must difficult as well. A very young child will tell their friends and then might get into problems at school.”

“Yes doctor – both ways have their problems. But we think that the truth is the better way. Nothing good can come from secrets.”

Comments

Post a Comment

Popular posts from this blog

Abscess

The phone rings. I am lying on the sofa in the dark squinting at the laptop screen: someone has lent me series 1 of Spooks. I struggle up and bump across the room to the phone. “Hello?” “Moran!?” “Yebo.” “How are you?” “I am fine.” “I am fine too.” And then those four dreaded words. “Please hold for maternity.” The line goes dead for a second and then a midwife comes on the line. “Moran?” “Yes.” “How are you?” “I am fine. “I am fine too. I have a 22 year old primip. She is in labour but I cannot do a PV. She has a Bartholin’s abscess.” I ask a few intelligent questions and then, pausing only check what exactly a Bartholin’s abscess is (an abscess of the Bartholin’s gland apparently) I head for maternity. On arriving I am taken to the woman concerned and, yes, sure enough there is a large abscess in the position that I imagine a Bartholin’s gland might sit if I knew exactly what it was. “I cannot do a PV to check the cervix because it is too painful.” The abscess blocks the way. “Right.
1 comment
Read more

10 years on

The door flies open. Lele peers in. "You must come out here and see. They are doing a play!" I finish up my case file annotation and come to the doorway. The waiting area is in chaos. A gang of school children are manhandling a couple of marimba's to the space in front of the consulting rooms, a team of nurses and counsellors are creating a stage area. Patients look on mutely. Some with interest, others - presumably feeling proportionately less well - without. "What is going on?" I ask. "It is 10 years since the clinic started. 10 years since MSF first started the HIV treatment programme and proved that it could be done in Africa. So the staff are celebrating. They are doing a show or something." The sister in charge of the clinic has moved to the front of the crowd of patients. She calls for silence and then gives a short introduction. Lele translates for me. "She is saying that this is a very important day. 10 years ago people were dying. And 10
3 comments
Read more

Ceza Hospital

I am woken with a jolt. The 4-wheel drive has left the tarmac and we are on dirt road. I look ahead into the hills – the road wends its way high up into the distance. “How far?” I ask Amos, our driver. “About 40km.” I settle back and watch as the settlements become less and less pseudo-bungalows and more and more mud rondavels. The road to Ceza It was about a month ago that our medical manager first mentioned that we had been asked to help out at Ceza Hospital – a remote rural hospital about 2 hours away. Its medical staff (only 8 at the best of times) had been steadily departing and only one remained. He was leaving at the end of May and they were desperate. Desperate enough to accept help from us. As I said – a month ago – but it was only last Thursday that I found myself agreeing to go. Two of the others had been that week. I phoned them to ask what it was like. “There are no words to describe it,” said Nomfundo, “speak to Dr Kekana.” Dr Kekana comes on the line and after humming an
3 comments
Read more