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I want the baby to die

“That girl is in again, Doctor Moran,” says the nurse. There is resignation in her voice. I look to where she is pointing and recognise the patient immediately. She has been in four times over the last 4 weeks.

“What is it this time?”

“Cough.”

Barely out of her teens she is 6 months pregnant and like nearly 50% of such patients, HIV positive. She started anti-retroviral drugs 6 weeks ago but has been failing to take them. And she keeps coming back to hospital: diarrhoea, breathlessness, cough – an array of trivial complaints which we have never actually seen first hand and improve within 48 hours of admission.

“Why do you not take your drugs?” I asked on that first admission. She looked at the floor. “If you do not take them there is a good chance your baby will get HIV and become very sick and die.”

She muttered something and the nurse gave an exasperated sigh before turning to me and saying, “She says she does not care – she wants the baby to die.”

So I have to admit to some relief when I find that she is on the side of the ward Emma is covering today. I see Emma moving to the girl next. A few minutes later they pull the curtains around the bed. I carry on the my round.

45 minutes later and Emma has not emerged. I am intrigued. Emma is not a soft touch and is ruthlessly intolerant of time wasters.

Just as I am finishing the curtains are pulled back and they emerge. As we walk to coffee I ask Emma what was going on.

“Poor girl. At first I thought she was just a foolish waster. I asked her why she wanted the baby to die. She started crying. It turns out her parents are dead, her sister is dead and she has to look after her sister’s four children. She never finished school because her sister died before matriculation. She has no job and no husband. When I asked her about the baby she just burst into tears. She doesn’t know how she can cope. Who will look after the children when she has the baby? Who will help her care for the other four? Who will pay when she has no money. That is why she hopes the baby will die.”

I am devastated. At one time I prided myself on communication. Looking behind the presenting problem to the real issue that lay beneath. But I have let the culture and language barrier inhibit me from hunting out those issues in the way one might at home. It is too easy to make the mistake of thinking that just because you cannot ask how someone might be struggling, or because they are disinclined to say, that they are indeed not struggling. You are protected by the insulation of the translator. Today I am reminded that fear, responsibility, loneliness, isolation and desperation are the companions of many rural Zulu teenagers and mothers – whether or not they choose to tell me.

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