Noelle is 13, HIV positive and her family’s caretaker

She walked all this way to collapse in my exam room.

Noelle is thirteen, but she bears the weight of two adults. At home, it is only this teenaged girl and her mother. Her mother is bedridden, terribly sick with a combination of HIV, TB of the spine, and malnutrition. It is up to Noelle to take care of her.

Noelle needs to take care of herself too. She also has HIV, this virus that destroys the body’s defenses and leaves it weak and vulnerable. She tries to take her cocktail of medicines every day, but that can be very difficult when you are only 13 and you are the one worrying about food and shelter and care for yourself and for your mother.

Noelle has been sick since Saturday, with a high fever, headache, and vomiting. She has not been able to eat much. And today, she finally decided that she was sick enough that she needed to get herself to our clinic. The $1 that it would cost to get a ride on the bus to the clinic was far too much for the budget in this little household. This clinic is a one-hour walk from the girl’s house. Somehow, she managed to walk for that one hour.

I think that this brave and struggling girl used up all the energy she had left on her walk, just barely holding it together to get to the clinic. Here I find her, on the floor of the clinic exam room. The clinical officer calls me urgently and I come running from the midst of my meetings, from another side of the building.

Eventually, I piece together the sad story of what brought her here, to my floor.

It is clear to me that she should be admitted to the hospital, but the clinical officers tell me that I cannot admit a child to the hospital wards without a parent or guardian to stay with her. And yet, how could I possibly send this one back home? Is she sick enough for me to fight the legal battle to keep her here? And what happens to her mother at home?

What to do, what to do… No one to pay. No one to be the responsible adult. Only this sick girl with too much weight already weighing her down. No good options. I start estimating how much it would cost me to convince a member of my study staff to stay here in the hospital with this patient overnight.

So often, my challenges here are not just challenges with the medicines or with the infections or even with the decisions about how to best treat a child with a complicated disease using very limited resources (although those are definite challenges!)

Instead, these are the issues that twist me up and sometimes break my heart: What to do when there are no adults to care for a child? What to do when your community has fragmented? What to do when a family crumbles under stigma and discrimination? What to do when poverty’s vicious cocktail of malnutrition and violence and stolen opportunity renders my drug cocktail ineffective?

Seldom do I have answers. But here we are, Noelle and me. Somehow, here we are. We are here in each other’s lives, and we need to be love to each other. This is what I struggle to do here — to be love for the children here with my brain and my hands and my resources and whatever else I can conjure. Today, love looks like a way for sick girl to stay in the hospital overnight.