child carrying

She walked into my clinic room carrying her 3-year-old sister on her hip. The 3-year-old was tired and on the verge of tears. They sat down at the chair next to my desk, and the caregiver tried to comfort the 3-year-old even as she pulled out the bottles of HIV medicine for me to check. Her face calm and composed, she had the usual multitasking ease of someone well-accustomed to looking after a small child.

But this caregiver is only 10 years-old. A child herself.

The pair of them had walked for over an hour to get to their monthly visit at the HIV clinic. The 10-year-old had to carry the 3-year-old almost half of the way.

And, yet, this is only a small taste of the burden this 10-year-old carries. Since her mother died six months ago, she has been the "head" of their little household. Caring for her little sister. Trying to find food for both of them. Maintaining their tiny home in a shack that once served as someone's cooking space. And, amazingly, giving her younger sister medicines and taking her own medicines twice a day, every day.

Her eyes are old.

They have an elderly, bed-ridden grandmother who is technically their guardian, but the 10-year-old reports only seeing her two or three times since her mother died.

"Food is a problem," she says. "It is a struggle." There are some kind neighbors who, while they say they already have more children than they can afford, are often willing to share a meal with the two orphaned girls. Those neighbors have probably stood between life and death for these girls.

I go next door to consult with the clinical officer about what we could possibly arrange for these two girls, and the clinical officer tells me that she saw a 7-year-old who came in by herself earlier. Another child living with only a very sick and old grandparent. Another child forced into great responsibility so soon.

Frankly, do not have much to offer these children. Our social support services have been cut dramatically with the current round of USAID/PEPFAR funding, and we no longer have a social worker or Orphans and Vulnerable Children services offered at this clinic. There is no one for me to send to the house to follow-up on them or to try to manage their cases.

Of course, what they need most are parents. I can't provide those either.

I try to piece together some follow up through my study personnel and connections in Eldoret (which is a 3-hour drive away.) I give them some shillings and the protein bar I had carried along for my lunch substitute. I feel like I am sending them out with nothing.

Just before they are leaving, as I try to muster up my usual talk about hope and the future and staying healthy by taking medicines, the 10-year-old stops my heart.

"We will carry on," she says. Carry on, small warrior.

Posted at 07:59

Off to Kenya

A little update (from an airport, as usual)...

My team was successfully evacuated from Kenya back to the US this weekend, and now I am headed into Kenya. Things in the country continue to be tense in the midst of a very harsh government response to the Somali community and increased risk for retaliatory and terrorist responses. Nonetheless, the hospital is open to us again and, as always, there are patients to be seen.


I work to build a healthcare system that provides the best HIV care possible for children and families in poor places. Sometimes, those are places with more conflict and risk. And, I know (because we have done the studies) that times of conflict hurt the HIV care our kids receive. So, that's why I am headed in. I want us to keep providing the best care we can.

I may not be able to go to the grocery store or out at night, but I do hope to get to my clinics in rural places. These clinics each see 80-100 children a day, supporting families in the challenge of giving children HIV medicines and treating their infections in the midst of all the other issues going on around them.

In our care system in Kenya, it seems to make a difference if I go to the clinics -- to supervise the quality of HIV care, to troubleshoot issues and to encourage the other clinicians that we really can provide good HIV care for children. I am privileged to have that job, and so back I go to my healthcare system and my children in Kenya.


Posted at 10:10

My Football Star

I just learned that my football star, Wilfred, died today in Kenya. In his memory, these are the words I wrote about him 2 years ago....


Admissions Committee

He looks like the perfect college applicant. He has a set of nearly perfect grades on his high school transcript, a really great score on the national exam for high school students that determines placement into the Kenyan universities, and a record of leadership in student organizations and leading his soccer team to national victory. He is 18-years-old, and he wants to be a doctor. When he talks about his hopes for the future, his dreams gleam in his eyes with the determination of the focused forward who fought through match after match until he shot that stunning final goal.

The only complications to this college application are the laboratory results printed on the paper in front of me. Not only is he infected with HIV, but his immune system is not doing well. His CD4 cells, the cells that fight infection, are low, low, low. And his viral load, the measure of the amount of virus in his blood, is very high.

If only his HIV medicines had been as successful as his row of straight As. Worse yet, he is already on our second-line of HIV medicines, and right now I can only occasionally get a third set of medicines from the government after special pleas and petitions for a few special cases. I will make my best case to this health admissions committee.

"I will fight it," he says. And I believe him. He has tried so hard. He has done so well. He meets my eyes as I sigh and struggle over our options. "I will fight it."

Fight we must.

(Dear Admissions Committee, Please accept him. We'll try to keep him alive for you.)

Posted at 14:11

Join the Revolution

Educate girls.

Change the world.

Screen Shot 2014-03-24 at 11.15.53 AM

Learn the stories of girls from around the world at the screening for "Girl Rising" today on the IUPUI Campus for free. The film will be shown in the Campus Center Theatre at 6:00pm with a panel discussion afterwards. I'm on the panel with some other fascinating women.

One girl with courage is a revolution. #wearegirlrising

Posted at 08:14


For International Women's Day...

If you want to stand for women and girls around the world, you have to think about HIV. You have to consider the ways that HIV tries to knock women down. HIV is the leading cause of death and disease in women ages 15 to 44 in low & middle-income countries. Many, many young women die from the complications of pregnancy and giving birth around the world, but HIV snatches the most lives. This damn virus.

On International Women's Day, let me draw your attention to Lucy. I invite you to stand for Lucy.


Two weeks ago, Lucy peeked into my office within the AMPATH pediatric HIV clinic with two pieces of paper in her hand and a special light in her eyes. She had just seen one of our Kenyan clinical officers, and the clinical officer had sent her my way.

It is very rare that a patient is sent to me because of good news. Usually, they get referred to me when there are complications.

There was a time about a year ago when I was seeing Lucy once a week because she was very sick with a complication of her HIV infection. We switched around her medicines, we gave her money for the bus ride to clinic once a week, we hoped… Thankfully, Lucy made it through those months of sickness. She is 14 now -- healthy and happy and stable on her HIV medicines.

Lucy is not defined by her virus. The light in her eyes comes from her other achievements. She had brought with her to clinic a copy of her grades for the previous semester, and she had reason to be proud - a row of perfect As in every subject. A row of perfect As from a school where anything above a B is a major accomplishment. Lucy was shining.

Lucy's other paper made me awfully happy too - a lab slip where the numbers indicated that there was no virus to be found in her bloodstream and that her immune system has the cells it needs to protect her from infections. My smile matched hers.


There are plenty of lousy things we could think of on this International Women's Day - so many women and girls dying, being infected, being abused, being deprived of opportunity -- but let's think about shining Lucy.

Young stars in the open star cluster NGC 2547

Posted at 11:57


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