I met another G today.
G was a special patient of mine in the AMPATH HIV clinics. He
was 15 years old, but you would have thought he was a malnourished
6-year-old if you saw him on the street. He weighed less than 40
pounds, and his head did not reach my shoulder. G lost his father
and then his mother to HIV, and he had the same virus in his blood.
His HIV stopped his body from growing and made him sick with
one thing after another. Tuberculosis. Pneumonias. Even a type of
cancer that grows when the immune system is weak.
- Me, G, and his grandmother on the
pediatric wards of the hospital. The first day he stood up in 2
Our medicines that fight the HIV virus did not help G as much as
they do for most children. While they suppressed the growth
of the virus in his body, his immune system never recovered. It
never began to make the cells that his body needs in order to fight
off infections. This is very rare (thankfully), but G was one of
the unlucky ones.
Today in clinic, I met Noah, another boy whose immune system
does not seem to be recovering despite our very best attempts.
10-year-old Noah, weighing just 11 kilos, with a body that is STILL
not making any immune cells to fight infection. I wracked my brain
for ideas for any other drugs we could possible try to get his body
to recover. I kept thinking about G.
"Not again, not again," I thought.
I don't know why I loved G so much. Certain children just stick
in your heart. I started seeing G in January of 2010 in the
pediatric HIV clinic at our referral hospital. He was staying in a
special shelter where he could be close to the clinic and get both
his medicines and food every day. Most of G's extended family had
washed their hands of this sick, seemingly hopeless boy. His
elderly maternal grandmother still cared deeply for him, but she
lives in a small rural village several hours away from Eldoret, and
her love alone was not enough to sustain his significant needs for
medicines and food and medical care.
I put G in the hospital 3 months after I first saw him in
clinic, and he stayed on the wards for 3 more months with one
sickness after another. Visiting him every day on the wards
and arranging whatever consultations and procedures he needed
became part of my daily routine. I brought him whatever treats he
asked for. Pineapple. Fingernail clippers. Photos. One of the other
pediatricians and I half-joked that the best thing we ever did for
G was probably to bring him fruit. I did love him, this tiny sick
boy with big eyes and a sweet manner.
At the end of June 2010, G was as sick as ever, and he began to
ask to go home. Not to the shelter. "Home," he said, looking
straight into my eyes. He wanted to go to his grandmother's home in
the village. He asked in a way that he never had before; it was not
just the plea of a frustrated child who has been in the hospital
too long, but an urgent request.
I think he knew that he did not have much time left, and he
wanted to spend it at home. We had given him the best medicines we
could come up with here for his infections, but we couldn't give
him a new immune system. It seemed like it was time to do what he
wanted. To let him go home, knowing he probably did not have much
time to live. At the time, there were virtually no services for
Kenyan children at the end of their lives. G could access some care
through AMPATH, but there wasn't much I could do for this final
part of his journey besides send him and his grandmother home with
the right medicines (and a few bags of groceries and my
I don't know how things went for G at the end. He died a few
days after he went home, the same day I left the country. He had
walked for me before he left the hospital, which he had not done in
weeks. He was proud and smiling and telling me that he wanted me to
bring him a bicycle from America. We said our goodbyes, and he was
so, so happy to be going to his grandmother's home. He left saying
that he would be going to a better place. In his heart, I think he
knew where he was going. That was my hope for him. A better
When I sent G home, I promised him silently that I would do what
I could to make our care system better at helping children like
him, children at the end of their struggle with this virus. I have
been trying. But as I saw Noah today, I found myself questioning
whether we could do any better than I had for G. Frustrated by my
lack of medicines, my lack of options.
Noah is getting the best set of HIV medicines and TB medicines
that we have available for kids of his age. The clinicians at this
clinic where we are working intensely are very attuned to helping
children sustain their HIV therapy over the long term, and they
have made exactly the right choices for him. They wanted me to
review his case, and there was not much more I could offer. Even
better, Noah is receiving food supplements and the most patient,
loving care that we can get him at my friend Juli's wonderful
hospice center, Kimbilio.
And so I tell myself that things are getting better, even when I
cannot do much more to stop this repeat besides hoping and