Sixteen and scrawny, Jonathan sticks out on the bench of mothers and aunties and grandmothers waiting with their children to see the pediatrician in the HIV clinic. An older boy among the line of women.

I often see adolescents who come to the clinic by themselves, often walking for over an hour to the clinic to collect their medicines and see the doctor each month. Jonathan is not here at the clinic for himself though. He is here because he has become a mother of sorts for his young cousin.

George's mother and father died from HIV in the course of the past two years, leaving six-year-old George in the care of his aunt, Jonathan's mother. Then, the virus took her life too, leaving both Jonathan and George orphaned, leaving Jonathan to take over the responsibilities of the household. Jonathan also watches over his younger brother, an 8-year-old.

Jonathan tries to take good care of George. He gives him his HIV medicines every day, although it becomes clear in our discussion that he has a hard time getting George some of his doses on time. He tries to get enough food for George every day, but "food is a problem" the 16-year-old tells me. I see the worry in his eyes.

I am worried too. George is not growing. He is losing weight, and the cells that mark how well his immune system is holding out against HIV are getting lower and lower and lower. I am worried that this sweetly smiling six-year-old needs more food and new HIV medicines. I am also worried that both George and Jonathan could really still use a mother.

One million children in this country have been orphaned by HIV. George and Jonathan are just two of one million.

I tried my best with my usual set of doctor tools - a physical exam and blood tests and prescriptions and lots of counseling about how to take these medicines so that they work. I was at a far-away clinic that did not have a nutritionist or a social worker today, but we attempted some arrangements for Jonathan's little family to get some extra help and extra food.

I am thankful for Jonathan, who has stepped forward to take care of his brother and his cousin amidst the devastation of his childhood and his family. I am thankful for a clinic with teachable, kind clinicians and my faithful study team who will follow families of any kind very closely. I am thankful for our Orphans and Vulnerable Children program, who will use what few resources they have to help children like these. How I depend on them… I want these teams at every clinic.

We'll do our best to offer Jonathan a few less days of worry, even though I find myself worrying about those two still.

Posted at 06:59


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