Monica's Collapse

on the floor

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

Monica 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 Monica to take care of her.

Monica 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.

"There is no one to help us," she says.

Monica has been sick since Saturday, with a high fever, headache, and vomiting. She has not been able to eat much. And today, she 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 my little office exam room. I piece together the sad story of what brought her here, to my floor.

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.

So often, my challenges here are not just 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?

Posted at 08:23

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