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
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
"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?