The Hardest Day


I just told Deborah that she and her 4-year-old son are infected with HIV. I look at her stunned face, her downcast eyes, and I think to myself that this might be the hardest day of her life. I know it would be the hardest day of mine.

We are sitting in a small clinic room at the rural HIV clinics that AMPATH runs in western Kenya. We treat more children for HIV than any other program in Kenya, probably more than any other program in sub-Saharan Africa. But that all of that experience does not make this moment any easier.

Deborah sits on one side of the desk with her son standing next to her, her arm around him protectively. I sit on the other side of the desk. I have just used my faltering Swahili and the interpretation skills of one of my favorite clinical officers to deliver this bad news. I explain to this mother that our tests show definitively that the reason her little boy has been so sick is because he has HIV. And his mother has HIV too.

"But there is hope," I say, trying to make this terrible day a little better. "There are medicines that can keep him alive - that can keep you both alive and healthy and strong - and we can give you those medicines for free here. We have many who are living with this virus; they are living positively instead of dying."

The paradox of my experience here in Kenya, all wrapped up in yet another encounter in another exam room: the horror of the suffering/the hope of healing.

It turns out this is not Deborah's hardest day.

When she was 26 years old and her husband of 6 years died after a month of illness, she thought that was her hardest day. Then, when Deborah reached a day, just a month after his death, when she did not have enough food or money to give her two children even one meal during a span of 24 hours. She thought that was her hardest day. But then, 6 months later, when she watched her little two-year-year-old daughter die a slow and painful death from a fever for which she could not afford treatment, Deborah knew that she had reached her hardest day of all.

When Alice died, the part of Deborah's heart that had lived outside of her own body and inside her daughter, was suddenly gone. And she thought maybe this incomprehensible loss would "keep paining her until there was nothing left."

"When my boy started to get sick too, I was so worried," Deborah told me, "I was so stressed. I felt that I would just lose everything. I would lose my entire family." She looks down at the frail 4-year-old at her side. "I would lose everything."

The boy is covered in a terrible rash, he is coughing and weighs probably 15 pounds less than he should. But here we are, in the clinic, and everything is not yet lost. He is alive. We know what the problem is. There are medicines. There is food. There is a system to follow this mother and son closely. There is the strong possibility of recovery. There is hope.

This is not the hardest day.

Posted at 03:31


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