When peoples care for you and cry for you, they can
straighten out your soul. - Langston Hughes (b. February 1,
Three generations sit in front of me, in two plastic chairs on
the other side of my wooden desk in the clinic exam room.
Toddler, mother, and grandmother.
Outside of this room, at least one hundred families wait on
benches to see the clinicians at this rural HIV clinic. A rooster
is crowing loudly just beneath my window. But inside this room, it
is me and the quiet females spanning three generations of a
Mary, the grandmother, holds 3-year-old Grace in her arms.
Little Grace is quiet and subdued, a too-skinny toddler looking at
me with big eyes. She is holding a strip of colorful stickers I
have given her, but she is not yet ready to make consistent eye
contact with the scary white doctor. Next to them, Grace's mother
Florence also sits quietly, holding a brown purse on her lap that
contains 6 medicine bottles - two for herself and four for
All three generations of women before me are infected with HIV.
Both Mary and Florence were infected by their husbands. Mary's
husband died a year ago, and Florence's husband left her when
Florence started to get sick. She thinks he is working in Nairobi,
but she doesn't know for sure. Grace's infection passed from her
mother's body into her own during Florence's pregnancy, before
anyone knew that Florence had HIV.
Three females with three beautiful faces. And, truly, they are
the faces of HIV around the world - women and children, living in
poverty in the world's poorest places -- marginalized by their
gender, by their economic opportunities, by their lack of
education, and by their infection.
We could have prevented all of these HIV
If Mary or Florence's husbands had worn condoms or had been
taking medicines for HIV, the virus would not have passed to their
partners. If Mary or Florence had taken one pill of HIV medicine a
day - something we call PREP - they would have been protected
against getting infected, even if their partners were not treated
and even if they didn't use condoms. If we had known that Florence
was infected with HIV when she was pregnant, we could have spared
Grace by giving Florence medicines to take during her pregnancy,
delivery and breast-feeding. We know how to stop these
We know how to stop the spread of this virus, but we have to
find ways to give even the most marginalized women the knowledge
and power to stop this virus. We need the political will, we need
the money, we need the empowerment.
This family sits before the pediatrician because Grace has been
coughing and coughing, and they are worried about how poorly she is
growing. I am worried too, and I get an x-ray and start her on some
medicines for pneumonia.
I can treat this pneumonia. I can give them the right HIV
medicines to keep their virus sleeping and keep their immune
systems healthy. I can try to get them food support and even
entrance into our microenterprise opportunities. I can continue my
work to make this a healthcare system that serves well the needs of
150,000 patients with HIV.
I wish, though, as I sit with these generations, that I could go
back in time and put the right prevention in place. I wish
for what I cannot do.
As Mary stands up, strapping her granddaughter to her back, she
turns back to me and says, "Asante, daktari. (Thank you,
doctor.) Thank you for your care for us today."