Hi Five
The baby on the table in front of me smells faintly of vomit. As he draws raspy breaths through fluid filled lungs, I can see that his entire mouth is thick with thrush. I hold him still while the doctor first inserts a naso-gastric feeding tube, then attempts to put a cannula into one of his tiny veins. He barely moves or cries as the doctor inspects arms, feet, hands, wiping them with spirit, tapping them to try to find a vein. I don’t remember how many attempts were made before the cannula was inserted. I think I may have gone home by the time the doctor finally succeeded. The next morning I hear that this baby has died. The doctors are a little confused as to the exact cause of his death. He has pneumonia, bu had been responding to antibiotics, and thrush, though unpleasant, is not a killer. Basically, another baby dead from unknown causes related to HIV infection.
HIV has been a constant feature of our stay in Botswana. On our very first day, Dr Sinvula came to show us around the hospital. “In the beginning, there was a lot of stigma, and people didn’t really want to talk about it,” he told us, as we walked through the dedicated HIV unit next to the main hospital building. “But now it’s not a big deal.” Next he showed us the paediatric ward “a lot of HIV related problems,” and the male medical ward “this is mostly HIV related.” The virus is a huge problem in Botswana; one in three adults in Botswana is living with HIV, possibly the highest rate in the world. Fortunately, the country has the means to provide HAART to everyone with a CD4 count of less than 200, arguably the best antiretroviral program in Africa.
Despite the lack of stigma, it has taken me a while to realise that people are rarely referred to as HIV positive or negative. “RVI positive” (retroviral infection), “PMTCT positive” (prevention of mother to child transmission – used to indicate that a mother is positive), “PCR positive” (polymerase chain reaction – a test), “on HAART” (highly active antiretroviral therapy) and even “hi five” (HI V – geddit?) are all ways that doctors and nurses communicate the HIV statuses of their patients to each other. I have also got used to wearing gloves all the time; the majority of doctors won’t touch a patient without wearing gloves. Where in the UK we would wear gloves, in Botswana they would wear two pairs, and one pair would be sterile, as sterile gloves are thicker. Needle stick and splash injuries, and the associated HIV tests and post-exposure prophylactic drugs are just part of the job for health care workers.
I wonder what this part of the world would be like without AIDS. Botswana is a very new country, only gaining independence in 1966. Since then, it has gone from being one of the poorest countries in the world to one of the richest in Africa. Most people here do not consider Botswana a developing country at all; one of the doctors even tells me it has more resources that than the UK. What would Botswana be like today if it had not lost a huge chunk of its work force to AIDS? What would the country have done with the money that it now spends on antiretroviral drugs? 50% or so of the patients on the wards are there because of HIV; I try to imagine the paediatric ward with half the number of patients, no mattresses on the floor and no problems with understaffing. An advert on SABC urges young South African’s to imagine a generation that is free of HIV. Botswana has been a success story in treating HIV; I wonder if it also has the potential to be a leader in preventing new infections.
