Stories about Sipho, Part 2

Left to right: Dr. Helga Loeffler, Dr. Julia Kim, Busi Bhembe (Director of the Baylor Clinic), Christy Turlington, Dr. Ryan Phelps, and Dr. Carrie Golitko, with two young clients of the Baylor pediatric AIDS clinic in Mbabane, Swaziland

Last week, (RED) posted Stories about Sipho, Part 1, a blog by Dr. Ryan Phelps about a Swazi boy named Sipho who is regaining his health due to the antiretroviral treatment that (RED) money is helping to pay for, through the Global Fund.

Here is part 2 of Dr. Ryan’s post:

I looked at the weary, diminished child, hoping that the letters after my name would give me the knowledge that I needed to help him, wishing that I spoke SiSwati (the local language) so that I could say something to try to make the child smile.

Sipho had traveled from Nlangano because, without medicines, his death would be imminent. If he had arrived in Mbabane, Swaziland a few years ago in search of HIV treatment, he would probably have returned home empty-handed, and shortly thereafter there would have been yet another funeral. Now, thanks to the Global Fund-supported national ARV program, through which (RED) money flows, and the growing conscience of the global community, there were pediatric ARVs right down the hall from me, neatly stacked in a cool, white room. If those shelves were empty, there would be no hope for this child’s recovery.

I asked the mother how the child was doing, and, after my words were translated, the mother said, "Not good, doctor." She then gave an abridged account of the above.

I asked if the child could take off his shirt so that I could examine him. He did, and I gave another accidental sigh. I tried to hide it by closing my mouth but the air hissed as it escaped my nose.

Sipho's shallow ribs encircled his frail trunk like the legs of a spider. His skin was more like a tight, fitted t-shirt than real skin. With each heart beat, the skin and bone of his left chest jumped forward slightly. The low-lying afternoon sunlight that flooded the exam room made him look even more wasted. His arms were like tree vines. His lungs made the sound of distant thunder and bubble wrap when he breathed. He had raisin-sized lymph nodes around his neck, armpit, and groin. As he sat there in his shrink-wrap birthday suit, there was nothing anonymous about Sipho.

As the child put his sweatshirt back on, I told his mother that he was still very sick, and that I wanted her to come back immediately if he was getting worse in any way, or if he was not gaining weight. I explained to her that, during the first couple months after starting ARVs, as the immune system gets stronger and begins fighting ongoing infections, her child could begin to have new symptoms, or even get temporarily worse before getting better, because the body’s first reaction to ARVs is an apparent but shortlived weakening of the immune system.

After answering the mother's questions, I asked Sipho if he had any questions. He shook his head a few times, his eyes swaying back and forth as they remained glued to mine.
There was no accusation in his face, just the subjugated, worn-out look of chronic disease.

I reached for my prescription pad and started writing. I gave him two medicines for pneumonia and iron supplements for his blood. I gave him a month’s supply of ARVs and a return appointment.

I then pulled the prescription from the pad, taking care not to rip it. (Keeping the tear along the perforated edge can be a bit tricky sometimes, but I have been practicing.) I handed the small blue piece of paper to Sipho's mom.

Without ARVs, I would not have a job and Sipho would not see his ninth birthday. What a marvel they are, these antiretrovirals. What good fortune to have a job that allows me to help distribute them. I looked up at Sipho, smiled, and told him, "We are going to work hard to make you feel better."

The translator repeated my words, but in SiSwati.

For a second, I thought I saw his eyes widen, but looking back I am not sure.

The frail child made his way to the Baylor COE pharmacy, leaning gently against his mother's outstretched arm.

TO BE CONTINUED…

ABOUT THE BAYLOR CENTER OF EXCELLENCE
In southern Africa, 40 to 60 percent of all deaths of children under age five years are caused by HIV/AIDS. Despite this fact, in almost every resource-limited setting worldwide where HIV/AIDS treatment has been initiated, children are grossly underrepresented among its recipients. The Swaziland Center of Excellence is helping to address this discrepancy. The COE is part of a global network of clinical centers created by the Baylor International Pediatric AIDS Initiative (BIPAI) at Baylor College of Medicine. These clinics are modeled after two landmark HIV/AIDS care and treatment centers that BIPAI constructed and opened in Constanta, Romania and Gaborone, Botswana. The purpose of this network is to build critical infrastructure and human capacity to catalyze access of children worldwide to HIV/AIDS care and treatment.

These clinics are staffed by local health care workers and members of the Pediatric AIDS Corps, a group of over fifty health professionals that are linked to one of the Baylor Children's Clinical Centers of Excellence for purposes of professional development and training, continuing education and clinical consultation. In collaboration with local health professionals, we spend our time here building local capacity through one-on-one clinical mentorship and didactic trainings. We also provide high-quality pediatric HIV care for children like Sipho.

For more on Dr Ryan Phelps’ experiences in Swaziland, go to pediatrician-in-swaziland.blogspot.com.