Stories about Sipho, Part 3

In September and October, we posted Stories about Sipho, Part 1 and 2, blog entries by Dr. Ryan Phelps about a Swazi boy named Sipho. As you will see in this latest entry, Sipho is regaining his health due to the antiretroviral treatment that (RED) money is helping to pay for, through the Global Fund.

Here's Ryan's latest update:

When my colleague, Dr. Eileen Birmingham, told me that there had been several casualties in the pediatric ward over the weekend, I had a feeling that Sipho was one of them. I had been out of the country and had not seen the child in over two months. Every time I asked for news of Sipho's condition, the news had not been good.

As Eileen started to list some of the causes of death, her shoulders sank, her head bowed slightly, and her face grew tired. There are few activities more dejecting than listing dead children. I rested my forehead in my palm, waiting to hear the name “Sipho” or the word “anemia,” which would probably have been what killed him. HIV-induced anemia, that is.

Late last week, Sipho's hemoglobin had been down to 2. As I explained in my earlier blog, it had been 3.4 when I saw him in September, the lowest I had ever seen in a living child (12 is the lower limit of “normal”). About two weeks ago, he was hospitalized so that he could receive a series of blood transfusions. Though he had received several units since that time, he was on the cusp of cardiovascular collapse. Sipho's bone marrow, after years of assault by HIV, had simply stopped making new cells. After several months of treatment, his ARVs had certainly done much to vanquish the virus, but his bone marrow needed time to recover.

I listened as my colleague continued the list of “late” children. I prepared myself for the news, ready to add Sipho to our list of failures.

"Oh, yeah, and then there is Sipho," she finally said.

The name entered my ears more like a sharp object than a name. My gut tightened, blood rushed to my head. I felt that queer, breathless quiver in my chest that immediately precedes bad news. Dread and anticipation became a slurry of anger and sadness.

Dr. Eileen went on to explain that she had last seen Sipho on Saturday. He had been bedridden, and still catastrophically anemic.

"He looked as if he might die right then," Eileen explained.

When she returned to the pediatric ward Monday morning, Eileen had found Sipho's father sitting next to his son's empty bed. Parents of deceased children often have to wait until Monday morning to pick up a child's official death certificate, as they are not available over the weekend.

Seeing this, Eileen asked the father what happened.

The man pointed out toward the hallway and said, "He is there."

"They took him away?" Eileen had asked to clarify.

"No," the man said, confused. "Sipho…went out there."

Eileen looked out the door into the corridor, and there was Sipho, marching toward her, chin held high.

Upon hearing this, I immediately asked Eileen for a ride to the hospital so that I could see Sipho myself...

---

For every HIV-positive child like Sipho who survived the weekend, many did not. ARVs are not reaching children fast enough. As I write this, and certainly as you read it, Sipho remains in grave danger, and for one simple reason. He was HIV-positive for eight years yet only recently started receiving ARVs. While (RED) and the Global Fund are doing a lot to expand access to treatment, most people who need treatment are still not getting it. There is still a lot of work for all of us to do...

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.