Monday, August 9, 2010

A Single Thread...

There is a little boy I can’t get out of my head. I saw him one afternoon at an extremely rural clinic on the paper mill. The nurse there asked me to see him because she was uncomfortable treating children. The boy was 6, HIV + since birth, never on medication. He was being seen in clinic that day because he had been exposed to TB at home, and they were concerned that he may also have TB.

The boy walked into the clinic behind his grandmother. She looked exhausted, worn down, and hopeless, the child looked downcast. From the door, I could see his cheeks puffed out bigger than they should. When he came in, I realized they were his greatly swollen parotid glands (saliva glands at the back of your cheeks). I examined him and found evidence that he has had lung disease for years…Likely not getting enough oxygen for a long time. I evaluated his chest xrays, one from 2008, one from a week before his visit, and confirmed my suspicion that he has had lung disease for some time, likely secondary to his HIV. I also suspect he had TB.

I told the grandmother we were going to have to treat him for TB, and about 2 weeks after that, we were going to have to start him on antiretrovirals. She sighed, and her face fell further, if that was possible. She admitted she was overwhelmed. One of her daughters was dead, one was hospitalized a day before with advanced AIDS complications, and she was left to care for all the grandchildren. As I talked to her further, she noted that she had another 7 month old baby at home who had also been abandoned, and likely exposed to TB. She sighed and said she would walk home and get the baby, so we could check him out as well. It took her about 30 minutes to walk there and back with the baby. In the meanwhile, the 6 year old sat with us. He stared straight forward, face expressionless, nothing we did could make him smile. How many 6 year olds do you know that can sit still without entertainment for half an hour? It broke my heart, and made me fear his young spirit was already broken. His deep, wide, dark eyes seemed that they had already seen much darkness and disappointment, and this had aged him. Finally, Vivian found a mint in her purse, and offered it to the boy. He took it and put it in his mouth, and I thought I saw a tiny smile as he sucked on it. It encouraged me to see a little light back in his eyes. I can only hope that as he receives treatment, he will have somewhat of a new beginning; that as his health improves he will feel life returning to his body and have hope for his future potential. Sadly, I know his health is not the only obstacle he must overcome.

A day later, we visited his mother in the hospital. She had the same wide, dark eyes, sunken with the pain and what she has seen. We updated her on her son, and a bit of worry crossed her expressionless face. Towards the end of our conversation, she suddenly perked up and demanded to be put on antiretrovirals. She had been refusing them in the past, and I think her hospitalization and the sickness of her son made her want to take control of her health. Again, my cautious optimism made me hope that she would follow through so that she could take care of her son, and not become another thing to fail him.

As I mentioned in my previous post, I am struggling a little with knowing in a week I will have to transition back to a completely different world. I thought about this as I took a walk around my neighborhood in Pretoria this afternoon. Although I have never done anything quite like this before, I have definitely had experiences where I have gone out of my comfort zone and had a difficult transition back. And I think I need to remember that every experience is a part of the bigger picture of our lives…And that in the short term, it is sometimes hard to see how a short term experience will fit in to the bigger picture. But it always does. Every experience leaves impressions on us and ultimately becomes seamlessly woven into the whole – as much as we feel so fragmented by our experiences in the short term.

So I hope and pray that as I leave, I will not feel fragmented or disillusioned or disconnected. I pray that I will have faith that this trip has been another thread in the story of my life, and as it continues to be woven together on the loom, this thread will also become woven in, and become a part of the bigger design.

I am deeply grateful for this experience, and humbled by it. I know I am changed, and I hope that I will stay changed, and not forget the lessons I have learned. I hope that this experience will become integrated into the person I am, that it won’t have to be compartmentalized or sequestered or become isolating.

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