Tuesday is pediatric day at the Anti Retroviral Therapy (ART) Clinic here in Mongu. Although we (Savannah & Leah) enjoyed our week at the ART clinic and learned so much about HIV/AIDS, Tuesday is the day that made the most impact on our experience, as it was one of the saddest, but at the same time, uplifting days of the week.
Just a little background for perspective, currently, according to Unicef.org, there are about 120,000 children under 15 years of age living with HIV in Zambia.
Every year, another 28, 000 babies are born HIV +. Furthermore, 11% of deaths in children under 5 years of age are due to HIV related causes.
This is why Tuesday is sad. Sad because it is children, and mostly sad because there are medications available so that no more children need to be born with HIV, and yet Tuesday continues to be a busy day at ART. The preferred PMTCT (prevention of mother to child transmission) is to start pregnant moms on a triple-action anti-viral medication as soon as possible in pregnancy, and which continues throughout her entire life independent of her CD4 count (this means how low her immune system is). Right now, pregnant moms will only get this preferred therapy if her CD4 count is low enough. If it is too high, both she and the baby will receive medication in labour & delivery. Although this method is effective in many cases, it is not AS effective as the preferred treatment, and some babies will still become infected.
However, there is hope that one day pediatrics will not need to have their own “day” at ART. Zambia is currently undergoing a campaign to eliminate the transmission of HIV from mother-to-child by 2015 (the plan was established in June 2010). So far, the campaign is having positive results – within 2 years, there has been a 55% decline in the number of new HIV pediatric infections (IATT, 2014). Furthermore, 86% of HIV+ pregnant women received ARV medication to prevent transmission in 2011, this is up 36% from 2009! Perhaps most impressive, there has been an 80% increase in HIV testing among pregnant women within 5 years…allowing mothers to know their status, access treatment, and prevent transmission in the future. Zambia has also promised to implement the WHO standard of treatment (remember that one where pregnant moms get the best treatment for their whole lives?) Unfortunately, as we all know too well, there is always a lag between the promises made at the “top”, and the actions that occur on the ground, especially in a country where resources are limited and accessibility to health care can be challenging (anyone up for a 5 hour walk to the doctor?)
It was sad seeing these children who were HIV+. It was sad that many of them were small for their age, possibly due to bouts of chronic diarrhea or lack of appetite from constant respiratory infections because of their decreased immune defence. It was sad seeing a 12 year old already having to switch to a second-line treatment because he had developed resistance to the first-line treatment and had a CD4 count of 84 (that is really low!)
It was uplifting because these children were smiling, laughing, and trying to catch all the bubbles Savannah was blowing at them (big hit!). They are on ARVs and are growing up living healthy, active lives – like all kids should, independent of the country they were born in or their HIV status.
The ART clinic is very busy any day of the week, and can seem overwhelming with up to 500 clients flowing through each day. The clients show up early in the morning to receive education, and then must make their way through registration (to find their file), then on to see the nurses where they are weighed and measured, and have their vitals taken. After this, they may have their blood drawn depending on when their last CD4 count was, and then back into the que to see the clinical officer (by the way – there was ONE clinical officer the day we were there). Then they still have to go to Adherence (to ensure the medication is being taken properly), and on to pharmacy to receive a new supply of meds. The whole process can take hours, waiting on hard wooden benches, or standing elbow-to-elbow on the concrete sidewalk in the sun (I will never complain about my 15 min wait to see the doctor again!) As you can imagine, this can be a tedious, frustrating day for the most patient person – imagine if you are 4 years old.
One of the fabulous student nurses here, Aileen, came up with the idea last week of creating a toy box for the children to utilize while they wait for their treatment. We have talked to the hospital carpenter and he is starting to design the toy box, stay tuned for more updates!!
Leah & Savannah