On Tuesday morning I received a phone call from the Home Based Care (HBC) Coordinator. One of their clients who was bedridden was refusing to go by taxi to keep her Pre Art appointment at the Hospital. Could I help? I agreed and drove through the village, along the very narrow sandy road between pole and dagga houses with their thatch roofs. Young children came running out to wave and chase the car. I stopped and picked up Lilly the HBC carer for the clients in that area. We drove on together a very short distance.
I knew the client, Namatama, as we had had her in the hospital and recently discharged her. Namatama contracted TB four months ago and was also at that time tested for HIV. Because of the TB she could not start Anti Retroviral Therapy (ARVs). She had also recently been in the hospital suffering from PCP, a lung-disease linked to Aids. The usual dusty and ill-clad children greeted us excitedly. The family rushed around to bring chairs to her tiny mud and thatch house. I went in to a dim room with a metal bed in the middle with a thin mattress and chitenge ‘sheets’ (cotton wraps) barely covering the bed. In the middle was Namatama skeletally lying with her face to the wall. We sat down and gave the traditional Lozi greetings. I got up then and insisted on greeting Namatama. This broke the ice with Namatama. I think most people discuss her rather than include her.
She proudly said that the bedsores that she got in the hospital had healed thanks to Lilly. Then she told me that she was hungry but could not eat the food that the family prepared for her as they kept frying everything and the Nshima (thick maize porridge) the staple was too heavy. The bag of soya that she was given by the project remained unused, as it was too strong for her. We then tried to discuss what she could eat and the answer was nothing. Anything the family offered her just gave her diarrhoea. She said that the ORS which Lilly had given her was making her stronger. I then tried another tack if she could choose what would she most like to eat? I smiled at the answer, a boiled potato. We are probably one of the few homes in Mwandi that has potatoes!
I then broached the subject of her appointment. She said that to ride in the car would be too painful for her lungs. We continued our discussion for a short time longer but Namatama was adamant that she would die if she went back to the clinic. I then frankly told her that if she did not go she would die anyway!
I stood up and said that we would pray but before I prayed would she agree to come back with me to the Hospital? She agreed and then we prayed.
Namatama sat in the front to the Hospital with her younger sister and Lilly in the back. Her real fear was that we would insist that she was admitted to hospital yet again. When we arrived I fast-tracked her to see the clinician. She weighed only 33kg. She had lost 10kgs in a month.
I left Namatama with the Clinician and went home and found some potatoes, carrots and a litre of milk.
As I was going back into the clinic I was stopped by a nurse to say that there was a mother and baby waiting for assessment. Mum had stopped feeding the baby at six months because she was HIV +. The baby was now 8 months looked very small and anaemic. The nurse said there is a slight problem in that she is from Namibia. She had come across the Zambezi in a mukolo (wooden canoe). I still enrolled the baby in the formula program as the border is only a colonial border. The people are all of the same tribe and often have relatives on both sides.
Namatama had had bloods done the CD4 was now 22. The clinician felt that she might not manage to take the ARVs as Namatama had said that the family were going at the moment to their fields to clear and plough all day and they did not believe that she was HIV+. The clinician and myself went and spoke to the Doctor. I put forward my case that Lily could step in and give the medicine in Namatama’s home until Namatama could manage to take it herself. It was agreed that Namatama would start on ARVs. Lily went with Namatama’s sister to the Pharmacy for Adherence Counselling and to learn about the medicine. Lilly herself is HIV+ so she understands. Triumphantly after two and a half hours we brought a tired but serene Namatama home.
A lesson was learnt. The food on the project did not suit everybody. We will have to buy for our clients what is best for them.
I came home in time for my Lozi lesson. The Lozi teacher, a retired English teacher, was waiting patiently for me. We have been translating together a pamphlet in English about TB into Lozi. The teacher then has lunch with us as he too is in need of a meal.
Keith came home from school worried. Kandiana the old folks home has run out of food. The government have not sent any money since August. He had been eking it out since then but there was no money left. Can the Guild project help? Fortunately, over half of the residents are HIV+ so beans , kapenta(dried whitebait) and a few other things are purchased. The Mission Farm promises to supply maize ,eggs and meat. They have also run out of firewood. We had a storm the night before that caused a large branch to fall just missing our car, so at the end of the day there is the sound of axes chopping up the branch and the old people who are able dragging the wood away.
The day is another testimony to the grace and providence of God in our lives here.
(We changed people's names for confidentiality)