This story won’t have a nice ending.  It’s can’t.  I don’t know exactly how it will end or when, but the ending can’t be good.  I totally understand if you don’t want to read any further.  I probably wouldn’t.  After the last few days, I have gone on all my friends’ blogs… in search of happy endings.  Birthday cakes.  Tiny muddy hands paired with smiling faces.  Strawberry patches ready for kids to pick.  Pink princesses at tea parties.

But this is a different world. 

On Thursday, I returned from Nairobi to be greeted by the glowing faces of my two beautiful children.  Several hours later I heard that our guard Jorge’s son, José, was in the central hospital.  José is three years old. 

On Sunday, Nalia, Matias and Elio left to visit Matias’ family in Chimoio.  Knowing that Jorge also has a 3-month old daughter, who was now not breastfeeding very often because her mother is in the hospital taking care of Jose, I asked Jorge to come over with the baby and try to figure out a plan.  I didn’t understand why Jorge couldn’t stay at the hospital with his son so his wife Lidia could go home and breastfeed the baby.

We talked it over and Jorge explained that men aren’t allowed to stay at the hospital.  There have been problems with abuse.  I agreed to ask Elio and Nalia’s nanny to sit with José the next day so Lidia could go home and feed her baby.  Jorge had been bringing the baby to the hospital once or twice a day to feed, but it wasn’t enough. 

Next, I offered Jorge a ride to the hospital to see his son.  I pulled up by the gate.  We both just sat there.  ‘But don’t you want to go in and see José?’

 After what happened with Oscar, I was trying to distance myself from this.  But I could tell Jorge really wanted me to go so I relented.  We ran up the stairs because the baby was now screaming to be fed. 

I wasn’t prepared for what I saw next.  I had met José before but I didn’t recognize him this time.  His whole body was swollen, head to toe.  The doctors had tried to insert an IV, but struggled to find a vein because of all the swelling, so they had shaved the sides of his head to look for a vein.  I brought one of Elio’s cars for José to play with, but his eyes were swollen shut; he couldn’t see.  ‘Tia trouxe um carro para ti… I’ve brought a car just for you,’ I told him, but he couldn’t see it.  I pulled out his small bloated hand and placed the cars inside.  He didn’t grasp it, so I closed his hand.  He sat up and started spinning the wheels around.  This was good.  There was blood coming out of his nose, and his eyes were completely bloodshot.  His mother said he had been vomiting blood, and also pooping blood.  He had had two transfusions in 2 days.  I kept asking Jorge and Lidia what the problem is all they could say was ‘anemia.’ 

The atmosphere in the hospital during visiting hours was like another macabre party.  It reminded me of Oscar’s funeral.  All these sick children lying listlessly on beds surrounded by relatives toting food, juice, and chatting and laughing.  I told Jorge that he needed to give José as much carinho as humanly possible…. To help him recover more quickly.  Carinho is love, affection, sympathy all rolled into one, but Jorge didn’t seem to know what to do.  He just looked overwhelmed.  Later, Lidia told me that Jorge had broken down from the whole ordeal and cried.  Mozambican men never cry. 

I know that I need to distance myself from these things… I can’t save the world, nor can I help everyone.  I am fully aware of this. But I can’t watch a child suffering when there’s something I can do to help. So I talked to some Mozambican friends who are nurses and doctors.  They told me I had to talk with José´s pediatrician. 

So I went this morning.  I wasn’t expecting much… I was expecting a curt, cold doctor, numb to all the suffering-- if I was able to see the doctor at all.  Not having the força, the strength, to go at it alone, I asked a friend to come with me.  Ask for help when you need it. I am learning slowly.

  

We had to wait for Dr. Simple (sim-play in Portuguese) for awhile.   She was giving a visiting doctor a tour of the ward.  The visiting doctor looked American, and when I got a closer look, I read UCSD on his jacket… a doctor from the pediatric department at the University of California, San Diego. 

‘This is where we treat with chemotherapy,’ Dr. Simple explained.  When they left, I looked inside the room, and there was nothing.  Nothing.  Just two beds with sheets. The California doctor looked totally shell shocked… from everything.  He was barely speaking.  If you have been to a hospital here and also in Europe or the U.S., then you will understand why.  The disparities are too wide to be described in words.

Then Dr. Simple called me in.  She was warm and attentive right away, but professional. She asked if I was a relative to José… I told a bleached-white lie.  Because I knew I had to.  ‘José’s mother is from Chimoio, where my husband is from…they are distant cousins.’  Not so much a lie… we are all related, right?

She sighed and opened the file.  First she told me that José is severely anemic.  His hemoglobin was 2 when he was admitted to the hospital.  I have seen blood smears with hemoglobin of 6 and the blood was so light that it looked yellow when I put it up to the light.  I can’t imagine that José´s blood was even red.  I gasped. From what I know, many people with hemoglobin this low are dead.  She then asked me if I knew what platelets do.  I had to admit that I had forgotten my biology lessons.  ‘Platelets are what keep the blood coagulating, and stop us from bleeding to death.  The low range for platelet count in a child is 150,000.  When José was admitted, his platelets were 1000. We almost lost him the night came in.’ 

‘So this is why there is blood streaming out of him all the time?’  ‘Exactly,’ she explained.  ‘I need to give him platelets, but we have a shortage of platelets in the hospital now, so I do a five day plan and ask for 2 times as many platelets as I need.  Usually I can get him platelets once a day. Yesterday his platelets were up to 70,000.  His hemoglobin is up to 8. The swelling is kwashiorkor.’

I know what kwashiorkor is.  It’s a form of severe malnutrition.  The body swells up, becoming incredibly edemic, and the child usually gets scaly open wounds around the body, especially on the limbs.

But what is causing all this? This is the question that kept burning circles through my head. I knew she was getting to it, but I knew to be patient. 

She flipped the page in José’s chart.  ´José has AIDS.´

I couldn’t contain my tears.  José is THREE years old.  He will be on medicine the rest of his short life, if he’s lucky.  He will never have children, probably never fall in love.   So many nevers.  It was too much for me.

‘We should get his CD4 counts back tomorrow,’ Dr. Simple explained, ‘and then his hematology report.  After that, we will know if we can put him on antiretrovirals (ARVs).  I am pretty sure he can start on ARVs soon.’ 

My mind immediately shot to the baby.  If José is HIV positive, so is Lidia, and the baby is breastfeeding, so at risk of contracting HIV through Lidia.  But formula is beyond the means of most people here, and when that is the case, the advice is to exclusively breastfeed up to 6 months… but Lidia could not do this because she was taking care of José. 

‘Does Lidia know that she and José have HIV?’ I asked the doctor. 

‘She knows that José is positive, yes, but I did not discuss her own status with her.’

I talked it over with my friend.  I didn’t mention to Lidia all I knew.  I will explain tomorrow what the doctor said about the platelets and the anemia and malnutrition, but will not mention HIV.  Matias, because he is a Mozambican and a man, will talk to them about the HIV.  That is the best way to go. 

Tomorrow Jorge is coming over and I will show him how to make formula, cleanly and hygienically, and explain that the baby should be weaned to formula, but not abruptly, over about one month.  I will buy the formula.  My mom wrote me an email asking what I wanted for my birthday yesterday.  All I want is formula.  That’s what I’m going to tell her.

I am praying with my entire core that someday I will see José smile.  I have never seen him smile.  He is three, but he looks like he’s not even two.  I have never heard him speak, but his mother says he does.  I have visions of the day he comes to our house to play in the dirt and eat cake and chase the dog with a stick… of the day he can be a child.