Chantal

I only get to know, really know, two classes of patients: ones hospitalized with chronic wounds or osteomyelitis and AIDS patients. There are really no other chronic diseases here...people don't live long enough (life expectancy = 49 years for men and 47 years for women).

For example, our little friend, Clement, has been back with us for a couple months now. He came to us three years ago with osteomyelitis of the tibia (bone infection in the lower leg) and has now had four surgeries to try and get his bone to heal so he can walk again. Two Romanian orthopedists were the last to operate on him in May and he's slowly but surely healing...we hope.

In the next bed over is his twin brother except that his is the right leg and he has been with us now for only two months. Both of them love it when we come on rounds. Their faces light up and they each try to outdo each other in slapping my hand hardest in giving me "five". Sarah also entertains them with the occasional balloon, animals drawn on their hands with markers or empty syringes she's taught them to use as water guns.

Two days ago, after giving me "five", Clement held out a handful of fresh, unroasted peanuts insisting that I take them. Even though I know he doesn't get enough to eat, how could I refuse his generosity coming from such a pure heart?

The other patients I really get to know are our AIDS patients. I consult them for free to encourage them to come to the hospital whenever they're sick without waiting too long at home hoping it'll "just get better." We also only make them pay half price for lab tests and medications.

Once they are in full blown AIDS, we are able to treat them for free, thanks to generous donors, with anti-retrovirals (triple therapy) and all other medications for opportunistic infections.

Plus, each week, they come to get a week's supply of ARVs and we have a meeting to discuss problems and teach them how to care for their health and how to recognize sickness and how to avoid transmission.

I get to know them very well. The down side, of course, is that I have to watch many of them die.

Koumabeng Chantal is an exceptional case. When I first arrived in Béré, she was already considered a "Cas Social" that was treated free by the hospital. She was eight years old, an orphan taken care of by a mentally slow, yet very loving grandma. I thought for several years that she was a "Cas Social" due to her being an orphan. It's so rare for a child given HIV by her mother during pregnancy or delivery to live past five years that I was sure she couldn't be HIV positive.

I was wrong.

Since before I came, HIV was kept a secret from patients and staff, there was no record of an HIV test done on Chantal. She was in good health overall. I treated her for several bouts of simple Malaria and some ear infections over the years. The only thing that gave me a clue that she might be immunocompromised were the umbilicated nodules on her face and arms, like tiny, fat donuts (molluscum contagiosum). But I'd found them on other children here who tested negative so I didn't think much of it.

When I came back from furlough this year, Chantal came to see me and I noticed she was getting quite thin. She had another ear infection and malaria again. This time, I decided to test her for HIV.

She came pack positive. I was shocked. She was now 11 years old. How had she lived so long?

I started her on ARVs which she tolerated well and was faithful in taking (at least, she came back each week to get her next week's supply).

Two months ago, she came in with a severe headache. She was in such pain that she cried and moaned all night long keeping all the other patients awake. I was afraid of some opportunistic infection like Toxoplasmosis but she did have severe malaria so I decided to treat her for that first before thinking of something else.

After three days, she went home pain free to finish her malaria treatment at home.

A month later, she repeated the same thing. She was suffering horribly. This time she needed five days of IV Quinine before the malaria and headache cleared.

Now, she's in my office again. As always she is gentle and subdued with big trusting eyes. As I gaze into that unblinking stare I see the quiet suffering. She only whimpers as I lay her on the exam table. Her only complaint is headache and vomiting.

Her malaria smear comes back very positive at 0,20% (I'm dead sick with 0,05%). We hospitalize her again and try a new, once a day anti-malarial called artemether. A single shot in the thigh once a day without all the side effects of Quinine.

Every day, I go to see her. She lies there quietly, her form thin, but not emaciated and that same look in her eyes. One eye is slightly crosseyed. Her grandma says she refuses to eat and has vomited several times. I decide to put her back on IV quinine. Her vital signs are stable and with some Tylenol and Ibuprofen, she doesn't have hardly any pain.

That night, the nurse goes to place her evening perfusion. She calmly looks up at him and tells him it's not necessary, she's going to die. He reassures her, although, she's not afraid and seems completely at peace. He starts the drip and moves on as she falls into a deep sleep.

At 2 am, she quietly stops breathing. She's gone.