I tried to tell her. I warned her so many times. I told her of the potential consequences. But she just wanted to do what felt right in the moment. She just wanted to have a baby.
She's only a child still herself; 19 years old but looks 13 or 14. She has AIDS, has already been treated for tuberculosis for 8 months and is on antiretroviral therapy. She's unmarried.
Now, she sits in my office cradling affectionately a tiny premature baby boy. All the books on HIV management tell me that if possible, the baby should not be breast fed, but formula fed to avoid the risk of HIV infection through the milk. However, this tiny, malnourished life needs all the help it can get. Despite her obvious thrill at being a mom and holding a baby in her arms, she has no clue what sacrifice taking care of this baby will mean so that it grows up healthy and HIV-free. She has been underfeeding him, feeding him "when he's hungry."
"So he tells you when he's hungry?" I gently chide trying to use humor to get her to realize it's her responsability to feed him regularly whether he "wants" it or not.
It does seem she is doing some things right: washing and boiling the bottle, using only clean water to mix the formula. I decide to continue the formula but I decide to hospitalize her to try and get her help with the idea of regular feedings and what's the appropriate amount. Of course, nurses who are trained to suture, treat emergencies, deliver babies and give shots and start IVs, like our locals, haven't been exposed to the other side of nursing, the educational, daily needs assessment, et cetera kind.
As I look into the gaunt, yet strangely peaceful and trusting face of this four pound premie, I fear his days are numbered
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