Nobathembu, Victoria, and Ayabulela

Here’s a story about three people I know and a difficult decision confronting them.

Nobathembu is a woman in her mid-40s or -50s. She has HIV and on a recent blood test returned a CD4 count of 22. This is in I-can’t-believe-you’re-still-alive territory. Under 200 is clinical AIDS according to the government and qualifies you for free anti-retroviral drugs. Not only is she still alive, however, she appears to be thriving and showing no outward signs that her immune system is under sustained attack from HIV. I frequently see her walking the long road from Itipini to town, pushing a wheelbarrow full of groceries or balancing something on her head.Nobathembu’s daughter is named Victoria and she is one of the students in my after-school English class. Victoria is 18, in grade 10, and wants to be a doctor. She’s a good student and her dream is at least plausible.

She also has a young son named Ayabulela. Ayabulela is a bundle of joy who used to come running over to me whenever he saw me. But one day he saw me playing my guitar for the pre-school children and since then has been petrified. He only comes near if I woo him with stickers.Nobathembu looks after her grandson during the day so her daughter can go to school.

Since Nobathembu’s CD4 count is so low, she should be in the midst of the long process to begin anti-retroviral treatment. But she hasn’t even begun. She’s not allowed to begin until she can find a treatment support partner who will go with her to all the appointments and ensure, for the rest of Nobathembu’s life, that she takes her pills as required. The problem is that Nobathembu can’t find a support partner. There are some men in the family but none appear interested in helping and none, certainly, are convicted of the gravity of the situation. (I’m not sure Nobathembu is either.) There aren’t any other women who could go with her, except a sister who lives in a village outside town who can’t really afford to make it to all the appointments. So that leaves Victoria as pretty much the only option.

But that is problematic. If Victoria becomes her mother’s treatment support partner, then she’ll miss lots of school going to all the appointments (the clinic isn’t open after school). But if Nobathembu doesn’t get on ARVs, her health is going to deteriorate dramatically and ultimately she will die. (Every other person I’ve ever met with a CD4 count below 50 is now dead.) If she dies, who’s going to take care of Ayabulela? Victoria will likely have to drop out of school to tend to him.

It’s awfully hard to provide advice in this situation when every option seems to lead a worse conclusion.