“That’s one small step for a woman…”

On Monday this week, I had one of the most satisfying feelings of my entire time in Itipini and it was derived entirely from one simple event. This woman walked unaided into the clinic.
Her name is Pakama and she has both HIV and TB. For the last several weeks, I’ve been involved in her care, taking her to the clinic and the hospital for various appointments, as I have with many previous people in similar circumstances.

The difference with Pakama is that when she came across my radar screen, she was already taking anti-retroviral drugs. With other patients, our goal has been to start ARV treatment. For Pakama, the problem was that the ARV regimen she was on conflicted with her TB pills such that neither of them were very effective and she began to get weaker and weaker. When she started her TB treatment, she was capable of walking to the clinic all by herself for her daily pills but for at least the last three weeks, we’ve been bringing her the pills in her shack, where she was virtually always lying in her bed, under as many covers as possible.

To their credit, a nurse at the ARV clinic noticed the conflict in the pills Pakama was taking and told her to stop the ARVs until she could see a doctor about it. That is where the problems began. I won’t recount the whole sordid history of the ensuing two and a half weeks, but it took at least three trips to the doctor, one to the ultra-sound, and several more to the ARV clinic before Pakama was finally able to switch her ARV regimen to one that would work with her TB pills. There were numerous unnecessary hurdles to cross, all of which had to be crossed by a woman who could barely support herself and needed to be carried and wheeled everywhere. Basically, Pakama was referred to a series of doctors who didn’t know a thing about her medical history and so treated her symptoms - constipation and an upset stomach - and prescribed her over-the-counter medications instead of addressing the root cause of the illness.

(The same nurse at the ARV clinic knew exactly what regimen she had to switch to but was unable to prescribe it herself. When it finally happened, all it was was a barely legible scrawl on Pakama’s records indicating the switch. Because that scrawl came from an MD, it was legitimate. It infuriates me how many trips it took to get a doctor to say the same thing the nurse said at the beginning.)

During that time, Pakama became very weak and lost energy and I began to sense her overriding will to live that impressed me when I first met her was ebbing away. Unbidden, the negative thoughts began to crawl into my mind and I became convinced that Pakama was about to fall through the cracks of the medical system and we would show up one morning to learn she had died.

But she didn’t. We got the new ARVs and I was with her in her shack when she took them for the first time, barely sitting up in her bed. A few hours later I came back and she was sitting in another part of the shack, having her hair done by the neighbour, and back to her usual bossy self. It was amazing how quickly she had been transformed.

Most of that initial transformation was probably illusory, however, and we continued to make house visits for her. She seemed to be getting better but it was a very slow convalescence. Much of her time was still spent in bed.

Until, that is, Monday, when I turned around in the clinic and saw her walking in the door. To be sure, she was out of breath from the effort and leaning heavily on a stick but she had made it to the clinic all by herself. It was an incalculably amazing feeling of accomplishment, tempered, of course, by the knowledge that she is still quite sick. But for a short time she has been moving in the right direction and I’ve silenced those negative voices in my head for now.