July 24, 2011

At The Hope Clinic

A couple of weeks ago I finally started the central part of my internship: the questionnaire part of the Mother to Child Transmission Prevention (MTCTP) study that I'm doing at the clinic. 

The entrance to the clinic

The first few weeks I was here were spent finalizing the protocol and questionnaire and getting everything approved by the ethics committee (and, let's face it, spending a decent amount of time by the pool), so when I finally got to start interviewing the women at the clinic I was really excited to actually be doing something every day.

That tree is a mango tree that was planted 6 years ago when the clinic opened.
The old man holding the tree is the village chief (in his 80s) who is a big supporter of the clinic.
I hired myself a driver (a very unreliable taxi man who comes to pick me up in the morning to bring me to work, but only on days that are convenient for him, without letting know when he's not coming, which has resulted in my being late a couple of times), and started spending four days a week at the clinic.

The outdoor maternity "ward"waiting area.

Because almost none of the women speak French, the interviews are conducted in both Bambara and French, with my translator, Sokona, as a critical part of the whole process. She's also my "screen" so to speak, between the clinic and myself. Because I work for GAIA, and I'm very recognizable (the only white person at the clinic), I've been for the most part associated with the HIV program, which means that HIV positive women who are not public about their status risk their being "exposed" by being seen with me. Sokona, on the other hand, is a member of the community and a nurse at the clinic, so even if she's seen working mostly with me, women who are seen with her aren't automatically assumed to be HIV positive.

The regular waiting area.

Which means that unless I'm talking to the MTCTP women who are very public about their status, I spend most of the day upstairs in the conference room, waiting for the women to come upstairs to me, since I can't conscientiously go down to get them myself. This means I spend a lot of time waiting around while Sokona is downstairs trying to find willing women for the study (the clinic isn't exactly overrun with MTCTP women all day every day). So you can imagine how delighted I was that there was wireless internet at the clinic, which means that I can bring my iphone to work and read the news and catch up on emails (and facebook) while I wait.

The space between the two wards where the HIV woman have their Friday cooking activities.

Last year the study ran from July til October but for some reason they only managed to interview twenty-eight women. This year we have to try to get more interviewees, to make the study more statistically viable, and luckily it seems like we might be able to make that happen. In the first ten days of interviews I've already talked to eighteen women, and I've been told that there are dozens more who are eager to participate. I'm hoping to get at least fifty women, but I don't want to be overambitious.

The delivery room.

Unfortunately, because we're only evaluating the MTCTP Program, we can only interview women who started ARV treatment before giving birth to at least one child. This means we've had to turn away several HIV positive women on treatment who just didn't happen to have children in the last five years, which has been hard for them to understand, especially because we're paying the respondents, and everyone wants to participate.

Inside the delivery room.

But that hardest part isn't having to turn women away, it's having to listen to the stories of the women we do take.

Because the MTCTP Program has had a 100% success rate (so far), all of the children born to these HIV positive women since 2005 have been HIV negative. And it's an incredible silver lining to the devastation caused by HIV/AIDS.

But it's not enough.

Inside the delivery room.

One woman with six children (five from two previous marriages, and a one-year-old from her most recent) was abandoned by her husband because he held her responsible for the deaths of her previous two husbands.Why this wasn't an issue before he married her in the first place I have no idea (given that she was already twice widowed before remarrying). The fact of the matter was she is now alone to feed, house, and raise six children, with an estranged husband who doesn't even help her support the child he fathered.

Patient logbook and a blood pressure gauge.

Another woman was in a polygamous relationship, and over the course of the last few years the husband as well as the two other wives passed away, leaving her to raise not only her own five children, but the children of her husband's other wives as well. She sells potato leaves at the market and is barely able to cover the cost of living for her family. She told us about the youngest children coming to her crying from hunger at the end of the day, and the hopeless feeling of not being able to do anything about it.

The way she told the story she seemed so strong and stoic, but even Sokona--who lives in the neighborhood and sees things like this every day--had tears in her eyes while she was translating it to me.

Our temporary interview room (when we got locked out of the conference room)
All but three or four of the eighteen women I've talked to have lost as least one child, and some have lost up to four, between the ages of four days and eleven years old. One woman was not even twenty-six years old and she'd already lost three children.

I cannot even imagine.

All but one of the women were completely illiterate; they couldn't even sign their own names on the consent form. Yet they were educated enough--more than most of their husbands, who still think HIV is a western invention to oppress Africa--to know about the dangers of HIV and the need to protect their children and themselves.

I cannot begin to explain the feeling of impotence I get from sitting and talking to them, wanting to give to, or do something for each of them. Sitting there with my $600 iPhone in my purse I feel almost disgusted with my own privilege, yet I don't have anything to give them except a willing ear for their stories and 1000 CFA for their time. I realize that it's not my fault they are where they are, and it's not my place to get them out of it.

But they manage. They move on with their lives, taking care of the children they have left, doing their best to feed and clothe them and send them to school. And on Fridays they even find the time to get together to cook and chat and eat and laugh. Because somehow even they manage to find somethings to be thankful for.

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