Friday, April 9, 2010

An unsteady rhythm of time well spent

Time is a strange thing here. It flows to an unsteady rhythm of unexpected twists. It can seem precious and oppressive at once. Some days pass slowly without any critical issues arising. Some days are happy. And some days are whirlwinds of crises, when the ominous presence of death looms heavily on the safe house and every minute is potentially a small child's last.

This week has been a strange mixture of such days, an emotional roller coaster that has made me appreciate TTL's presence here even more and, at the same time, made me wish there were still more that could be done, that there were more resources, more options, more equality…

Liteboho went home on Tuesday, his respiratory issues having been resolved. I drove to his rural village last week, hiked up a mountain into a cluster of rondavals, and found his grandfather eating lunch alone in a haze of mid-afternoon cooking smoke. Matello, our outreach coordinator who was with me, informed him that Liteboho would be coming home, and the grandfather smiled and offered his thanks. I had the sense that Liteboho's young mother, who wasn't in the village at the time but was expected back soon, won't be alone in the struggle to care for him -- a reassuring thought.

Seithati turned 3-years-old today -- an un-promised milestone in her young life, as when we found her two months ago, she was in rapid decline and weighed less than a healthy child two years her junior. Back then, my first week here, she was a silent, shy child who was lethargic and unresponsive. Her limbs were tiny sticks protruding from the dueling spheres of her distended stomach and seemingly outsized head. She was deferential, indifferent, shadowy.

Today she is the life of the playroom. She's rapidly putting on weight. She is talkative, mischievous and hilarious. She is quick-witted, sometimes irreverent and often challenging. She's fully alive, visible, present and demanding of attention. She is boisterous and happy. She is released from her former prison of lethargy. When I first saw her two months ago, I had no idea -- no hint -- that the sharply smart, engaging little girl I see now was inside that frail, emaciated body. Today that little girl is unmistakeable and on full display.

As Seithati continues to burst out of her former shell, Ithateng is sadly falling into one of her own -- induced by severe dehydration that we have been battling all week long with Katie and Sean, two Georgetown medical students who have been visiting TTL since last month.

When Ithateng first came to TTL, she had severe oral thrush, which we all assumed was the leading cause of her being underweight. When she drank from a bottle, I was relieved. But it wasn't long before she began vomiting what she was taking down. The bo'me continued doing their best trying to feed her, but diarrhea also began. Thrush can cause gastrointestinal issues, so we hoped that by curing the thrush we would put Ithateng on the right track.

By the start of this week, however, the thrush had largely disappeared but her vomiting and diarrhea were not stopping, and she was becoming more and more dehydrated. Since then, our frustrations have mounted as her health has continued to fluctuate.

Through Katie and Sean's efforts, we finally got an ARV treatment settled upon to help Ithateng start battling her HIV, but she hasn't had much success keeping those medicines down either, nullifying their effects. Critical medicines that Katie and Sean are familiar with in the U.S. and are used in the battle against dehydration aren't available here. Ithateng is anemic, which complicates things. She's also malnourished, which means any attempts at rehydrating her have to be balanced against the threat of overwhelming her tiny heart. Because of a lack of resources at the hospital, we can't check her electrolytes either.

Katie, Sean and I went with Ithateng to the hospital today, and I watched helplessly as the chief medical officer and a nurse searched, at first unsuccessfully, for a vein they could put an IV into. Finally they found one in her foot, after failing twice in her tiny hands. Despite the struggle of finding the vein, Ithateng at least got some fluids from her couple hours on the IV, but too much would have overwhelmed her, and she's back in the safe house now.

The only other thing we've been able to provide her with is oral rehydration, a slow process that requires someone encouraging her to swallow even the smallest amounts of sugary water anytime she rouses. That process continues. Wednesday, Ithateng seemed distant, and we all sat around the play room together, wondering if she would survive the hour, much less the night. Yesterday she looked a little better. Today she is worse again. We are all hoping for the best, fearing the worst, and cursing the lack of more resources.

Another little girl, 13-month-old Mpinane, arrived at the safe house yesterday. She is underweight, and her young mother is struggling to save enough money to provide care for her. Hopefully, Mpinane's stay here will allow her to gain some weight and allow her mother to figure out the best course of action for caring for her. She's shy still in the playroom and watches Seithati and Nteboheng closely.

A new 16-month-old baby girl from the Thaba Tseka district arrived today as well. Ntseliseng is malnourished and has tested positive for HIV. When she got here, it was clear she had a severe rash or skin irritation of some sort that extended all over her tiny body. Looking over her Bukana, or health booklet, I suddenly noticed that two weeks ago she had been diagnosed as having scabies, or little mites that burrow into your skin.

I told Katie, who did a quick once-over and confirmed Ntseliseng still has the scabies -- a good thing to know before she became integrated with the other babies. Sean and Katie headed over to the hospital, where they scooped up some lotion to treat the horrible infestation.

Hopefully the little bugs will be wiped out quickly, and little Ntseliseng will soon be on her way to recovery, feeding well and receiving all the medications she needs. Hopefully we can also figure out a plan to get the rest of her household treated for scabies, and her actual rondaval cleaned of the mites, before she returns home.

Looking back, each day this week seems to have taken a lifetime, but the week as a whole has flown by.

The best thing about time here is that it is time well spent.

2 comments:

Mary Ellen R. said...

Kevin--powerful writing! Thank you for sharing these challenges and accomplishments. Your descriptions of Ithateng's plight are heart wrenching--please let us know how she is doing. We are praying for the babies and you and all your coworkers at TTL in Lesotho.

Anonymous said...

Wow. Thanks for sharing. You are doing great things Kevin. "Time well spent" indeed.
I'm with Mary Ellen in putting prayers out there for all of you, and the kids. Your proud Uncle, Franny