Yesterday, as 6 p.m. edged closer and the sun disappeared behind the surrounding peaks and the cold mountain darkness slowly crept into the safe home, I found myself staring back at the ravaged face of 15-month old Nketeleng, a tiny girl who had arrived at TTL an hour before with one of our outreach teams.
I had plastic gloves on my hands and an uncontrollable grimace on my face, one borne of disgust for what had been allowed to happen to Nketeleng and of the terrible sadness I felt as I watched her whimper in distress while one of the bo'me cleaned her. The whimper was more devastating than any cry, any scream, for the little girl in front of me was, in fact, silently writhing in pain. She was only tearless and silent for the fact that a horrific, unchecked outbreak of herpes simplex had turned much of her face into a burning pattern of raw skin, scabs and bloody lesions, and allowing tears to fall or opening her mouth to release the full vocalization of her pain would have caused just another dose of that same pain.
Tragically, she'd been discharged from a distant hospital only a week ago, for some unknown and terrible reason. She belonged in a hospital, but for what time it was, we knew the local hospital here would have no doctor to respond to her even if we showed up, so she was ours for the night. Kirsten and I scoured our medical literature here and came to the correct conclusions, both about the herpes -- a common cutaneous manifestation of HIV -- and the Karposi's Sarcoma lesions on the rest of her body.
We noted from her bukana that she'd been prescribed acyclovire cream, but that it was out. Kirsten also said Nketeleng should be on an acyclovire IV or be receiving acyclovire pills, as the infection was far more systemic than a topical cream could treat. We cursed the confusion surrounding her treatment, a treatment so clearly wrong.
The medical assessment was helpful for me in that in made me stay in the moment, instead of shrink away from the horrible reality of it all.
"You poor girl," I found myself saying repeatedly. She lay there and looked up at me, as the heater in the changing room continued pumping more hot air out and the bo'me spoke to each other softly as they tried to make her more comfortable.
Last night, after I'd left the safe house, I started to think about all the logistical nightmares that must have contributed to Nketeleng's not getting the treatment she needed, and before her condition became so bad. The remoteness of her village, the distance to the clinic or hospital, the family dynamics, the lack of resources...
This morning, Kirsten and our safe home supervisor, M'e Mamosa, took Nketeleng to the hospital, where the district medical officer confirmed our assessments. The pharmacy there had acyclovire pills, but they didn't have the IV. Nketeleng's mother arrived at the hospital to be with her daughter, and we promised we would check back this afternoon.
Just minutes ago, Kirsten arrived back from the hospital with Matello, our outreach supervisor. Nketeleng just passed away.
I feel like a broken record, but I wish we'd found her sooner. I wish she hadn't had to go through what she went through during her short time in this world. I wish there weren't other babies out there dealing with what she dealt with, but I know there are.
The only reassuring part is that I know we'll continue searching for them, and there will be times when we reach them in time, and there will be happy endings and babies brought back to health and babies who get to have their futures.
It doesn't make me forget Nketeleng's face, but it reminds me why I'm here.