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Daring to bring hope - life at the AIDS coalface
Kerry Cullinan of Health-e News Service. Sunday Tribune, 6 October 2002. Republished courtesy of Independent Newspapers (Pty) Ltd
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Half of its patients die of AIDS, and 54% of pregnant women are HIV-infected. But in the absence of any national HIV/AIDS treatment plan, the tiny and embattled St Mary's Hospital has started its own projects to try to restore hope to its community.
The tiny babies lie side by side in their transparent cots in the high-care nursery at St Mary's Hospital. A little mouth gasps for air; two little noses have tubes up them. One baby pulls up her pencil-thin legs, stomach taut with pain.
Pain is one of the few things these babies will know well before they succumb to infections such as pneumonia, gastro-enteritis, tuberculosis and meningitis, their bodies' immunity immobilised by the rampant HI Virus passed on to them by their mothers. There are no last rites for those too small to speak. They die quickly, wordlessly, at a rate of about five a week. One dies while I am there.
Their mothers, huddled beside them, bowed over and silent, know that their babies are on death row. Sister Philomena Pakade, who heads the paediatric ward of the hospital, is so burdened by this knowledge that it makes her wish she were young enough to change professions. "Children are dying like flies, more especially the very small babies," says Pakade heavily, showing me the list of "RIPs" noted down in a small brown exercise book. "In July, we had a death almost every day. These little ones suffer so much. They have just come into the world and the world is so cruel to them."
About three quarters of the 200 children admitted each month are HIV-positive. "We get so excited when we get an HIV-negative child," says Pakade. "We sit with the mother and talk and educate her about HIV and prevention."
Elsewhere in the busy paediatric ward, toddlers scream from their cots. Skin conditions are endemic - one child's entire face is covered with angry red pustules of impetigo, or veld sores. "We never used to see impetigo this bad," says Dr Douglas Ross, superintendent of the Mariannhill-based hospital that is owned by the Catholic Missionary Sisters of the Precious Blood. Ironically, now the precious blood of most of their patients is infected with HIV, and this is causing unusual presentations in a number of diseases, from impetigo to TB.
A 10-year-old girl lies on her side in a corner of the ward, staring out into the room. Too big to have been infected at birth, Ross suspects she is being sexually abused by a family member. "This year we have noticed a big increase in HIV-positive children between the ages of four and 10. We suspect it is because of sexual abuse," says Pakade.
The 234-bed St Mary's serves a population of about 750 000 people in the west of Durban's vast metropolis, 250 000 of whom are estimated to be living with HIV. It gets an 84% state subsidy and no-one is turned away from the hospital, although the patient load has increased considerably as the HIV epidemic has turned into the AIDS epidemic. "Our patients are much sicker now than they were 10 years ago, and 50% of them are going to die," says Ross, who has been at St Mary's for seven years. "We have had to change our expectations about who is going to get better, and also start to pay attention to caring for the carers."
The hospital soon realised it could never deal with the demand, and has therefore become heavily involved in community outreach. Its oureach team has trained a network of about 200 volunteers to help families to care for their dying relatives at home. The mounting deaths have presented a new challenge.
"We have a problem of abandoned bodies rather than babies," says Ross, with an ironic laugh. "We have to cremate unclaimed bodies as there's no space left in the city for paupers' burials and this cost the hospital about R48 000 last financial year."
But while death is now routine, it still takes its toll. "There is a high level of staff burnout," says Ross. "Staff have to deal with an increased workload, dying patients and, at a personal level, with the effects of HIV in their own families. Every four or five months, one of my staff members dies."
Nevertheless, the hospital has the remarkable ability to attract funds and everything from furniture to incubators seems to have been donated. It has also managed to attract a number of other organisations to its premises to start small but promising initiatives aimed at fighting back against the tidal wave of HIV/AIDS.
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