Day 9, Happy sick kids, sad well Kev

We started by heading over to Baylor University’s pediatric HIV/AIDS clinic. The Baylor clinic looks particularly out of place compared to the other buildings on the Kamuzu Central Hospital campus. It’s new and clean, and it looks as if someone picked it up in suburban America, gently carried it over the ocean, and set it down next to the hospital.

The doors open at 8 AM, and we were told to arrive at 8:30. The waiting room was PACKED with children and their parents. Most of the children were frolicking like children do, not demonstrating any effects of the sleeping infections they carried.

The room where we were supposed to meet our preceptor for the day was in use, so we waited in the administrative waiting area. A coffee table book entitled “The Art of Texas Children’s Hospital” caught my eye. I found myself tearing up as I flipped through the pages.

When I was five years old, we moved to Houston. Shortly thereafter, I woke one morning unable to move my neck. My mother is a nurse, and she became alarmed. I went to the doctor, and I soon found myself admitted into Texas Children’s Hospital. I had an infection - that much was clear. Beyond that, the doctors were fairly stumped. For two weeks I was an inpatient of steadily declining status. Despite my current girth, I was a skinny kid to begin with, but I quickly began losing weight. I was subjected to a battery of tests, including a spinal tap, and my infection continued to grow. Two weeks into the process, a young doctor noticed that I cried when he touched one of my teeth. The tooth was pulled, and I recovered completely.

The book included a photograph of a mother lying in a hospital bed with her child. It hit home that my parents must have felt completely helpless as they watched their youngest son begin to waste away. My mother stayed with me all the time, and my father would come and spend the evenings with me after getting off work. Occasionally, he’d smuggle in a little Kentucky Fried Chicken to my delight. During the entire process, I never saw my parents upset. I can’t imagine the burden they were carrying, and the strength they showed by never letting me see them strain under the weight.

I put the book down, and I looked down over the balcony. Below were dozens of parents of children afflicted with a horrible virus, and the children who for the most part waddled around completely oblivious to their status. I felt a certain kindred spirit with all of them. I knew there was no tooth we could pull to let them go home and get on with their previous lives.

Our preceptor arrived, and brought us into the board room for a brief review of the oral manifestations of HIV/AIDS. We’d all taken oral pathology, but the review was a useful primer. Most of the conditions mentioned are seen comparatively rarely in the US due to widespread and consistent use of anti-retroviral drug cocktails. In Africa, some of these complications are more commonplace. After he did a quick check with the unit’s pediatricians, we headed over to the wards in the hospital to meet two patients.

The first child was a two-year old boy afflicted with noma. Noma is a horrid, disfiguring condition associated with a particular combination of HIV/AIDS, malnutrition, and other factors. If you’d like to see it, I’ll let you google it with the warning that it is truly horrible. Our patient had already had surgery, so we were seeing it after some improvements had been made. In noma, an infection can bore holes in the patients face, sometimes eating away flesh to leave gaping wounds. Our patient had a hole just below his chin opening into his mouth. The surgeons had removed all the infected tissue and placed him on antibiotics to remove the bacteria responsible. The child, once he realized we weren’t going to hurt him, didn’t even cry when we surrounded his bed to take a close look. He’s expected to recover from the noma, but he’ll still need to battle HIV/AIDS for the rest of his life.

Our second patient was a one-year old with Kaposi’s sarcoma. Kaposi’s sarcoma are purplish tumors associated with later stage HIV/AIDS infections. They can be found on the skin, in organs, or in the mouth. Our patient had one on the side of the cheek, with a white spot where he’d been chewing on it. Again, this is a child who cannot be cured from his infection by any magic that science possesses.

After the morning, we decided that we needed a break from the hospital for lunch, so we drove out to a nice restaurant. We took our time (as everyone does in Malawi) and savored the break from the rigors of our day’s experiences.

When we returned, we went to the hospital dental clinic, but found that there were no patients for the afternoon. The dentists were scheduled to be in the operating theater all day, and the dental therapy students were taking exams. We returned to the guest house.

Jiayin’s room occupied by a newcomer, a nursing student named Amber. Following the lead of those who were at the guest house when we arrived, I took her on a brief tour of the campus while my teammates took yet another trip to the curio market. Amber is UNC’s first nursing student to come to Malawi, and she was very friendly.

After the tour, I went with Trevor (med student) and John (surgeon) to the ABC Christian Center gymnasium to demonstrate my legendary basketball skills. We found a ragtag collection of professors and pastors engaged in a shootout, and we joined them for a game of 4-on-4. I shot 0 for 175 in the first game, and 1 for 5345 in the second. Just my presence in the room lowered the shooting percentages of the poor fools who were doomed to be playing alongside me. To those who were ruined, I am sorry, but I was totally open.

We got home just in time for Joyce’s delicious spicy chicken stew. After a few games of Tonk with Amber and the others, I went to look for Julie online. Luckily, I was able to find her.

A few extra pics are here. There are the white-breasted crows that correspond to the traditional all-black American models, a tiny gecko living in Trevor’s room, and some incredible Malawi sunsets.