Abigail is overwhelmed. When she sits in our office in the HIV clinic, her shoulders slump as though she is carrying a huge sack of rice. You can barely hear her whispers as she recounts her story.
Her husband died three years ago, leaving her alone with their three small children. Abigail never went to school beyond 5th grade, and she struggles to find even small jobs so that she can pay for food and shelter for herself and the children. She says that when her family found out that she had HIV, they rejected her. Her mother sometimes watches the three young boys, but she will not let Abigail or the children stay at her compound for more than a day or two.
“I am all alone,” says Abigail with a deep sigh.
Abigail’s one-year-old son, Noah, has his HIV medicines in a special bottle. This bottle has a chip in the cap that records electronically the exact time that the bottle is opened each day, and then my study team can download a history of when the bottle was opened onto our computer. My study team can see more evidence of just how overwhelmed Abigail is – gaps of days when Noah did not receive his medicine. Her youngest boy is at serious risk of dying if he does not get these medicines.
Much of my research in Kenya is focused on those gaps – how can we find out when families are having problems giving children their HIV medicines? And when they are having problems, what can help them?
For Abigail and Noah, my study team did a lot of work with the clinic staff, with the social workers, and with a local psychiatrist to get this little family help with things like food support and treatment for Abigail’s depression. Within our HIV clinic system in Kenya, my team follows hundreds of families very closely, asking them all kinds of questions every month about how they are doing with the HIV medicines, using these special tracking bottles to record exactly when they are taking their medicines, and wrestling through complicated challenges like how to tell the children that they have HIV and how to deal with the stigma that goes hand-in-hand with an HIV diagnosis.
As I launch into another month in Kenya, we have an
insanely busy exciting few weeks ahead for my research projects. My to-do list — with all of its little checkboxes — is way too long, and jet-lagged Rachel cannot help but feel a bit overwhelmed. But I am still excited.
We get expand our efforts this month. We get to know new families and dig into the stories of more mothers like Abigail and more children like Noah. And maybe, just maybe, we get to figure out how to help them better.