Everything about Mwangi’s presence in my clinic room speaks of failure.
As I was racing in between giving a presentation about our research findings and a full schedule of interviewing candidates for new positions on my team, my clinical officer Jane called me and said the words I cannot resist, “Please, Daktari Rachel. Please will you come to see this patient.”
Mwangi was already in the room when I got there. He is 16-years-old and is dressed like a teenager in jeans, a t-shirt, and black jacket. His lanky arms and legs speak of a body that could grow tall, but his body is failing him. He sits next to my desk, slumped over, with his head leaning heavily on hand propped up on the desk. His face has the gaunt, hollowed out cheeks and temples of a body that has lost every possible bit of padding. Even worse, his eyes are dull, sad and distant.
The clinical officer tells me that Mwangi is an orphan. He has been looking after his own medicines for the five years since he was diagnosed with HIV. He has tried to take the medicines as prescribed, but he admits to the clinic staff that he sometimes misses them.
Looking over his laboratory results from the last year, I can tell that the medicines are not working to keep his HIV virus under control. The amount of virus in his blood is high, and the cells of his immune system are far, far too high. He has been coughing for weeks, and Mwangi lost 30 pounds that he could not spare in the last 2 months.
I am concerned that TB is now attacking his body, allowed in by the lack of defenses. His weakness makes me concerned that his body is going to give out on him completely unless we do something very different.
I can give Mwangi a new set of medicines to try to disable the virus in his blood – and hopefully restore his immune system. I can wallop the TB with the best medicines I can find. I can get him extra calories and even put him in the hospital if he needs that kind of care.
But I am worried that I cannot give him hope.
I look into his sad eyes, and I tell him, “You can meet this challenge.” I tell him that I am worried about him and that I want to help him become strong again. I tell him that the medicines will work, that they will heal his body and give him strength and allow him to do anything that he wants to do – school, get a job, get married, have children. I tell him that this is all possible if he meet the challenge of taking these medicines. I want to believe what I am telling him.
It’s a lot of talking, but even more drawing. I like to draw pictures to show my patients how HIV tries to kill the soldiers of your body, leaving it weak and susceptible to germs, but also how HIV medicines can work to keep the virus sleeping and allow the body to recover.
I draw and I talk and try to check whether Mwangi understands me and whether this time together brings back any of the light in his eyes. I am hopeful that I see the beginning of more sparkle.
“I can meet this challenge, Daktari,” he says confidently. “I will go and become strong.”
“Go with hope,” I said.
He wants to take the drawing with him when he leaves the clinic, along with all of his new medicines and a special bottle that will help us monitor electronically when he is taking the medicines.
I hope that he carries a spark of hope with him too.