By Surafel K Gebreselassie
I woke up to a rare beautiful day in the winter of 1999. It had been raining for over a week. The dogs were out barking. The clear blue sky was hosting flocks of birds. It was a day for all the creatures. I decided to walk to the hospital. It was located about two miles from where I used to live. I was not alone. Everyone seemed to have waited for this day to walk to work creating a human traffic. It was no place other than the glamorous city of Addis Ababa, the capital of Africa.
I was a GP at one of the busy hospitals in Addis. Working in the pediatrics out-patient department, I had the opportunity to treat many of the city’s babies, admit those who needed inpatient care, and follow the chronically sick. On that beautiful day I was yet to have the most challenging case of my life.
The hospital work began with the usual morning report followed by an infant with pneumonia, a 5 year old boy with seizure whose twin brother was healthy. I recall to this day his facial expression that posed the unanswerable question, why me?
Then I saw a couple with their baby girl. They looked familiar. Suddenly all the memories got loose. Yes I sure did see them before; two HIV-positive patients on treatment for pulmonary tuberculosis. I was doing HIV counseling when I first met the couple. That had to be 2 years back. I remember the shock during the first encounter.
In most places in Africa, even at present time, being HIV-positive is like receiving a death sentence. And the most gruesome fact for the physician was to break this deadly news, which is probably true even today.
Certainly the first day was tough. I counseled them subsequently for weeks. In a matter of months they went beyond finger pointing to accepting their medical problem and started working towards optimal health but things would get from bad to worse in a matter of few months. He had a bad viral infection of the eyes (bilateral CMV retinitis) and would lose both visions. He was a long distance truck driver and had to stay home. She became the sole bread winner washing clothes for well- to-do families. In a place with no anti-retroviral treatment options at the time, my advice was mainly healthy diet, exercise , detecting early some of the common and treatable conditions that HIV patients faced, such as tuberculosis and diarrheal diseases. But the most satisfying part was to give them emotional support in a society where the stigmas of such diseases were sometimes graver than the disease itself. One of the topics discussed was how to avoid pregnancy through effective contraception methods. In the pre-retroviral treatment era, pregnancy carried about a 20-30% chance of infection for the newborn and another 10-20% coming from breast milk. Those 50% of kids who may not acquire the disease would have lost their parents by the time they reach adolescence and would be subjected to homelessness and all the fallbacks that come with it. So we strongly advised them against having a baby.
I looked at them again; they are the same couple I sure counseled for a while. Suddenly they were full of tears. Their cute baby girl seemed to sense the tension of the room and started crying.
She wasn’t afraid of me.
She crawled in to my arms.
What is her name?
Mimi is often a name used for baby girls before actual names are given but some do end up taking it as a permanent name. I was curious why they named her Mimi but they hesitated to say more.
Mimi was within her expected range for weight. She can walk unsupported. She was a little older than a year. Her chart revealed no major illness in her 12 months on earth.
I picked up my stethoscope and listened to her lungs and her heart. She had calmed by then and her heart rate wasn’t fast.
Started bouncing back and forth, myself, confused, I guess.
But why this little girl ? I asked, like the boy with the seizure.
I looked straight in their eyes, which were swollen like a person with nephrosis but with no answers.
Why did they bring about this innocent life knowing the risks after so many weeks of counseling?
It was about continuity. It was about living full, and leaving the rest to God. After all it was not a world governed by their will. Ultimately it was about hope. In their mind they never doubted she would be fine. They lived for a year with denial. They were getting weak from the opportunistic infections and they wanted to know the truth.
Would this cute baby be free of the virus and face the uncertainties of the future on her own?
AIDS killed many people and left many children orphans. Her parents were still waiting to name her and hoping that grandparents would see her through childhood and adolescent years like so many children in sub-Saharan Africa. I wish there was anti-retroviral treatment then.
I wish I was able to do more than give them the good news.
Yes, Mimi indeed had no HIV!
Yes, the test came negative!
Yes she can have a proper name!
Mimi lived to face the other childhood killers like measles.
very interesting article. thank you Surafel
I loved this story. Thank you for sharing it.
Yea , in Ethiopia in that era of “no available treatment” while the other world had plenty was so painful . Many kids were left Orphans . It did not matter whether they were HIV Positive or Negative , becoming an orphan from parents who had AIDS was the end of their life due to the profound stigma and discrimination.
Thanks God, now the drugs are available,the prevalence is dramatically decreasing, and the associated death as well.
Thanks Surafel for bringing the old memos .
Lovely story Surafel. I lived witnessing so many die of HIV in Ethiopia. People I worked with, friends of friends, distant family members etc…I hope things the infection rate has come down by now. Please keep the stories coming.