Little veterans of the children's ward

At Easter, Masi* was in the ward again. This time it was gastro-enteritis with diarrhoea. He was in the ward at Christmas as well; and three times in between. In the past calendar year, he spent more than one hundred and fifty days in hospital, each time with a new infection. He is no exception, Vicky*, Gary* and tens of other children follow the same pattern.

It is amazing to see what a sick child can get used to. You will not often see one of these children cry when they are being admitted yet again. Even though they know that someone will be taking blood or putting up an intravenous line, that there will be needles and that they will have to tolerate an oxygen tube at the nose for weeks on end. Even though they know their mothers will soon be going home and that they will be alone in the ward. They seem to know that feeling sick means an infection, an infection means hospital and a while in hospital will mean feeling better again.

Despite the fact that the HIV infection causes serious damage to their immune systems, our little patients who get pneumonia still manage a speedy response to ordinary treatment. Providing their parents can get them to hospital soon enough, children with HIV and AIDS benefit from good nursing, antibiotics and oxygen almost as rapidly as other children would.

The nurses and doctors working in the ward become just as accustomed to the regular return visits of their patients. Day and night, patients and parents are welcomed back as the old friends they have become. Masi can be sure of his favourite stokkie (lollypop) Vicky will get her potato crisps and Gary will add to his collection of 'Tazos'.

Masi is four years old and an orphan. His grandmother looks after him. She struggles to make ends meet on her old age pension and often has to borrow money for bus fare to make it to the hospital. So far she has always been lucky enough to find someone with a little cash, but once Masi is in hospital it can be weeks before she finds the money for a visit. But Masi is a sweet child and easily pleased.

Vicky is nearly five and also an orphan. She lives at Nazareth House, a home for AIDS orphans in Cape Town. She can't walk properly and doesn't talk much. For all that, she has a strong personality. No one is ever in doubt about what Vicky wants or just how quickly he or she should jump to please her.

Gary is nearly six. His parents are still very well. They have no problems coping with the machine they have at home, which concentrates room air to provide Gary with oxygen. They are a thousand miles up country right now, in Pretoria, complete with spare oxygen cylinders for the trip. A handful of other children also need home oxygen to support them. Their mothers sometimes ask for extensions to their oxygen tubes, so that the children can stand at the garden gate and greet their friends who are on the way to school.

The medical consequences of an HIV infection are pretty simple: After a few years, often sooner in children, it results in so much damage to the immune system that the child will catch almost any virus or bug going around. From then on, sometimes for many years, the child has a chronic illness characterised by one infection after the other.

As yet Masi, Vicky and Gary are surviving partly because they have access to continuity of care from the same team of doctors and twenty-four hour access to acute treatment. Imagine the consequences for your health if you had asthma or high blood pressure and did not have your own doctor to look after you.Of course, this kind of treatment is expensive. Masi's one hundred and fifty days in hospital cost an estimated seventy-five thousand rand last year, enough money to buy him eight years of very effective anti-retroviral medication.But that's another story.

* Not their real names

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