AIDS-related deaths avoidable

A relative of Vimbayi, I finally got a chance to see her five months after first hearing of her failing health.  By that time, she was very weak. On first seeing her, I asked her husband whether she had a test for tuberculosis (TB). He nodded in confirmation and even handed me all her medical records.

 

At first, I thought this a breach of confidentiality. Later, I realised time was running out and we needed to do our best from an informed position.  In my community, before HIV/ AIDS, people easily shared medical records within the community. No one felt ashamed to let their colleagues know that they were suffering from cancer, diabetes, or any other disease. The stigma attached to AIDS changed the way people share information about their personal health.

 

The records confirmed that two sputum tests for TB had produced negative results. Unlike her husband, I also realized that Vimbayi had tested positive for HIV. As someone who was working in the HIV/AIDS field, I knew the meaning of phrases such as “patient referred to OI (Opportunistic Infection) clinic,” and “post-test counseling done and positive living discussed.”

 

I looked around, but could not see any packets of cotrimoxazole prophylaxis, which the records indicated a prescription. She told me she stopped taking it about two months previously because there was no improvement. There was no one to encourage her to take the pills, as her mother-in-law also fell sick during that time and her husband was out of the country. 

 

Both Vimbayi’s husband and I both arrived the previous night, each coming from different parts of the world, under different circumstances. I returned from Asia, where I was working for a non-governmental organisation responding to AIDS and TB. He was coming from neighbouring South Africa, forced to go there through illegal immigration because of the harsh economic conditions at home in Zimbabwe. He was away for six months with no idea about his wife’s deteriorating health.    

 

We agreed to take her to the hospital that same morning. However, incessant rains pounded the village, an overflowing river separating us from the nearest hospital. We also soon learned that the only doctor serving that hospital had already left for Christmas and New Year celebrations.

 

Thinking of going to other hospitals was completely out of the picture. To reach the main road about 40km away, we had to cross several streams, which were all flooded. As the heavy downpours continued, Vimbayi’s condition further deteriorated.

 

While waiting for an improvement in the weather, I sat down with Vimbayi’s husband. `In the discussions, I mentioned HIV infection.  We talked about positive living and the availability of antiretroviral drugs that can prolong a person’s life. At the end of the conversation, he assured me that he was prepared to accept any outcome and that he was not going to blame himself or his wife for the cause of illness.

 

When we woke up to a cool blue sky, I used the opportunity to visit the shops at the hospital to buy some groceries and I unexpectedly received the good news that the doctor had arrived the previous night. I went to see the doctor and talked about Vimbayi’s situation. He told me that there were no films to carry out the chest x-ray.

 

The doctor informed me that this problem was common to most government hospitals and that the only option was a private hospital run by a mining company about 150km away. The fee for the chest x-ray at that hospital was 25 million Zimbabwe dollars, approximately USD 13, at the time. This amount of money is beyond most people’s reach.

 

I brought Vimbayi to the hospital the next day so that he could review her situation. Before I left, I also spoke to the head of the Opportunistic Infections (OI) clinic. He told me there were enough drugs for TB and that there was an improvement in the supply of antiretroviral drugs. I went back home encouraged and convinced that Vimbayi would live and be able to look after her children.

 

Early morning the following day, I arrived at the hospital with Vimbayi and her husband. The doctors gave us a month’s supply of cotrimoxazole and further referred to the private hospital for the chest x-ray test. This time, Vimbayi and her husband had to go there alone because I was nearing the end of my vacation.

 

Before I left, we had another lengthy discussion to talk about treatment adherence to both TB and AIDS drugs, CD4 tests, and positive living. The doctor and the head of the OI clinic pledged their support to the couple once they come back from TB chest x-ray tests.

 

That was the last time I saw Vimbayi. A week after, I received a phone call telling me that Vimbayi had passed away on the day when I was flying in mid-air between Harare and Bangkok.

 

Her memories can fade but the words in her final prayer requests continue to haunt those who were present. For her children, like many others in Zimbabwe, hope is like a distant horizon.