Usually, I fly along in my work here with barely a pause from one sick child to the next. I have found though, that every so often an extremely sick child who has been suffering stops me in my tracks. Last week I had another one of those that makes your stomach hurt. This 8 month old child had been admitted to the hospital 4 times already. He had already suffered from meningitis, pneumonia multiple times, chronic cough, possible tuberculosis, oral and esophageal candidiasis – treated and returned four times, malnutrition, fevers, night sweats, diarrhea multiple times and rashes. He was seen many times in clinics where he had been put on medicines to prevent opportunistic infections from HIV but never apparently tested and certainly not in care for HIV. He was at our clinic for a first visit, tested positive along with his mother and sick once again. Now his growth was stunted, his weight for height showing him severely malnourished, he had cough, fevers, diarrhea, sores in his mouth, probable esophageal candidiasis, dehydration and weakness. These are the children that take my breath away and it is just all too common. As a doctor here at times like this I want to be mad at someone but I don’t know who. I want to scream, “why didn’t you bring this child to me sooner!” I have difficulty coping with the needless suffering of innocent children knowing that help has been there, just a matter of access. Should I be mad at the mother, the absent father, the health care system, HIV, TB, world inequities, the US government, Swaziland, all of them or none of them? I don’t know but the urge to lay blame is hard to fight.

These children, if taken care of right away, can lead happy, healthy, suffering-free lives. Instead, his life has been nothing but sickness, pain and suffering for the entire 8 months as far as I can deduce. At the same time I have to be happy that they made it to our clinic before the child died. He has a chance of turning around but it is working against some formidable foes like severe malnutrition, tuberculosis, poverty, transportation issues and poor sanitation. These are our enemies and their strength when combined with HIV is a force to be reckoned with.

There are likely as many successes as failures but often we forget about the one we saved when the next one is dying in front of you. I still feel honored to have the opportunity on a daily basis to literally save the lives of beautiful, innocent children. Seeing them get their appetite back, gain weight, fight back when you are trying to examine them, get stronger and not have such frequent illnesses is a degree of satisfaction as strong as the degree of frustration when it is too late. For now, we will keep on swimming upstream.