Two days after arriving in Botswana, Robyn was invited to join Alan's induction at the Botswana-Baylor Children's Clinical Centre of Excellence, known as the Baylor COE. On their fourth day in the country, they travelled to the nearby village of Mogoditshane for an outreach visit [Chapter 2].
Still in sight of the impressive Ministry of Health building, we turned off the tarred road onto a sandy track running through what we were to discover was a typically poor but not unpleasant neighbourhood. The huts were all quite tiny, but well spread out. Simple wire fences and a few little trees and scrubs divided the properties, each of which had neatly swept earth and two or three little huts in it. In the front of the bakkie [a pickup or ute] Kefilwe and Mary debated the detailed directions as they twisted and turned along tracks which were indistinguishable from each other to me.
In the back, Rebecca and Florence gave Alan and me some background to our visit. They explained that families often did not come into the Baylor COE to have children tested because of lack of money for the transport, health problems or unwillingness to go through such a formal approach. When the COE identifies families who are particularly at risk, the outreach team visits them to test the children and their families at home. The team had started using rapid test kits on their outreach visits, which enabled them to give families the results on the spot.
On this occasion the team was visiting the family of a child who had tested HIV-positive at the clinic where his grandmother had taken him the previous week. Worried that this situation was sure to mean that other members of the family were HIV-positive, the team had arranged to visit to the whole family.
Overhearing our conversation, Mary explained some of the sensitivities to us. Given the size of the huts, it is easiest to perform the tests in the yard, if the family is happy about this. As we travelled deeper and deeper into Mogoditshane, I could see that the yard plays a critical role as sitting room and often kitchen. Although obviously well used to having much of their life on display to their neighbours, Mary pointed out that being tested in the yard could be immensely embarrassing for a family, enabling all their neighbours to see that they are being tested for a disease about which there is a strong stigma. It is for this reason that many village headmen strongly encourage all their villagers to be tested together, so as to remove the implication that those being tested have particular a reason to think they are HIV-positive.
When we found the house, we discovered that the family was dominated by the short and stocky grandmother. She looked somewhat annoyed with her daughters for bringing HIV to her family, and insisted that they were all tested, outside. The grandmother seemed to be sensible, straightforward and practical, keeping a close eye on proceedings throughout. As Alan discovered over time, it is often the case that the grandmothers are the wise ones in the family.
…While one of the younger girls took charge of carrying the baby, the young mother's blood was dropped onto the little slip of paper [to be tested for HIV]. The minutes passed slowly. Then the faintest of marks spread above the line [indicating HIV positive]. The young mother was wide-eyed with horror. The mark was so faint that she, indeed everyone, desperately wanted there to be a doubt about the reading. But the outreach team discussed it and all agreed that any sign means positive. The rapid test does need to be followed up with a full blood analysis, but this young mother was HIV-positive and was distraught. Not least, her baby was now at risk of having contracted the virus through breast-feeding. Testing babies is a different process and could not be done in the spot, so her mind could not be set at ease. To our relief, on his subsequent testing the baby was found to be negative.
Prior to our arrival in Botswana we had been told by a nurse who had visited only a couple of years previously that the HIV/AIDS epidemic was apparent the moment you stepped off the plane. We imagined people being thin and drawn, coughing blood from tuberculosis and generally looking at death's door. We found a city where the people on the street looked remarkably healthy. This was the affect of the government's free provision of treatment.
In contrast to what we could observe on the streets, our visit with the outreach team gave us a glimpse of the reality of the epidemic.
Batswana [the people of Botswana] are immensely fortunate that the country's diamond wealth has enabled the government to provide free treatment, although it can not guarantee that this will be able to continue for ever. There do seem to be some signs of improvement in the infection rate and we could only hope that children like those we visited on our fourth day in the country would learn the lessons and stay negative.
I felt extremely privileged to have been able to visit this family in their home so soon after arriving. It was a poignant start to our time in Botswana.