It is time for me to let all of you know just how the Stoughton’s are doing in Zimbabwe. We really are quite well, and continue to love the work that we are doing. We continue to be frustrated at times by how slow things seem to go, how difficult it is to get needed supplies and medicines, how much AIDS there is, how poor some of the people truly are. But then, we see how thankful all of the people are, what a good staff we have at the hospital, and how we are truly needed to provide good medical care to all of the people in this area.
There are some early success stories. We have been involved in a “Mother To Child Transmission” (MTCT) prevention program for nine months now. It involves educating pregnant mothers(and their husbands) about the need for the mother to have an HIV test to see if she is positive or negative. If positive, then we make sure that she delivers here. She gets an anti-retroviral agent during labor, and the baby gets a dose soon after delivery. We then carefully instruct the mother in proper breast feeding technique, and also that she does NOT give supplemental feeds of any other foods for the first six months. We follow both mother and baby closely after discharge, and at five months we do an HIV test on the baby. If it is negative, then we have the mother stop breast feeding, and instruct on what other foods to now feed the baby. By doing this, it is hopeful that we will decrease the transmission of the HIV virus from about 50% when the baby is six months old, to around 10 to 15%.
About 75% or more of our mothers are electing to be tested. Of those tested, we have about a 30% positive HIV rate. So far, of the first nine babies that we tested at five months, none of them were HIV positive. When I heard that news, it sent a shiver up my spine. At last, we have something that we can do to prevent this terrible disease.
Another program we are just beginning is a “Faith Base Approach to HIV/AIDS” (“FaBATHA”; sounds like a soap, doesn’t it? I think we need to think of a catchier acronym). This entails an integrated approach of educating Church Leaders and having them help us then spread that education throughout the area. We have already had a three day workshop for Church Leaders, and it was inspiring. It was clergy from all Faiths in this area. At the beginning of the program, they had the attitude, “AIDS is caused by sin, and the sinner deserves it.” By the end of the program, they were wanting to become involved in Home Based Care to help those living with AIDS, they were wanting to educate all of their parishioners, and they were wanting to be tested themselves so that they would know their HIV status. And, they were wanting even more information! This FaBATHA is being supported by the Swedish Government, and they will provide us with personnel, a vehicle, kits so that we can test everyone that wants to be tested, and supplies for the project for the next three to five years. We are quite excited about it, and hopeful that we really can make a difference. I am appalled at how little factual knowledge the local people, including clergy and teachers, have about HIV. It is definitely time to change that.
The following is from a journal that I keep. It is one day of making rounds on our pediatric ward, and includes each child that I saw on that day. I think that it gives you an idea of how severe the problems are that we are facing:
THURSDAY 18 JULY: Today was rounds on the pediatric ward, and so I am going to list and explain each child on that ward.
1. Stephen: age 7 years. Admitted on 4 July with severe Kwashiorkor (protein/calorie malnutrition with severe edema fluid). He was brought in by his father, which is very unusual. The mother died of TB in 2001. He is anemic, has chronic diarrhea, and is HIV positive. He weighed 28 1/2 pounds on admission, but after two weeks and losing all of his edema fluid, he now weighs 20 pounds – what a normal 1 year old weighs in the US. He has been running a fever of 105 degrees, and it is doubtful that he is going to get better.
2. Hardlife: Stoughton’s are doing in Zimbabwe. We really are age 1 1/2. Admitted 7 June, with cough, fever and large lymph nodes behind left ear. The father works in town; mother is divorced. X-ray shows large lymph nodes in chest also. Anemia, HIV positive. Has shown just slight improvement on TB drugs, plus multiple other antibiotics. He really is having a “hard life”.
3. Millan: age 9 mos; admitted 16 July with cough for 2 months plus diarrhea. Has lost weight since he was 6 months old. Mother died in May of ? Malaria; most likely HIV. Baby now is taken care of by the Ambuya (grandmother), who really does not have the ability or knowledge or finances to feed a baby this age. X-ray shows bilateral upper lobe pneumonia plus some early cavities on the left, indicative of TB. Mildly anemic. Just started on treatment.
4. Tafara: (means “we are happy”) age 1yr, 1 mo; admitted 15 July with cough, shortness of breath, and fever of 3 days; very lethargic on admission. Weight is normal for age. X-ray shows bilateral pneumonia. Has responded nicely to antibiotics. Discharge soon.
5. Timothy: age 4 yrs. Fourth admission since 2/’00. Has only gained 3 pounds in the past 1 1/2 years, and even that is probably just fluid. He has been treated for TB, has Kwashiorkor with frequent episodes of diarrhea. Mildly anemic but HIV positive. The family has been getting food from Home Based Care, but because of the HIV status and recurrent diarrhea, this child is not going to get much better.
6. Mavis: age 5 mos; admitted 13 June with severe failure to thrive. Mother is on TB treatment; father died in 2001 (almost certainly of HIV). This child is negative! Baby weighed only 6 pounds on admission; she has gained 3.2 pounds since admission. We have had the mother take the baby off the breast (which is definitely better for her since she is HIV positive), and started the baby on formula and High Energy Milk (HEM), and she is doing well. She cannot go home until she weighs at least 11 pounds, and then we will have to have her come back frequently to make sure the baby is continuing to gain weight. Home Based Care will again supply food for them.
7. Precious: age 7 mos; a twin; admitted 10 June with diarrhea and severe malnutrition; the other twin is alright. Father died in 2001. Mother is HIV positive, but this baby is negative. Had the mother stop breast feeds, and we are giving baby HEM. The child has gained 1.3 pounds since admission. Another referral to Home Based Care.
8. Musiiwa: age 5 mos; admitted 12 July with cough, no weight gain, diarrhea, and severe oral thrush. Had just been here with pneumonia in June. Father died of TB 2001; mother is HIV positive, and baby probably is. X-ray is consistent with TB. Baby has been started on TB treatment. She will be here for two months.
9. Farai: 7 yrs, admitted today; is a brother to Musiiwa. Severely malnourished; weighs only 24 pounds. Treated here for TB in 2000. Mother says she recognizes that he has been ill for some time, but did not bring him for treatment. They have very little food at home. His x-ray shows relapse TB, and I am certain that he must also be HIV positive.
10. Takudzwa: age 2 1/2 yrs.; admitted 17 July with severe Kwashiorkor. He lives with the Ambuya and is fed “sadza chete” (corn meal only). The parents are divorced, and the mother “ran away” leaving all five of her children with the Ambuya. It is apparent that this child is the farthest down the chain from the food, and only gets what is left over, which is usually not anything. He is anemic and is HIV positive. This is going to be a very difficult problem in getting the Ambuya to give this child the correct food. And such a burden to put on this poor grandmother.
11. Tinotenda: (means “we are thankful”), age 1 1/2 yrs; admitted 24 June with cough, fever, no weight gain for one year; parents are divorced; father works in town (very strong evidence that he likely is HIV positive). Anemia, x-ray shows TB, and is HIV positive. Is responding nicely to TB drugs.
12. Lydia: age 7 yrs; admitted 16 July with bloody diarrhea for 3 days. Has early kwashiorkor; the mother has three children, two by her first husband who she divorced, and one by second husband, who she also divorced. Neither are providing any support, but the mother has done nothing to get support. The mother stays with her father; her mother has died. They have nothing to eat!! The baby is improving on treatment. One more case for Home Based Care.
13. Precious: age 1yr 3 mos; admitted 16 July with very high fever. It is on TB treatment as an outpatient. HIV negative. Parents are together in this area. Child has responded nicely to antibiotics.
14. Peggy: age 7 mos; admitted 22 June with severe cough and oral thrush and malnutrition. Mother is HIV positive. X-ray shows TB; quite severe anemia, and has developed seizures since in the hospital. This is probably due to cerebral HIV. The baby has improved somewhat on treatment, but most likely will have a rapid downhill course.
15. Trish: age 2 yrs; admitted 9 July with very large lymph nodes in neck; only 2 pounds weight gain in past year; very anemic, x-ray shows TB nodes in chest, HIV positive. Is maybe improving on early TB treatment.
16. Laston: age 2 yrs; admitted 9 July with severe kwashiorkor and diarrhea. Weighs 16 pounds. X-ray shows pneumonia plus TB, mild anemia, very high white blood count (going along with the pneumonia), and is HIV positive. He is slowly responding to treatment.
17. Sunungurai: This is a 30-yr-old mother of twins on the pediatric ward, and this is a very interesting case. She has TB, and has been breast feeding the twins. Both of them were not gaining weight, and the mother was not doing well at all. She is HIV positive, but both of the twins are negative! We finally convinced her to stop breast feeding the twins, and they have done just fine on supplemental HEM. Three weeks after stopping breast feeding, the mother gained 20 pounds! It shows that with good nutrition, not having the energy drain from breast feeding, and adequate TB treatment, a patient can really do very well, and most likely live for several years with HIV. She will be going home soon, with help from Home Based Care.
18 Freeman: 1 yr; one of the twins; admitted 27 May with severe malnutrition. Is now gaining quite well.
19. Francis: 1 yr; the other twin; admitted 27 May with malnutrition, but not as severe. Also doing very well.
20. Wellington: 3 yrs; admitted 11 July with severe kwashiorkor. Was brought here by her 16-yr- old sister. Mother died in June of this year; father died in August ’01; there are five siblings, all living with the Ambuya. Child is anemic, x-ray shows TB, and is HIV positive. This child will not do well.
21. Nyemudzai: 7 yrs; admitted 28 May with a long chronic illness; she has been known to have an enlarged spleen for many years, without any definitive diagnosis. Quite anemic, x-ray shows probably TB, and she is HIV negative. Everything has slowly improved on TB treatment, although the spleen stays the same. She likely has some type of congenital abnormality of her hemoglobin, and that is affecting the spleen and also causing the anemia. She will go home soon on TB drugs as an outpatient for four more months.
So, that is pediatric rounds. It can be discouraging because so many have AIDS, and such severe malnutrition and opportunistic infections. The food supply is getting worse and worse, and we are seeing more and more people admitted with malnutrition with the story that they “do not have anything to eat”, or that they have “sadza chete” which does not give them the number of calories per day that they need. Of course, no one has vitamins, and so vitamin deficiency is also frequent. We also do not have vitamins, but are hopeful that we may be getting some, along with many other drugs to help with AIDS related infections, from our organization ZACH (Zimbabwe Association of Church Hospitals). They are supposed to be getting money from the Global AIDS Fund, and they will use that to get the supplies needed by the Mission Hospitals and Clinics.
And that brings me to the request part of this letter. The problem of no food and starvation is really increasing, because of the drought during the last growing season. There were NO crops this past year, and so the people do not have any of their own food. IF a relative is working in town, they will have some money for food; if no one is working, then most will have no money, and then no food. We are doing what we can to help, and also trying to get all foreign Aide Associations from overseas to step up and give the needed assistance. The political situation does not help.
We are able to change foreign currency at quite a good rate, so that any money given to us buys the most food for the people. Any donations that we receive are used either for medicines or for food, with no “middle man”. If you would like to help, please send your tax-deductible donation to: Mission Doctors Association, 3424 Wilshire Blvd, Los Angeles, CA 90010. They will then see that we get all of the money donated.
Thanks for your continued support.
Dick and Loretta Stoughton
St. Theresa’s Hospital
Pvt. Bag 7015