This day, I feel I lose all of them - a family

A woman of around twenty years old wearing a black dress and shabby flowerish chitenje is in the consultation room. A baby is sleeping on her lap. She hands me a small orange book with a torn cover. Unlike in Indonesia, here in Malawi, patients keep their own medical records - a little book we call “health passport.” The soiled dull papers show that it was long time ago since her last visit to our health centre. She has been suffering from fever and abdominal pain for two days already and decided to come to our health centre. But there is something else that catches my attention - printed on the front page of her health passport, there is an inscribed red oval shape with two horizontal lines. She is HIV positive... There is neither a record of any treatment nor a sign of follow-up in her health passport. Except for one curly handwriting recorded almost two years ago when she was tested positive. I conclude she is one of our patients who was lost to follow-up, meaning a patient who stopped coming to the health centre for HIV treatment.  "A Mai, where have you been?" I curiously asked her.  Apparently, she has been following her husband who lives at the border of Malawi and Mozambique.  Now, she finally decided to seek treatment for pain and fever that never subsides. She coughs once or twice while I examine and talk to her. According to the record, she lost over 10kg of her body weight since her last consultation. I am planning to start antiretroviral (ARV) treatment on her. While writing the instructions in her health passport, she starts breastfeeding her moaning baby. She opens the chitenje covering her baby and I am stunned with what I am seeing. The baby is so tiny! He might not even be a year old, but all I see is skin and bones His fragile little hands are trying to hold on to his mother.  His bony face and the dry and wrinkled skin show that he is very malnourished.  His mother is not aware of her baby’s critical condition. I do not know how to react, I feel sad and sorry for both of them... I asked for her baby to be tested for HIV using a rapid diagnostic kit and also a more accurate and elaborate examination, too. After 15 minutes, like his mother’s, the baby’s health passport has the same oval shape with two horizontal lines. He is also infected with HIV... I decide to send the baby to the district hospital to get proper treatment, unfortunately the vehicle is only available the next day. They still need to wait for the night to pass by... The next day, my morning starts as usual. A morning handover report takes place in a small room in our maternity ward. The medical assistant who was on duty the night before reports that there was a patient who died this morning. I remain silent. My thoughts run wildly searching all the possibilities amongst the 20 patients in our ward, guessing who passed away? “Is it a baby?”  I ask, hoping he answers no. “Yes, it is the baby of an HIV positive woman who we planned to refer to the district hospital today.” In this moment, I hate myself for guessing it right... Yes, the baby died at dawn... and my heart is aching. In our health centre, we do not have a special room to keep a dead body. When someone dies, the other patients will voluntarily give the space in the ward for the family and the remains. And the other patients will move temporarily to the court of our health centre, until the dead body is carried back to their home. But this morning, I do not see any patients lying in the court of our health centre. The woman and her baby were gone before sunrise. My intuition tells me that the woman and her husband will never return again to our health centre... This day, I feel I lose all of them - a family. This article is first published in www.kompas.com in Bahasa Indonesia language.