A day of medication and the beginning of a friendship

My alarm clock rings and wakes me up. I rub my eyes to keep away the bad dream I had.  I look at the watch, it’s 06:30 AM and I realise that I have overslept. It’s Tuesday, the very day that I don’t want to be late.  Tuesday is the day for antiretroviral (ARV) initiation. It means, there are new patients coming,  it implies even more work and the need to  start work earlier. I pack my breakfast into my bag and pour coffee into my water bottle. It takes 10 minutes by foot from my house to the health center passing by the vibrant village market and church. “How can  this little place be busy almost 24 hours everyday? The sun has not even fully risen yet!”  I think to myself while seeing patients lined up neatly on the concrete benches in our outpatient department (OPD) waiting room. The tail of my eyes catches a glance of a small girl sitting in the row. “I remember that girl!” I say to Andy, my translator. “Yes, you know her, she was one of the patients in our ward couple of weeks ago,” Andy replies quickly. And memories take me back to a few weeks ago. It was a busy day like today when a guy brought a 12-year-old girl to our health centre. She was in very alarming condition. She was really weak and breathing fast. I put the thermometer under her armpit and after a few minutes, I checked it and it showed 40.1 degree Celsius. “She’s burning with fever!” I  gently placed my stethoscope on her chest and all I could hear was a rough breath. It seemed she had severe pneumonia. “What happened to this girl? Why have they just brought her now?” and many more questions were running through my head but it wasn’t the right time to ask them. The girl needed a fast response. I couldn’t wait for a full blood count result, so I quickly tore a malaria kit and pricked the little girl’s finger. A drop of blood fell onto the tiny hole of the rapid diagnostic kit. “Please, not malaria, please...” I whispered while waiting for the kit to reveal the result. My prayer got answered. It wasn’t malaria. The human ability of survival always amazed me. Little by little she began to recover. After one week of treatment she went home and recovered from the life-threatening disease but she returned again to the health centre with a bitter fact: she was infected with HIV... Thekerani Health Centre has more than 3000 HIV/AIDS patients and it keeps on growing. Monthly, we conduct approximately 3000-4000  consultations in the OPD and our inpatient services can reach up to 150 patients each month. There is also a considerable number of women who give birth in the health centre and babies in need of neonatal care. I am the only doctor here. Like all over Malawi, we have very limited manpower and heavy workload, so we do most of the things ourself - from registering and diagnosing a patient, simple laboratory test, and administering the drugs. These are the things that I wouldn’t find and do back home... In Indonesia, even there are still many areas needing health worker support, we always have nurses and midwives to help us do these kinds of work. In Malawi, the number of doctors  who work for the goverment is very limited making it difficult to cover rural areas, like Thekerani. Clinical officers are available but they work at the district hospitals.  Thekerani Health Centre has large catchment area and thus a great need for doctors and clinical officers. Today, the girl is back, and I assume that this is just a regular follow-up for her. After her appointment has been set up, she comes into the consultation room. “Maswera buanji! (Good afternoon!)” she greets me with slighty bended knees a sign of respect. I greet her back and ask about her condition. She gently smiles and says she’s OK.  “I came to bring you a cassava” she says and hands me a basket of cassava that she covers with her chitenje (a traditional woman’s garment worn like a skirt). I am suprised! Here, in one of the least developed countries in the world, life is not easy. It is a place where children grow up with sugarcane - probably the most common “candy” they try in their day to day life. I know that a basket of cassava means a lot - it  can even support a family’s meal. This is a big present for me. “Zikomo Kwambiri” I say out loud and smile. Then I remember I still have some chocolate bars in my bag. I hand them to her as a gift. I can feel her sense of curiousity in accepting it. “Have you tried chocolate before? I ask. Unfortunately, she never had.. “I hope you like it, it’s one of the best tasting chocolate in the world” I say to her and we both laugh. Later on she excuses herself to go home. I hand her three more bars of chocolate to bring home to her family. Today, we met in the health center again but not just as a doctor and a patient, but as a friend to each other. ...Perhaps, there won’t be a  bad dream tonight.