The first Zikomo kwambiri from my first HIV positive patient

The village of Thekerani is a far-flung village in Malawi, one of the least developed countries in the Southern Africa region. This is going to be my home for nine months. But getting here wasn’t really that easy. When I arrived in Lilongwe, the country’s capital, I had to travel 6-hour by car to Thyolo Boma in Thyolo District – where the Médecins Sans Frontières (MSF) project office is located. “Is it my final destination?” I asked myself after a long and strenuous ride to the MSF office. Unfortunately not. I had to endure another three hours on a bumpy and muddy road from Thyolo to my health centre post in Thekerani where patients are waiting for me – their doctor – to treat them. Hours had passed by and finally I arrived in the small village located literally in the bush in the south of Malawi. It is one of those places on earth that probably not even the highly praised Google maps can point to. It was a very foggy afternoon and I could barely see anything as the car starts to slow down. Slowly, I could see what surrounded us. Slowly, I could see a humble structure made of bricks. That was it, the Thekerani Health Centre! This is my first field assignment with MSF. I am originally from the middle of nowhere of Indonesia, and now I am in the middle of nowhere in Africa for the first time in my life. When I accepted my first humanitarian assignment with MSF, I was very excited. But when I took my first step into the health centre I was confronted with mixed emotions. I was greeted by more than 200 eyes, all staring at me. These are my patients, I thought. New on the African continent, new in Malawi, new in their colourful culture, I looked back at them with curiosity and I saw the sparkle of hope in their eyes. As a medical doctor, unfortunately I didn’t have previous experience working in an HIV/AIDS context. I had read, learned and attended trainings but I had never handled even one HIV patient. That made me feel nervous. I was afraid I could not perform what my patients expected me to do. “What if I forget something... What if I made a wrong diagnosis?” Those were the questions haunting me, while I took my first steps into the consultation room. Within a few moments of silence, someone knocked on my door. It was my medical assistant, a Malawi national staff from the Ministry of Health, whom I would be working together with closely. He introduced himself and asked me to follow him into his room. Inside his room was my first patient. I felt my heart skip a beat. A mother was sitting with a baby in her arms. She looked tired and her eyes were gushing with tears. The medical assistant gave me a brief explanation of the patient’s case. “The baby has diarrhea since four days ago. He’s our HIV patient and also on malnutrition follow up. We tried to stabilize and insert intravenous lines (IV) but we failed inserting the hollow tube because his veins already collapsed.” I looked at the baby. He was so tiny, sunken eyes and with a very dry skin. His eyes were closed but his mouth was opened as if trying to get as much oxygen as he could. I approached him and his mother to introduce myself. I held the baby’s tiny cold hand. He was struggling, he was dying. From the pricking wound, it looked like the medical assistant already tried to insert an IV lines couple of times. My heart was beating fast, I needed to think. This was probably the last chance to save the baby. I examined his hand closely; held my breath and put the smallest IV tube to a shade of vein. A thick red blood flowed into the tube, I put the infusion set and that’s it! I was inserting an IV line on my first HIV patient,  my first African patient. There is nothing that can describe how happy I was in that moment. I instructed the medical assistant to continue the treatment and to help in monitoring the patient’s progress. I gained back my confidence. After all, I know what to do and how to initiate the treatment. But maybe it was too late already because the baby was too weak. At a glance, I saw him opening his tiny eyes and looking at his mother. Suddenly, my worries flew away. I believe there’s hope. Yes, there’s always hope. After a long first day, night’s solitude gave me the space to reflect about my presence in Thekerani. “What am I doing here? It is thousands of miles from home, from the people I love. How will the HIV positive patient cope with their dependency on HIV drugs for the rest of their lives? What if the drugs are out of stock, are no longer available in the country? What will happen to them?” I had so many questions building up inside my mind until I fell asleep on my first night in Malawi. I woke up the next day, got up from my bed in a rush and went to the health centre. All I want was to see the baby. As I was walking towards him and his mother, I could see that he was still weak but very much alive and that he had already improved a lot since the day before. I no longer saw tears from his mother but a genuine smile of happiness. She smiled at me and uttered gently “Zikomo kwambiri” – a simple way of saying thank you. I answered back and we both laughed. I was so happy and satisfied. Another life had been saved and a new day had just started.  I think the answers to my question of why I am here are slowly starting to sink in now.  I am thankful for those moments of helping others who need treatment the most. This article is first published in www.kompas.com in Bahasa Indonesia language.

Dr. Husni Mubarak Zainal is an MSF doctor from South Sulawesi, Indonesia, who joined MSF in 2011.