We returned to Mpilo Hospital a week after our visit to meet with Miriam. This time we’d come to visit the teen resource center. Dr. Nyathi was not around but we met a young MSF doctor from the states, we’ll call him Dr. Y, who agreed to take us around for a quick tour. When we first found him, the doctor was seeing a patient who had come from the rural areas for ARVs. The boy was maybe 7 years old and as he sat on a bench next to a man that looked like his grandfather, his feet hung far off the ground. He didn’t swing them, and he didn’t smile. I knew that this boy had acquired AIDS by no fault of his own. Dr. Y spoke with his resident, a Zimbabwean, who translated into Shona for the patient and his guardian, whom we’ll call Mdada. Mdada is a term of respect for a male elder in Ndebele. Turns out Mdada was actually the boy’s father. Dr. Y and the resident searched for the term in Shona that means “the child who comes after all the others,” essentially, that last child that was a mistake. After a few minutes and with Mdada’s help, they figured out the term and Mdada laughed and nodded but the boy remained silent. He hadn’t looked at us. I think he could sense that we were here to look at him. To watch and possibly learn something from his suffering. I felt instantly guilty. Dr. Y and the resident reviewed the boy’s lab results and said something about how the adult dose had improved his CD4 count. They agreed that they should continue with the same strategy and Dr. Y gathered a stack of papers, tapped them together on the desk to order them, and slipped them into a fading green cardboard folder. No computerized records here. No computers. He excused himself and we bid Mdada and his son goodbye and followed Dr. Y on a tour of the hospital.
Dr. Y would later explain that the boy in the consult room is suffering from HIV cardiomyopathy. The HIV virus has infected his heart and gives him the symptoms of an old man with heart failure at 7 years old. He gets out of breath after walking short distances. Dr. Y says that the boy is doing much better on his ARVs. I was thankful for that but I just hope that he will continue to have access to the clinic. There are so many potential barriers and money, transport, and distance are just the beginning. He will have to remain on ARVs for the rest of his life to stay healthy and it’s difficult to predict how he’ll feel when he reaches his tumultuous teenage years or early twenties. This is the very scenario that Dr. Nyathi has described to us – sometimes even kids who have been on ARVs for as long as they can remember will default when they reach their teens or early twenties when they gain a full understanding of the implications of their diagnosis and life with HIV. They might be angry with parents for not seeking Prevention of Mother to Child Transmission (PMTCT) resources or they might simply despair at the nature of their condition. The support group we’re trying to form for HIV+ youth at Mpilo will aim to support these very kids and help them cope with their status in healthy ways. I truly believe that the Grassroot Soccer approach and curriculum combined with the power of soccer and team building can create an effective supportive environment for these kids. Soccer is life here; we have seen that time and time again in only 8 weeks of living here, and it can give these kids the self-esteem and peer network that they need to cope.
Dr. Y showed us around the hospital and explained how MSF has teamed up with the World Food Programme and Catholic Relief Services to implement a nutrition program at the hospital for those receiving ARV treatment. WFP and CRS provide mealie-meal (to make sadza), the Zimbabwean staple, as well as other dry goods. In other cases they provide food stamps, and we pass papers tacked to the crumbling walls which list the supermarkets where the stamps are redeemable. (Speaking of crumbling walls, the hardware stores down here still advertise and sell asbestos. I’m sure they also use lead paint.) During the course of the tour I asked Dr. Y about the young Zimbabwean doctor’s training. Dr. Y explained that Dr. M, is an excellent young doctor but that he is not actually a resident. There is no medical residency in Zim. Dr. M will receive his full peds training in 2 months at Mpilo under Dr. Y. He will then take his place as the fourth pediatrician in the entire city of Bulawayo. MSF is leaving in December, and Dr. Y with them, so the count for the entire city of 2 million will return to its former total of 3 pediatricians. Since there is no residency training in Zim, med school graduates must leave the country for further training and they have no incentive to return. The result is an enormous brain drain.
We finished our tour outside the Mpilo teen resource center, located on the Mpilo campus but in a small building detached from the main square of the hospital. Dr. Y had informed us that the resource center is a teen-only space and that part the preparation for the MSF handover to the Zim Ministry of Health in December has involved training teens to run the center on their own. When we arrived a girl in her late teens popped her head out the door with a huge smile and bounced out to introduce herself carrying a broom. In the dim interior of the center several other teens looked out with various cleaning implements in their hands. They were ecstatic to have visitors but asked us to come back in 10 minutes – they were in the middle of cleaning the center.
When we returned we were properly introduced to Marilyn, the young woman with the broom, and Tanatswa, a young man who couldn’t contain his smile. These two seemed to be in charge but were quickly joined by Talent, Gladwell, and Immaculate to give us a tour of the small, 2-room resource center. Most of the teens sported t-shirts reading “Mpilo teen resource center” with cool designs and slogans (can’t remember what they were right now, but Dr. Y was wearing the same t-shirt while he took us around the hospital. MSF is really behind these kids!) We were first shown into the media room, complete with TV and VCR and stacks of VHS tapes against the wall organized neatly below hand-written signs stating the genre. Talent insisted that comedy is his favorite. We said maybe we’d come back and watch a movie with him some time. We left the media room and passed through to the library and reading room. The kids told us they have a self-run book club – teens take the books home and then engage in discussion when they return to the hospital for their ART appointments.
Marilyn also explained that another NGO runs art therapy sessions at the recourse center and that adolescents and teens are encouraged to create arts and crafts using the center’s supplies at any time. Gladwell even had some beautiful hand-made sandstone sculptures for sale, displayed on top of the book shelves. Ale gave him $5 for a carved hippopotamus on the spot. The reading room included a computer with internet access so that teens can use facebook and do research for book reports. The walls were covered with posters about HIV prevention, responsible living with HIV, and messages of adolescent and female empowerment. As we prepared to leave, the kids were sorry to see us go. We hinted that we hoped to return and bring some GRS games to the resource center to support kids who are visiting the hospital for ART. Before we could excuse ourselves Immaculate spoke up – she wanted to sing a song for us to thank us for visiting and say goodbye. Another teen rushed to silence the house music that had been pulsing through the computer speakers and Immaculate unabashedly launched into a beautiful medley of religious songs without accompaniment. After our applause had died down, Talent quickly spoke up, asking if we’d like to hear some poetry. Of course! He began to recite a poem in the style of poetry slam (is that what it’s called?) but the poem was about HIV prevention- using condoms, being responsible, having one partner, getting tested – it was all there. Who taught them that? It was awesome. After the poem we prepared to leave and Marilyn insisted that all the adolescents write their names in my notebook. It had been an amazing visit; the teens’ pride was so palpable. They are all volunteers, trained as peer educators, waiting for visiting adolescents who utilize the center’s resources while at Mpilo for their ART. What an incredible resource and a fantastic opportunity for GRS to get involved on behalf of HIV+ youth! Dr. Nyathi had already pointed out the need, and here was a physical plant with space outside for GRS programming, all within the hospital grounds! We can’t wait to possibly bring GRS SKILLZ Club programming to the resource center to give Marilyn, Tanatswa, and the rest of the crew another tool to help HIV positive adolescents and teens. And the best part about the center? Only adolescents and teens allowed !