The paediatrician’s goal is the same whether doing rounds on wards in Africa, seeing patients in an anti-retroviral treatment (ART) clinic in India or taking part in an international panel discussion in Rome. Isn’t it time, asks Dr Nandita Sugandhi, that we simplify the language and unite around goals that everyone can understand?
I was working in Swaziland in 2006 when paediatric anti-retrovirals (ARVs) were just coming into the country to treat children infected with HIV. At the government hospital where I joined daily rounds on the paediatric wards, ARVs had come too late for many of the patients I saw. For them, “access” would have meant that the drugs were available when they first got sick, not when they were lying wasted and weak on a hospital bed.
There were a few who made seemingly miraculous recoveries – the “Lazarus effect” that seemed so remarkable in the earliest days of anti-retroviral treatment. But more often than not the miracle had gotten to them too late. “If only we had tested and started treatment sooner,” I would think, drawing sheets over the heads of little bodies that would sleep forever.
In Botswana, two years later, ARVs were in plentiful supply. Pregnant women were routinely tested and given drugs to prevent them from transmitting the infection to their unborn children, and babies who were born positive would be started on a cocktail of three drugs as soon as their test results returned from the laboratory. They would probably need to take the drugs for a lifetime, but at least it would be a long life.
The Botswana national programme had been started early in 2002 and by the time I arrived there were thousands of HIV-positive children receiving free treatment. I remember once urging a young mother to have her child tested for HIV, using the argument that if the test were positive we would have the drugs necessary to keep her son healthy.