Let's Play Pretend Again

It's officially last Thursday...

I arrived early at the clinic to await a ride to Icyuzuzo and sat down at a table on the balcony where the women wait to be seen. I decided to put my headphones in and listen to some music while I was cutting out more of those eyeholes for the paper plate masks. At first I was alone. Being engrossed in my own musical world, I continued to feel alone and ended up singing loudly. I look up as I feel eyes watching me to find that I was no longer alone...a few women had filed out onto the porch and as I looked up, began laughing hysterically at me. I continued to sing, and playing the fool, started to dance. It was great, and I'd like to think everyone was entertained. These are the little moments that make my day here.

I also played with another cute baby that was crawling around on the floor by her mother. She kept watching me out of the corner of her eye and I was really hoping this wouldn't end up a repeat of the sobbing toddler incident from the day before. After a few minutes she wandered over to me, stuck out her chubby hands, and pulled herself up. Within a few short minutes, she was on my lap giggling and cooing in that special way that only little ones do. All the women seemed to let me in after that and became very smiley and talkative. Fabulous start to my day!

The WE-ACTx clinic in town (our home base if you will) accidentally scheduled patients for our arterial stiffness experiment/project, so I went to the Icyuzuzo clinic and Nina, awesome as she is, graciously volunteered to stay behind and work with these patients. At the clinic I began my ARV (anti-retroviral) non-compliance study with Dr. JMV. We're asking patients what kinds of things effect their ability to take their medication correctly each day.

Another little boy came in today. He looked to be about 3 years old, but appearances are very deceiving here with respect to age. Many people look far younger than they are. Anyways, little peanut walked in stuck out his hand, which I took to shake and, with lightening speed, was settling into my lap. (I swear, I've held more kids in my two weeks here than I have my entire life in the US.) He snuggled with me and had an intense desire to hold my hands. He was sitting on me, laying his head on my chest, and yet that wasn't enough. Every time I moved my hands, his fingers found mine and he just wanted that special attention. I was goofing around with him, looking at him, then away, little kids are excited by the simplest things! Then, out of the corner of my eye, I see a tiny finger sneaking up to the side of my nose and he started talking to me. Dr. JMV told me the little boy noticed my nose piercing and thought it was pretty (ha! mom, some people do like it!).

Dr. JMV continued, by telling me the young boy that had clearly worked his way into my heart with lightening quickness was here to start ARV therapy. His CD4 count was 246. Under 200 is AIDS defining. This child was very sick, though you'd never know it. (CD4 is a receptor found on the surface of white blood cells that alert the immune system of a need to mount an immune response when you're sick. HIV strips the cells of these receptors and so your body is not able to get its shit together to mount a successful immune response. Hence the severity of the disease and the commonness of opportunistic infections, such as TB, herpes, etc. The more severe the stage of HIV, the less CD4 receptors-->the worse the immune system functions.)

This is the epitome of my experience in Rwanda. Powerful, loving interactions that leave me feeling drained and heart broken. Everyone's story has a twist...it's never good. I knew that this would be a hard place to spend the summer. But I never expected to see such hopeful, loving people here. This is what makes it hard. I feel jerked around emotionally, even in this short time, because I build up hope that the patient in front of me will be different. Something will be positive for them. It is uplifting to interact with them, and crushing to hear their story. How can people so loving, have such terrible lives?

I'm really learning a great deal about Paul Farmer's theory of structural violence here. The idea that social structures act in ways to keep the poor, poor. More on these thoughts later, I'm sure.

Friday:
Masks, Masks, Masks. I saw patients at the WE-ACTx clinic for our study then worked on those damn masks all day. They're finally done! We had awesome pizza for dinner and had a mask making party. I don't know how I always seem to volunteer for the most time consuming stuff. I can't wait to see the kids decorate them. That'll make it all worth it!