In a large sunny room decorated with big bright paintings, young children play with toys while others sit on their mothers’ laps or on new wooden chairs made especially for them.
The paintings are the creative work of school children, supervised by Mozambican artists; the symbolic red ribbons in the pictures are a reminder of those who have died of Aids and give a hint as to why the children are here.
They are waiting in the new Paediatric Day Hospital in the Mozambican capital, Maputo, where Dr Paula Vaz, who heads the hospital, can now offer her young patients a far wider range of support services in a child-friendly environment.
The hospital, supported by the UN Children’s Fund (Unicef) and the French Embassy, has replaced the cramped clinic in Maputo Central Hospital where Vas worked for a decade, and is bringing new hope to tens of thousands of children with HIV/AIDS.
Although full of energy and joking affectionately with her patients, Vaz concedes that “it has been a tough job. Thousands of children with HIV/AIDS who have had consultations with me have died,” she said. “I have felt furious that these children have not had access to antiretroviral drugs (ARVs) — it has been an injustice, a scandal.”
Every year around 30 000 children are born with HIV/Aids in Mozambique. More than 50% of them die within the first year and the rest usually do not survive their second year. An estimated 68 000 children under the age of five are currently living with HIV/Aids.
Most of the children Vaz sees are referred from Maputo Central Hospital or district hospitals in the provinces. They are usually two to three years old.
She has been treating her oldest surviving patient, 11-year-old Gina, (not her real name), since birth. Gina is unusual in that her health has declined slowly but progressively: although showing no outward signs of poor health, her CD4 count (immune cell count) last year dropped to only 8% compared to a healthy child, whose CD4 count is normally above 25%. “She had about just one year to live,” said Vaz.
The doctor managed to secure ARVs for Gina from the day hospital for adults, which has already made a big difference. “She is in school again, she has grown and her CD4 is measuring 14%. Now she has the chance of living a normal life.”
The social dimension of the problem is a challenge says Vaz, who is pleased to have the support of a psychologist and nurses.
The most difficult task, concedes nurse Maria Louisa Ronga, is counselling young mothers whose children have been referred from the main hospital, because “they are often in shock.” After her initial counselling, she refers them to the psychologist.
Gina’s parents, like many others with HIV-positive children, are counselled by the psychologist about the importance of schooling. She has fallen behind, not because she was too sick to study, but because her parents wrongly felt it was not worth investing in their education.
The psychologist will also counsel Gina about her condition. “She does not know what she has, but her parents have agreed that we should find a way to tell her. It is a gradual process,” explained Vaz.
Two sisters, five-year-old Fatima and one-year-old Linda, (names have been changed) both HIV positive since birth, have had regular consultations with Vaz. Fatima is running around the ward looking perky. “I feel better today,” she said, showing off a large smile. The cold sores around her mouth have dried and do not bother her. Their mother, Deolinda, who is also HIV positive, is camping in the pediatric ward to look after Fatima while she recovers from pneumonia.
Deolinda is dressed stylishly but her clothes hang loosely off her emaciated figure, and although she smiles warmly, sometimes her lips quiver and her voice shakes, giving a hint of the stress she faces daily.
She explains how her husband, who is HIV-negative, and her mother-in-law who is a nurse, hid from her the fact that she had tested HIV-positive while in hospital four years ago. Deolinda said her mother-in-law told her to return to her family in the northern province of Zambezia. “I didn’t understand the real motive. I refused — I said my husband is here.” Only after suffering repeated bouts of malaria did she discover she was HIV-positive.
Today her husband, a university student, sometimes brings the two girls to the day hospital for their appointments. “If it wasn’t for the children, he would divorce me,” said Deolinda. Her own condition and the frequent hospitalisation of Fatima, who has been seriously ill eight times, mean that Deolinda’s life revolves around hospitals.
The Day Hospital has given them hope that they may have a brighter future. “My first dream is that my daughters will become well again, and then I can dream about study, work and building a future for them.” — Irin