Hard lessons to learn

we have just gotten the ability to do HIV tests early for the babies
of mother's who are positive. We've done several lately and just got
the results back this week. One was positive. My heart sank. It sank
even more when I heard the name. It was the child of a lady who has
been positive for several years. Her husband was a doctor and as he
was dying, he told her that he was positive and had been for awhile.
He never told her before or did anything to protect her. So she tested
positive. She was actually able to marry again and her new husband is
amazingly gracious with the illness. He wants her to be treated. He
himself is not positive. When they had their first child together, the
father had a job. She never breastfed the child. He is negative. They
had the second child, Samba. She always asked me for formula. I told
her that I thought she would be fine. She had been on medicine for
years, her husband was negative, so to me, that meant she had a low
viral load and her risk of giving it to her son was low. According to
Mali protocol, women are to breastfeed for 6 months then abruptly
stop. This is hard for several reasons. It is known that women stop
breastfeeding at 6 months when they are positive. So people don't want
to do it. Also, formula is expensive. They can't buy it. We try to
give them a special recipe of a cereal type thing that has a lot of
nutrition but a lot of kids won't eat it. I helped several women with
formula but thought at the time that it was not a doable thing to give
out formula to all my HIV ladies. Now, I'm just not sure that that is
a good excuse. It's probably about $300 dollars for each woman for 6
months of formula. Yes, this is expensive, especially in Mali, but I
think it's worth it. I can't help but think that it was because I was
unwilling to give her formula that her child is now positive. She put
her trust in me that I was telling her the best thing to do. Now, no
other woman who has breastfed has yet to pass it to her child, but it
just makes me wonder. Maybe she passed the illness during labor and
delivery. We'll never know. We didn't have the test to do early on and
know at about 6 weeks of life whether he was positive or not. So now I
have to face this mother and tell her her child is positive. I just
cried at the thought of having to talk to her, to look her in the
eyes. It turned out she had to go to Bamako for a funeral and was
unable to come see me the morning I wanted to talk to her. Her husband
came instead. He took it better than she would have. I won't be able
to talk to her until a week from now. When I talked to the Pastor that
I work with, he assured me that I shouldn't feel guilty. I had done
all I could do. Things happen. I guess the problem lies that I'm not
convinced I did my best, that I did all I could do. There came a time
when I chose not to give formula to every lady and it started around
the time she needed it. Now, maybe this choice was wise at the time,
or maybe it was just selfish. I think maybe a little of both. I
remember being overwhelmed by the needs of all the ladies and the
financial burden that it was. Now I have to deal with that in the
light of a positive child. Money shouldn't be a limiting factor.
Something has to change. Even if this is all a lesson for me- to
consider the life at stake even when I'm tired and overwhelmed. To see
the necessity of getting formula to each of my ladies, no matter what
the cost. I don't know. I'm saddened by the case and pray that this
doesn't have to happen again, though I know in reality it will.