Vitamin D

Vitamin D for me:

I'm sitting outside on a perfect afternoon typing away. Reason #12 why I love Jo'burg is the incredible amount of sun that the place gets. It reminds me so much of sunny days in Colorado. I think that moving from CO to Dublin made me realize how great sunlight is, and sadly gave me pasty white skin. I'm thinking that after a year here, I'll be back to pre-Dublin day. So I've been making it a point to be outside as much as possible and get some vitamin D for me.  Friday I left clinic early, as there was really nothing going on, all the patients had been seen, and I wasn't really all that motivated to stay indoors and read. So I took off and headed out to the nature park (where I go running) and had a nice afternoon hike. In fact, maximizing sun exposure has been the theme this weekend. Saturday S&S I went for breakfast/lunch, and sat outside of this incredible café for hours. (I'll add a plug for coming across a new favorite SA coffee roaster, but there is more to this, and I'll comment next weekend). We then went back to their house where we sat outside for the rest of the afternoon and read, chatted etc. (I finished reading the new David Sedaris book-good stuff). I've got a fair bit of stuff to do today, but it requires me to be indoor, and honestly, it can wait until after sunset.

 

Vitamin D for kids:

Ricketts. I took care of a kids the last week on Ward 18 who was a textbook case of Rickets. Not something seen very often in developed countries, but we see quite a bit here. This kid had it all: craniotabies, frontal bossing, rachitic rosary, Harrison's sulcus, wrist enlargement etc.

Vitamin D for Adults:

As is Denial. I was seeing a 3 year old girl in clinic. One of the things that we do is see if the primary care giver knows their HIV status, and also see if they are on treatment etc. This mostly applies to when the primary care giver is a parent, but with so many orphaned children, the caregiver is often the grandmother, or occasionally an Aunt. So we ask the primary caregiver if they know they status etc.. I noticed on the notes from the last visit, that the status of the primary caregiver was unknown, but it didn't' say who the primary care giver was.

 

Me: Is this your daughter

Mama: yes

Me: Mama, have you been tested for the HIV?

Mama: no

Me: They didn't test you when you were pregnant

Mama: They did

Me: And?

Mama: blank stare

Me: What was the result?

Mama: I never got the results

Me: Oh, I see. Did they give you the pill to take or medicine for the baby when she was born

Mama: No

 

Or this exchange which happened the same day, again with a mom and her 2 year old daughter.

 

Me: Mama have you been tested.

Mama: Yes when I gave birth.

Me: Are you on treatment?

Mama: No, I'm negative.

Me: Really?

Mama: Yebo, I tested negative when I was pregnant.

Me: have you been tested again?

Mama: No

Me: why not?

Mama: I don't want to know my status

Me: Oh.

 

So on Friday afternoon, while enjoying my own vitamin D I thought a lot about these two exchanges. Both moms are clearly in Denial. Well, actually I think mom #2 has some insight and knows in fact that she is positive. Is it complete denial? These kids congenitally acquired HIV. From their mothers. These two women. Is there denial in thinking that they don't also harbor HIV? Is there guilt which keeps them from wanting to get tested? It's very complex. Discussing this at dinner last night, somebody asked what about ignorance on HIV transmission in general? I don't honestly know. This is SOUTH AFRICA. 30% of the population has HIV. HIV has been around for a long, long time. HIV is everywhere. HIV is a fact of daily life. HIV is on the radio. HIV posters are up in the clinics. Everybody knows somebody who has HIV. HIV is rumor and gossip...
 
I didn't see it as my role to address the denial of these moms. I think I felt less inclined to bring it up because there are counselors who address these issues at regular clinic visits, and I don't think I have the cultural understanding to effectively address this issue with these moms...