‘Jane,’ 19 years old, was admitted to the Hospice programme with HIV, pulmonary tuberculosis, and breathlessness. She had a history of not taking her drugs regularly. She looked very unwell, with nausea and vomiting, chest pain, cough, loss of weight, and hunger.
Jane was married to a man whom she did not love; they were now separated. She was still annoyed because she had had an abortion during their time together as a couple; she was also thinking that the man infected her with HIV. Her mother was mentally ill, her father had died, and she was living with a brother with whom she did not get on well.
Jane was put on anti-tuberculosis treatment and encouraged to take her ARVs for HIV regularly. She had very little money and didn’t know how she would afford to come to Hospice. Once on the Hospice Program, the team allocated her money for food and transport. We visited Jane monthly to make sure she was adhering to her treatment. With time, Jane improved so much that she was weaned off the programme and transferred to the ART (HIV treatment) programme near her home area. She was able to live with her mother who was on treatment for mental illness; they were fine together at that point.
One year later Jane came back and told us that she had been working as house help and was raped some months earlier. Since then, she had not had her period. She looked unkempt, was talking incoherently, seemed very dehydrated and was carrying stones and broken glasses in a bag. Jane’s feet were swollen, and she said that she had walked a long distance. On further investigations, we determined she was indeed pregnant.
The Hospice Team arranged for Jane to be taken to the psychiatric ward for assessment, where the staff welcomed her as a long-lost friend. They told us they knew her well; she was on treatment but had absconded. Jane was admitted and restarted on psychiatric treatment, which helped her immensely. She was discharged and we took her to antenatal clinic where she was followed up during pregnancy. We talked to one of her relatives to arrange a place where she could stay while attending ante natal and psychiatric clinic. She was taken to a paternal aunt who agreed to take care of her.
We continued to take care of Jane and to encourage the aunt to make sure she took her drugs regularly and ate well. When the aunt saw that Jane’s pregnancy was developing she chased her away; she was afraid of what would happen if labour started in the middle of the night. They lived very far from any health centre, and we had emphasized the importance of prevention of mother to child. The Hospice team helped Jane connect with a friend near the hospital who was willing to take care of her until the baby arrived.
On 25 November 2013 Jane delivered a healthy baby girl. Everyone was happy for her, and she loved her baby. She was given baby clothes and other items. She was now very keen on taking her treatment regularly. Hospice continued to support her by giving her money for food and transport to collect her drugs.
As Jane continued with treatment and ongoing counselling, she developed insight into her sickness. She came and told us that she as much as she loves her child, she was unable to care for her. We could see that the baby was not gaining weight, despite being HIV negative. The baby was hungry all the time. So, we found someone willing to take care of Jane’s baby. Jane agreed, so long as she would bring the baby to Hospice to visit the mother on a monthly basis.
Jane decided to go back to her mother’s place to live and continue with subsistence farming and to care for her mother. She came to Hospice once a month to pick her drugs and see her baby. This way the Hospice team was able to keep track of Jane and ensure that she was maintaining her treatment and was continuing to maintain the stability she had found.
Jane was facing multiple physical problems and social problems that affected not only her but also the family and friends who were caring for her. With the help of Hospice, these issues were identified and addressed, and she is now able to live a more productive and happier life! The only problem is that Jane’s baby has no paternal relatives which is a situation that still has to be addressed.
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