Unsure

One of our doctors from the ANC clinic called yesterday in the middle of the OPD. She had an HIV positive lady at the clinic in 39^th week of pregnancy, who needed to be admitted for elective LSCS. A decision had to be taken regarding treatment. Over next few minutes we discussed the plans and decided to meet with the lady and her relatives in the afternoon. At about four, she came to us, and we stood away from the crowd and started talking to her. She had come alone, which was unusual for a 39 week pregnant woman in this part of the country. You would have the mother-in-law, sister-in-law and the brother-in-law with them even if the husband is not! When we asked her about people who have come with her, she said she has come alone. Husband – she told he is working in a place about 4 to 5 hours away. Then the story tumbled out. She knew she was Positive, her husband also is positive. No one else in the family knows. The only way to keep this within them two was to come alone to the hospital! We concluded our discussions, asking her to come back the next day with the husband, to make plans for ART and treatment plans. We also assured her, that her status and situation, will be known only to the treating team and her husband!

A few weeks back as we were coming from the wards, we saw two small kids – one year and three years probably, sitting alone in the middle of the crowd in front of the OPD block. There were about 500 people hanging around, which is not unusual on a Monday morning. Seeing these two small kids alone, we were concerned. It was about two weeks before this, a child was lost in the crowd. The security staff moved in, picked up the kids, called out for parents, and realizing that there were no one with them, took them to the emergency. We kept them there, and made plans to call the police and then start the process of hospital keeping them till decisions can be made. Half hour later, there was crying and commotion in OPD. A lady was crying aloud, looking for her children. She and her husband were waiting in the counter for registration, and we had taken off the kids! The family was reunited and we gave the parents a good talking down, how careless they have been, this is not acceptable behaviour etc. An hour or so later, this couple along with the kids were in my room to show the husband. Then the story stumbled out. He was Positive, with almost nil vision is his eyes (CMV retinitis) she also was positive, children status unknown.  Theirs was probably a cross cultural marriage, so was thrown out of the house, and they had no other support systems. The only way to come to hospital was to come together as family. In the crowd, with his visual difficulty, she had to be with him to get the registration done, and children had to be left alone!

Another family was in the OPD today. Husband, with end stage Liver disease, portal hypertension, and bleeding from stomach (varices) with 4.5 Hb and A – blood. He has been sick for three years. His parents had passed away many years back. He has siblings but they have no relationships with them. Wife also has no family support system. They have three small kids, 5/3/2 or so, and they came to the hospital, with the villagers providing some money for registration and treatment. We saw him and realized that, he does not have too long a life to live. A year or two at the most. Even to support till then with an A – blood, no relatives around, no community support, she was facing a soon approaching widowhood with three small kids.

All these three stories have few things in common. One - All were in their early thirties. Young couples who have just started their families, with young children or about to start their families.

Two - loneliness. Lonely because of stigmatized diseases and fear of rejection, lonely because of choices they have made, lonely because of contexts itself. If in couple of weeks there were three families coming to us, how many more might there be in the villages around? Is it the tip of the iceberg, of a changing social context?

Three – An uncertain future. All these three families are facing an uncertain future, with both health, lively hood, support systems, children’s future etc. But in their discussions and talk, I never heard much about future, they were talking about what they can do now. This is due to the next issue.

Four - A daily struggle for survival. With no support systems they are not too bothered about future, because there is no time to think about future. The daily survival itself is a tough task. Each day’s issues itself keeps them occupied.

Who will give these families a listening ear to listen to their past stories? Who can take care of their future? Who can take care of their present? Can institutions become a “second family” to them”? Can villages where they are be supported to provide support to these families? Can some of us (I am afraid to put “I” here) become a second family? 

If this is the tip of the iceberg, what does the future hold for our Nation which is fast losing the Community togetherness?

Questions for which I have no answers. Other than this cartoon strip.