By Owen Nyaka:
Akweti Sani is a woman aged 36 with four children and has given a written consent to this writer to tell the world her story. She got divorced eight years ago when she was four-months pregnant. She tested HIV positive on February 9, 2012.
As per Malawi guidelines, she started life prolonging Anti-Retroviral Therapy (ART) and was put on Prevention-of-Mother-to-Child- Transmission (PMTCT) as by then, she was lactating.
Akweti, a daughter of a traditional chief, hails from Sani Village, which is 45 Kilometres away from Salima District Hospital. Her nearest facility where she gets treatment is Lifuwu Health Centre, which is about 15 Kilometres from her home – Chigolo Trading Centre.
She got pregnant while on ART and gave birth on December 8, 2014 to a healthy child. Niverapin Syrup (NVP) was administered. She came to Lifuwu facility with the child on February 12, 2015 after 2 months for DNA-Polymerase Chain Reaction (PCR) test, which is offered for infants under the age of two months.
Instead of collecting Dried Blood Sample (DBS), the health personnel at that time collected rapid test and the results were positive since HIV-exposed infants still have maternal antibodies at this age. The positive result was given to the guardian on that day.
“I was told that my baby was HIV positive. I was heartbroken and accepted the result but no any further counselling was provided,” Akweti said.
While Baylor Tingathe Children’s Foundation team was on the ground at Sani Village, specifically at Chigolo Trading Centre, they met Akweti on May 15, 2015. This was three months since the HIV positive results for her baby was announced.
Dunken Phiri, the then Community Health Worker and Counsellor for the area, asked Akweti for the second DBS collection but she refused. She responded in a deep sullen voice to the community health worker, saying the child is already living with HIV and why should they keep on pricking her fingers?
“God, why putting the punishment on this innocent child, at least if you could just let it be on me and not on my child,” she said to herself at the time.
Phiri vividly remembers that as Akweti’s tears rolled down her face, the voice went slow and she seemed totally lost.
At this point, Phiri had to be tactical and immediately stopped talking about the issue of DBS and decided to hear her story.
While using her wrapper to wipe her tears, Akweti explained that she was told that her child was HIV positive on the same day she got a rapid test.
“I realised that something was amiss. I went to through the HTC register and discovered that the child was tested and given the final result of reactive. I asked her if we can talk for a few minutes, she accepted; I did outline procedures that are supposed to be followed on any exposed child with interventions along it. Later, she accepted to give the sample, but I could read her face that her mind was already made up that the child was infected,” Phiri said, adding that “it was pathetic while he was drawing the sample as her tears started again.”
The sample, number 243, was taken on May 15, 2015 and the results were received from the laboratory two months later on July 7, 2015. The result was negative. Immediately, authorities linked up with the Health Surveillance Assistant (HSA) from the area to advise Akweti to come to the clinic, but she never turned up.
Her heart was still broken because a month elapsed without coming to the clinic. Permission from Coordinator of Tingathe was granted to make a home visit, together with the then Assistant Environmental Health Officer, Kennedy Nyirenda. They travelled 15 Kilometres and managed to locate her.
Phiri asked Akweti if it was proper to discuss issues of her child within her house and she gave a go ahead.
Phiri asked her how she had been finding it in her heart about the issues to do with her child, but she clearly stated that she was still not happy with the outcome of the result.
“I went on to ask for consent to give her fresh results, she said yes and I disclosed to her that the DBS was negative, she could not believe it… she looked me into the eye and said, “Adokotala…you mean my child is HIV free?” Phiri said.
This is how Akweti’s child escaped the manacles of being enrolled onto pediatric HIV treatment. She was advised that the final test shall be after twenty-four months to determine if the virus has, at all, been passed during breast feeding period. She got the results on February 15, 2017.
“God is good all the time. The nurse certified that my child is HIV negative. I am more than happy because my child is amongst the HIV free generation,” Akweti said.
She urged health workers to handle with care HIV screening and testing, especially for infants.
My investigation on Akweti’s issue established that the health provider who had conducted the initial test on February 12, 2015 was not qualified, not even as an HIV Testing Counselor.
With inadequate knowledge, the ‘cruel nurse’ who is recently graduated as a nurse – did not know what to do at that time, neither did she consult her supervisors on the matter.
HIV services require multiple lab diagnostic tests to initiate, monitor and effectively treat patients but due to lack of laboratories in most health centres, samples at Lifuwu facility and other rural areas in Salima are transported through motorbike riders to the district hospital where they move the biomedical samples to Kamuzu Central Hospital (KCH) laboratory – a distance of 45 Kilometers.
For now, Akweti is all smiles because of the change in fortunes for her child but one wonders how many other children might have been poorly diagnosed in the area.