Tuesday, July 29, 2008

Service Proposal & Hospice

Yesterday, I was able to identify a service I (and perhaps 1-2 of our students) can provide Cotlands on an annual basis for a short period of time each visit! Busi, the Outreach Manager, let me know that she would love us to perform assessments for the Outreach (Home-based Care) children; there are about 100 of them, and they all have developmental delays. The schools in Soweto are the worst in the area, she informed me; she thinks it would be important to know where the kids stand, as she is beginning to focus on the educational needs of these children. She also recruited me to provide a "debriefing" session for the careworkers (9) here at Cotland sometime next week. On Monday, Meisie has asked me to do an inservice for the same careworkers, revisiting basic counseling skills as well as some psychological diagnositic concepts related to children with HIV.

This morning I had a chance to visit Hospice, where I 'stimulated' an emaciated little girl--holding her, touching and moving her arms, hands, legs and feet, and eventually feeding her some Rooibus tea with milk and sugar out of a bottle. There were a physical therapist there, who comes every Tuesday morning to assess and work with the Hospice babies. She talked to me about the little girl I was holding; Meisie brought the child, 18 months old, two weeks ago from the clinic because she was "failing to thrive." The child's legs and hands were emaciated, but her lower body had not developed at all from infancy. This is apparently common, because the children are often left sitting for long periods (her upper back has developed and is strong, but her lower back is curved and that of an infant), and so they cannot crawl or walk, as a typical 18-month-old would have already mastered. Her legs were floppy and would not straighten out on their own; the bottoms of her feet are rounded like infant's. The child is very passive and fairly unresponsive to touch; she did attend to the sounds of other children in the room, and would follow a toy with her eyes when I moved it in a circle before her. When it was time to feed her, she couldn't manage the sippy cup, letting the liquid spill out her mouth onto her clothing. When we brought her a bottle, that also seemed a challenge until the physical therapist took her tiny hands and put them on the bottle; then, the child grabbed the very end of the bottle and pushed it into her mouth, drinking gustily. The PT said that this was common for babies who are left alone to feed themselves, which suggests a fair amount of maternal neglect. Almost needless to say, she is HIV+, which means her mother is too.

I made the connection at some point between this child's situation and the story Meisie told me last week: Meisie had been trying to get a hold of the mother of a child she had admitted to Hospice the week before, because she had not yet visited her child there. She finally spoke to a family member while we were driving from Soweto back to Cotlands; the mother had left the area, telling her famly that her child was in the hospital and she could visit her. Meisie, somewhat despondently referred to the mother's disappearance as 'respite.' Child neglect is a serious problem here, primarily due to poverty and all its sequelae, and to AIDS. Cotlands will make sure the child is not returned to the mother until she can care for her appropriately. The physical therapist assured me that she would improve physically with time and Hospice care; she has seen other children come into Hospice in this condition (she's worked there 25 years!) and improve significantly.

1 comment:

Linda Lee said...

I am so impressed by your vision and ability to see the needs and find ways to meet them. Clearly, this is an impassioned and inspired path for you. I look forward to further postings, and hearing more about your work there.
thank you!