Wednesday, October 10, 2007

Unexpected Pregnancy

All day throughout the clinic, I hear Dr. Mugyeni rant and rave. Why are these women still getting pregnant? They have 3,4,5, even 8 children already, they know they are HIV-positive, why are they getting pregnant?

Uptake of family planning is very poor here. (Amusingly, the Runyankole word for family planning is family planning.) It is available; there are IUDs sitting unused, there are pills, condoms, whatever. But the women don’t accept contraception, and I am very curious as to why. Malaria is a huge and deadly problem; is is that the women assume that they will lose half of their children to malaria, so they have more than they want? Or do they want huge families? Or do they want to stop having children, but they are afraid of family planning because of rumors and misconceptions (we have enough of those in the Bronx, too)?

The last patient of the day in the HIV clinic is a 32-year-old woman with three living children. She is HIV-positive and 25 weeks pregnant. She is a gaunt, timid woman wearing a large red blouse that hangs off her – if it doesn’t have shoulder pads, then it looks like it does because she is so skinny. She is the only patient I saw who didn’t bring a plastic bag or colorful cloth to lie on the examining table.

Again, Dr. Mugyeni is ranting to me in English over why did she get pregnant. She doesn’t know what he is saying. I ask him “How many does she want?”

He translates my question into Runyankole, and to our surprise, she doesn’t answer, but pulls the collar of her red blouse over her face. I look at Dr. Mugyeni, but he is also clueless. Her chest starts to heave, and we realize she is sobbing. She sobs and sobs and sobs, and she can’t stop. She sits up to sob some more, curls herself toward the wall; whatever it is, she is already breaking my heart.

Finally, after looking at her card and asking her questions, we piece it together. She is a widow; her husband died three years ago of AIDS. She did not want more children, and was abstinent, but in April she was raped, and the pregnancy is a consequence of the rape.

We don’t know what to say. She is still sobbing. And sobbing and sobbing. Dr. Mugyeni rubs her back, I put a hand on her leg, trying to comfort her. “Do you have a social worker? Or maybe can we send her to psychiatry?” I ask. He says “Usually they are very connected to social work through the ISS clinic. Here we just do the family support group.” She keeps sobbing and sobbing. Finally he says “Yes, I think she needs the social worker.” He calls in a nurse, who embraces the patient and speaks gently to her in Runyankole while we quietly exit the room.

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