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October 3rd, 2007, And Often We Fail, by Jim Newton

Here is a story about my friend Moses:

We’ve had lots of successes. Many people tested, many on treatment. Stigma drastically reduced. A well functioning health team, including two full-time nurses and 12 community health workers. Doctors come three times a month to our clinic, and many people on anti-retroviral treatment receive their medication directly from our clinic.

And often we fail. Moses died yesterday, and he didn’t need to die.

Moses was one of the first workers we hired to build the community centre. He was brash and funny, and he was good enough that even though we tried to change crews often to give more people jobs and to spread the money more widely in the village, he was one we hired on crew after crew. He was smart and he worked hard. He had many skills, and he was always ready to learn something new. Even after the centre was finished and all the drainage in, there were still jobs for Moses to do, and when we continued to hire him he once kissed my hand. He made me laugh, and I kissed his hand back. We laughed together so many times.

When there was no more work Moses went to work on a nearby farm. He often was on the road as we went by on the way home, and he would yell “Jimmy,” and wave like crazy. When I had time to stop he would run to the bakkie and lean in the window and we would chat for a few minutes. Moses was a friend.

We watched him grow thinner, and we told him he needed to get tested. I happened to be helping with the HIV testing early in the program when our home based care workers weren’t trained to do that and we hired outside testers. I was in the room when he learned that he was HIV positive. His CD4 count a year ago was 220, very low, and we urged him to continue to get CD4 counts so we could initiate him on antiretroviral treatment when his count went below 200.

He came in to have blood drawn in May, but the whole country was on strike, and many people died because no one was doing the blood work. Then he came in a few weeks ago. Chris told him she would give him a present if he came in. We took blood, but we messed up in filling out the form, so his blood went for a viral load instead of a CD4 count. When the CD4 counts didn’t come back, we followed up, and learned that he didn’t have a count, so we couldn’t initiate him And he died. I didn’t see him that often in the last year, but already I miss him. The world is poorer without Moses. I know I’m poorer.

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