"The treatment was stopped because the patient defaulted numerous times."

Less information, more reflection in this one, and to be honest, a little hesistant to post this entry. Chris and I did rounds in the pediatric ward this morning. While a lot of what we've seen has been tough to swallow, there was one case in particular that really hit hard today. At the end of rounds, we went into the Tb quarantine rooms with one of the pediatricians, where we saw two different patients. The first was a twelve year old boy, who weighed a total of 17 kg (~40 lbs), was severely malnourished, and battling numerous infections (some visible on the surface of his skin, others visible on CXR or blood counts). It's becoming a depressing pattern; usually I guess about 4-6 years under the actual ages of the peds patients I've met, with much of the country's children afflicted with stunted growth from malnutrition or disease. The second patient in the room was a little girl, about 10, HIV positive, who was hospitalized with Tb. According to the physician, Tb treatments were "stopped because the patient defaulted numerous times." With broken family support (the HIV problem has created a "generation of orphans" in Swaziland), repeated attempts to treat the girl's Tb had been interrupted. One one hand, continuing this pattern could potentially be quite dangerous, because it can allow the bug to become resistant to standard Tb treatments, exposing the population to an even more dangerous disease. At the same time, it's absolutely devestating to think of a child as a "patient who defaulted", a thought that completely violates any sense of compassion. With 3.5 more weeks left, including at least 5 rural clinics, I'm sure this theme will be repeated, but clearly and painfully highlights the fact that the HIV problem is not only about the individual patients, but also the crippling effects this disease is having on families, social structures, the economy, etc., allowing further proliferation of the virus with heavy human cost.