A Valentine’s Day-HIV Update from Bali
While HIV continues to be a serious problem among the community of women Robin works with, the ability to test, counsel and treat those who are HIV-positive means more women will receive treatment and more babies will survive. Last year’s Valentine’s baby didn’t make it, but we’re hoping this year’s babies will.
Last February, we posted a heartbreaking blog post from Ibu Robin Lim, a midwife we love and support as a friend and grantee, who founded the Bumi Sehat Birth Center in Bali, Indonesia where she delivers the babies of every mother who seeks care there. She described theValentine’s Day birth of a desperately ill baby to a mother who was later diagnosed with HIV. The baby was born covered with open sores and needed mouth-to-mouth resuscitation to keep him alive. This meant Robin and others on her team were exposed to HIV. Since there was no laboratory immediately available to test mothers for HIV during their pregnancies, no counselors to guide those who tested positive into treatment and no clinic to dispense medications, Robin and her team had no way of knowing in advance what they were dealing with. When we read Robin’s blog, we knew we had to help. Since then, we’ve funded a grant to cover the construction of an HIV lab and clinic on the Bumi Sehat premises plus supplies and staff to operate it.
What a difference a year makes. While HIV continues to be a serious problem among the community of women Robin works with, the ability to test, counsel and treat those who are HIV-positive means more women will receive treatment and more babies will survive. Last year’s Valentine’s baby didn’t make it, but we’re hoping this year’s babies will.
Today was a hard one for the midwives at Bumi Sehat, as all of us care dearly for each and every mother and child. We had a visit from a single mother, seven months pregnant, who is afraid she has been exposed to HIV. She came in for counseling and testing.
She is suffering culturally because, as a Balinese woman she MUST marry the lover who got her pregnant. He’s a Westerner. She misinterpreted his sexual advances over the course of three years as love and commitment. Since he did not want to use condoms, when she became with-child, she assumed he would rejoice. This man, her first and only lover, refuses to take responsibility for the baby because he says, “What if it’s not mine?” There were lots of tears, as this mother-to-be shared her story.
We worry that on top of everything, she is barely eating and her blood pressure is creeping up. She tries to follow our nutritional advice, but living alone, surviving from the money she makes doing occasional massages for women, it’s hard. She could make much more money, if she would consent to massage men.
This young vulnerable woman, rejected by her family, cast aside by the father of her child, is living all alone. She has symptoms of Sexually Transmitted Infections. We await the lab results, later today, and will treat her. The landlord where she stays believes that because she will be “Kotor” (dirty from flowing birth blood) after childbirth, so she may not return, even for a day, to her rented home. This is culturally quite normal here in Bali among Hindu people. It’s not exactly the “Eat, Pray, Love” Bali people see on the outer layer. Beautiful as this culture and island are, it is a hard place to be a woman — especially if you are not under the “protection” of a man. This may explain the high rate of suicide in beautiful Bali.
Team Bumi Sehat is looking for a place where she can stay in her first three months postpartum. Usually this is my home. I am very keen to create a space for single mothers to share, be with their babies, breastfeed and learn skills, i.e. computer, seamstress, organic farming, anything they are interested in. There is no such place for women in Bali, yet!
The next patient, I will call Dini. She had her baby at Bumi Sehat 18 months ago. Her husband fell ill, and the hospital said he had cancer. I asked them to allow us to test him for HIV. He does not have cancer. He is in the end stages of dying of AIDS. Dini is also infected. She feels so blessed that their daughter, her only child, is NOT infected with the HIV virus.
She spoke of the challenges of being on Anti-retro viral (ARV) medication, the headaches, rash, joint pain, diarrhea and nausea, symptoms I know all to well. I experienced them myself while being on post-exposure prophylaxis for 28 days, after I resuscitated a newborn with AIDS. Dini, for all her heartbreak is so positive. She showed us her latest lab results. Her T-cell and viral load are not good, however, she feels gratitude that the medication is freely available, and she is “rajin” (diligent) about taking the ARV medication, every 12 hours, as directed.
Dini’s big challenge is the fact that she has no money at all. She spends a lot of time at the hospital, looking after her husband’s every need, and has no pocket money for food. We of course will provide this for her. Her husband’s family blames her for the condition of their son. They say; had she satisfied him, he would not have frequented prostitutes, and would not now be dying! She does not want to seem the victim, but she has only been sexual with her husband, and he transmitted the virus to her.
Her father came along for the visit with us. He cried, lamenting, that parents of girls must allow them to marry away, to the husband’s family compound. He wants to take her back to live with her own family, but legally in Bali, the man’s family “owns” the children. If a woman leaves her husband’s family, even if she is abused, she cannot take her children with her. Dini does not want to leave her toddler. Her husband will soon die, his family can kick her out, and she will at least be welcomed back into her own birth family. Many Balinese widows are not welcomed back home, and resort to working as prostitutes, for food and lodging. When Dini is sent away, after her husband’s funeral, she will not be allowed to take her small daughter with her. Her only dream left, is that she will be allowed to visit the child.
Dini is getting therapy from Bumi Sehat, like organic vitamins, acupuncture, homeopathy, cranial sacral therapy, in an attempt to keep her healthy. All of these services are free, and the women can depend upon our drivers to pick them up and bring them in for therapy.
I had a phone call from Ibu Kasih today. She is the young mother who lost her husband to AIDS, two weeks before their baby was born. I spoke of her in my correspondence with EMC. This young father-to-be contracted the virus 10 years earlier via a blood transfusion. This couple had only been with each other sexually; neither of them had ever been raped. We did not imagine they could have HIV, but the young father-to-be did not tell us he had been given blood transfusions after his appendix ruptured. On this island, when one needs blood, it is necessary to pay an extra $65 per pint, if you want it tested for blood born diseases. Even though it is a Red Cross, funded by Australian Red Cross, one can never assume the blood is clean. It is not tested, unless the patient pays extra. The poor of course do not have the luxury to pay.
Ibu Kasih is on ARV medication; she says the side effects have become mild now. Her baby girl is growing, she looks just like her father, she reports to me. She is having trouble registering the baby’s birth. The baby’s father who has passed away traditionally does this. I assured her that our staff is always willing to help with this kind of paperwork. Also, I told her Bumi Sehat would pay the fees. We try to help her out, any way we can.
Sadly, in Bali, the protocols for HIV-positive mothers here are antiquated. She was forced by the doctors to have a cesarean birth. The hospital took the baby away immediately and gave her infant formula. The World Health Organization states: “Breast is always best, even for HIV-positive mothers.” The benefits of exclusive breastfeeding, for the first six months of baby’s life, are well known and recommended by all the HIV counselors here in Bali, but the medical doctors refuse to follow these evidence-based guidelines.
Ibu Kasih is sad that her baby is now forced to be fed with infant formula, as once formula is introduced, it changed the PH of the baby’s gut and makes micro lesions in the stomach, making it much more likely the baby would contract HIV, if her mother dared to breastfeed. Ibu Kasih knows it would have been much better for her baby to breastfeed, but the hospital made that impossible. Her parents are bearing the substantial burden of buying the very expensive infant formula. Bumi Sehat’s HIV counselor does visit Ibu Kasih, along with some of the midwives, and we manage to give her some money now and again, to help lesser her burden.
A good friend and I are paying a young mother to stay out of prostitution. When she became big pregnant, she could no longer “work” so, squatting on a cement slab, she hand washed the dirty clothing of sister prostitutes. In September she had a beautiful baby girl. Thank heaven she is still HIV-negative. She also has a six-year-old daughter, who she kept in an orphan home for many years. Her little girl does not want to go back into an orphan home. We of course want to keep the mother and children together. Niki’s husband is in prison. A “pimp” says if she earns a lot, he will use the money to buy the husband out of jail. We have convinced her that this will only result in more tragedy for her; that he would extort her and do nothing to free the husband. So, we have convinced her to take the salary we offer her, her job is to breastfeed the new baby, and to be a mom. She lives in a small neatly kept room, and waits for the day her husband will be free, in six more years.
Tonight there is an HIV awareness concert being held in Ubud. The Bumi Sehat team is there, distributing free condoms and brochures filled with HIV information, and facts, inviting everyone to come for free confidential testing at Bumi Sehat.
Thank YOU Every Mother Counts, you are making a big difference here in Bali.
-Ibu Robin Lim in Bali
