MALARIA, TB, HIV AND THE LITTLE RED BIKE

I hate the little red bicycle. It is the first thing I see when I get home and the last when leaving.
My 11-year old daughter always parks it near our front door. She loves it, very much. She lovingly cleans it and even puts ribbons on it. It’s a pretty girly bike and under normal circumstances, I would feel proud to see my child riding it.
But then, there is nothing nice about that little red bicycle. It always triggers an emotional storm, which is hard to ignore. It belonged to my niece, Pamela Kasongo. The only member of my family to share a name with me and the last of my cousin’s three deceased children.
Thirteen-year old Pamela is a painful subject that I normally ignore but someone had to tell it, unfortunately, it has to be me.
Nobody knew that Pamela was born with HIV, not even her parents. She always was relatively healthy and showed no signs of a weakened immune system. She was tall and clumsy, always a straight ‘A’ student at school and her most prized possession was the little red bike. She earned it as a present from her Dad for her educational excellence.
Pamela’s story began in 1999, a year after her parents’ colourful traditional wedding. My cousin came to ask for permission to give her my name, I was pleasantly surprised. Normally, Zambians name their children after great ancestors but there I was barely a child and already passing on my name. That is a great honour in my culture.
In no time, the happy family built a house, a mansion by Zambian standards and shortly after moving in, twin boys where added to the list of children.
Life was perfect. But not for long!
In 2004, one of the twins died after a short illness. The doctor said he died of malaria, a common occurrence in a country where children under five constitute 29 percent of all deaths, according to the Ministry of Health statistics.
The 2001-2002 Zambia Demographic and Health Survey estimates that under-5, infant and neonatal mortality rates for the preceding five years were 168, 95 and 37 per 1000 live births, respectively. The under-5 mortality rate in Zambia is ranked 13th highest in the world out of 193 countries.
Before he turned one, baby Honest added to that DHS statistic. Five years later, his twin brother died from undisclosed complications. At this point, everybody thought the twins’ demise was unrelated.
It was not until there Mother died late in 2011 that the possibility of the family been infected with HIV was ever discussed. But Pamela was healthy and was not suspected to be carrying the deadly virus.
The family of five was reduced to just father and daughter. That also changed in January 2012 when Pamela died suddenly while watching TV with her dad.
“Pamela was on the couch watching TV and the next thing I knew, she was on the carpet gasping and she died a few minutes later, “ her father explained.
The cause of death was said to be tuberculosis.
Tuberculosis is a disease that usually attacks the lungs but can affect almost any part of the body.
“A person infected with TB does not necessarily feel ill – and such cases are known as silent or “latent” infections,” explains the World Health Organization (WHO). “When the lung disease becomes “active”, the symptoms include cough that last for more than two or three weeks, weight loss, loss of appetite, fever, night sweats and coughing up blood.”
If Pamela suffered any of those symptoms, she did not tell anyone.

A few facts about TB from WHO;

• It is estimated that one-third of the 40 million people living with HIV/AIDS worldwide are co-infected with TB. People with HIV are up to 50 times more likely to develop TB in a given year than HIV-negative people.
• HIV/AIDS and TB are so closely connected that the term “co-epidemic” or “dual epidemic” is often used to describe their relationship. The intersecting epidemic is often denoted as TB/HIV or HIV/TB. HIV affects the immune system and increases the likelihood of people acquiring new TB infection. It also promotes both the progression of latent TB infection to active disease and relapse of the disease in previously treated patients. TB is one of the leading causes of death in HIV-infected people.
• An estimate one third of the 40 million people living with HIV/AIDS worldwide are co-infected with TB. Furthermore, without proper treatment, approximately 90% of those living with HIV die within months of contracting TB.
• The majority of people who are co-infected with both diseases live in sub-Saharan Africa. Each disease speeds up the progress of the other, and TB considerably shortens the survival of people with HIV/AIDS. TB kills up to half of all AIDS patients worldwide. People who are HIV-positive and infected with TB are up to 50 times more likely to develop active TB in a given year than people who are HIV-negative.
• HIV infection is the most potent risk factor for converting latent TB into active TB, while TB bacteria accelerate the progress of AIDS infection in the patient.
• Many people infected with HIV in developing countries develop TB as the first manifestation of AIDS. The two diseases represent a deadly combination, since they more destructive together than either disease alone.

TB took young Pamela to an early grave and her father remains the only surviving member of her family. It is hard to imagine his pain. His loss is too much.
Unfortunately, he is just one of the many Zambian’s whose families have been wiped out by Malaria, TB and HIV/AIDS.
This calls to mind the story of Mary Kampengele of Livingstone, Zambia. Mary’s story is both sad and inspirational.
In her late teens, she lost her limb after a vicious snakebite. She now walks with the aid of an artificial leg, which members of her community tailor made for her from a tree branch.
Late in her 50s, Mary lost all her five children to HIV/AIDS and inherited several grandchildren with ages ranging from three to early twenties.
At first site, one cannot help but to feel sorry for her. But she wastes no time in making it clear that she does not appreciate pitying her.
The first time, I visited her home; I could hardly believe that a person could be so poor that their house had literally nothing!
The only source of income that Mary gets is from selling milk from her 16 goats. Goats which she bought using her US$ 10 per month grant, which she gets from the government’s social cash transfer project.
With the little that she makes, Mary barely manages to take her grandchildren to school. She has managed to educate one up to college level. But that is a story for another day.
Looking into her eyes, I can see Mary’s pain from the loss of her children. It is similar to the deep pain I feel every time I look at the little red bike.