Dibujos! Dibujos!

Wednesday morning at the clinic, this little girl - we'll call her Maria Elena - snuck up on me and tugged my sleeve, saying, "Dibujos! Dibujos!" She was so familiar, but I couldn't quite place her, nor could I remember what dibujos means, so I asked her her name. "Maria Elena!" she said, and launched into a description of dibujos, which is when I remembered.

In April of 2008, Maria Elena appeared at our HIV unit to be seen by a specialist in pediatric infectious disease from the US. This doctor was to come with a team of film-makers working on a documentary about something - I really can't remember what, and we never heard any more about it. But that morning the team was running very late, though Maria Elena and her caregiver had arrived very early and were dressed to the nines. To occupy her, I pulled out a stack of paper and a bag of left-over crayon bits that we save for emergencies. When I handed them to her, she looked puzzled and didn't really know what to do; coloring is not an activity most Dominican children engage in, even in school. So I grabbed a magic marker and sat down with her to make pictures and shape outlines on the paper that she could color in.

I asked her what she wanted in each picture, and the requests got more and more complex as the hours passed. Soon I was scrambling to create images that included a bed AND a window AND a boat AND the moon AND a cat AND three pairs of flip-flops AND an apple tree (whose fruit she later colored orange). We spent hours drawing and coloring and had a very fun time getting to know each other.

When the specialist finally arrived, she invited me to shadow her as part of my medical education, so I did. I had known that Maria Elena was thin, and that her skin was covered with large, dark sores, but I was surprised by our examination findings. Maria Elena was extremely underweight for her age, had a chronic and advanced dermatitis, and chronic respiratory problems that she just couldn't seem to shake. We did a CD4 test, which counts the number of a type of immune cell integral to initiating the body's defense systems in her blood. Her CD4 count was 12. We generally admit and start treatment for adults with a CD4 lower than 350.

Here was a child in full-blown AIDS - with a CD4 count that should have kept her from standing - vivaciously coloring and touring the waiting room.

The specialist decided to start anti-retroviral medication right away, and began to prepare more tests for after the lunch break. As the team left for lunch, I went to give Maria Elena a hug, since I had to do community visits in the afternoon. She immediately kneeled down and wrapped her arms and legs around my left leg, telling me I couldn't leave and laughing as I tried to make my way to the door. Once I disentangled myself, I gave her a quick hug and quickly ducked out to avoid further restraint. I never saw her again.

....until Wednesday! What a wonderful thing to see her more than a year later, doing so much better than before! Maria Elena is at a normal weight, her skin has cleared up, and as far as I could tell, no respiratory infection was keeping her from following me up and down the stairs. A true success story!! We unfortunately didn't get to make any more dibujos (drawings) together on Wednesday, but I'm hoping to run into her again in a couple weeks when the regular pediatrician is back.

Running into Maria Elena again was touching on so many levels: She is an inspiring example of the great combination regular care and antiretrovirals can make in an HIV+ child's life. She is smart and fun and on her way to some great experiences in school. And I must admit I teared up when I realized she remembered our one morning together, and wanted to continue it. It's both immensely satisfying and heart-breaking to be back to see everyone, knowing that I have to leave again so soon. I know I will never forget this place and these people - nor will I ever forget again what dibujos means!

Hope your weekend was restful - have a good week!