“He was quiet when he died,” reported Thabo’s auntie. “He hardly made a sound. I would almost never have known if it hadn’t been for the flies, really.”
These were the words that announced the death of eight-year-old Thabo, a small boy who died in Soweto, South Africa. The clinic knew Thabo well—he had first come there with his mother, a young woman who was found to be both mentally ill and to have HIV. She was admitted to the mental ward, and Thabo took to sleeping on the clinic floor until his aunt finally picked him up. Eventually, his mother’s health improved and she came home; Thabo enrolled in school. Although he remained small for his age, things were looking up for him and his family.
That soon began to change. Thabo developed a fever, and would sweat terribly in the night. He was too weak to go to school. Thabo’s mother began to cough. On a rainy morning while hanging laundry, she spat bright red blood onto a clean blue sheet. Terrified, she returned to the clinic, where she found that she had TB. Worse, the strain she had was resistant to at least one of the first-line drugs. Her clinic referred her to another hospital, but without money to go there, she hiked back home.
Over the next weeks, Thabo and his mother became sicker and weaker. They barely ate, and garbage piled up outside their home. His auntie finally came with money to go to the clinic. Everyone was frightened by the way the doctor stopped everything and moved quickly to Thabo’s side upon their arrival. “This boy is critical,” he said, and everyone moved to let him pass. He found large lumps in Thabo’s neck and fluid in the boy’s belly. “They must go to the other hospital now!” he shouted, so worried that he even gave them taxi fare from his own pocket.
When the hospital medical officer saw Thabo’s mother’s paper from the clinic saying she had DR-TB, he ordered her home. He was frightened for his other patients, and he did not have medicine for patients with DR-TB. He prescribed the mother and son first-line TB treatment—even though both likely had the drug-resistant form of the disease. They lay in the grass outside the hospital and waited for days.
Thabo’s mother died there. A nursing sister who knew Thabo’s family found him, barely able to lift his head, and drove him to his auntie’s. Thabo still sweated in the night. His body still shook from chills. The lumps in his neck grew bigger and he, too, began to cough up blood. He grew smaller, but his belly grew bigger. He was visited every day by a worker from the TB clinic, and he took his first-line medications in spite of the nausea it brought him. It was just a few hours after receiving his directly observed dose of drugs that Thabo died alone in a corner, covered in flies. “At least they gave me money for the funeral,” his auntie remarked. “At least this way we can finally do something nice for Thabo. We can give him a small place to rest. And to know his peace.”