• Constance and Baby Lubona Constance at work

By MIRIAM ZIMBA –

THE pain of living through the loss of three children, was enough to discourage Constance Mudenda from ever contemplating parenting!
Her story dates as far back as 1989, when she dropped out of school in Grade 12, in preference for marriage to her high-school sweetheart Martin Bwalya (real name withheld).
She gave birth to her first daughter Natasha in 1990, but even the joys that follow motherhood were short-lived for Constance.
Baby Natasha became sickly about a week after birth, and this went on for the next six years of her life.
She suffered chronic diarrhoea and persistent coughs, and eventually an enlarged spleen, the medical personnel tried all they could do within their powers, but eventually gave up- there was nothing more they could do for Natasha!
In the meantime, Constance had given birth to her second born child Martin Junior in 1992, and he too became sickly after only nine months!
“He really lost a lot of weight and just when he turned one year in 1993, he passed on,” she recounted.
This meant that Constance had to ensure nursing two sickly children, almost at the same time.
In 1996, Constance fell pregnant again, and just when she was in her first trimester of her pregnancy, her first daughter Natasha succumbed to illness, and within a matter of space of few months, her third child also died at the age of two months.
Around this period, there was a lot of misinformation about HIV and AIDS, largely due to limited understanding on the difference between HIV and AIDS.
After the demise of her third child, people she considered as friends about the continued loss of her children.
“These were people who I thought were my friends because they could come and console me and comfort me, but still went behind my back and talk about the loss of my children with so much impunity, they even started saying I would be the next one to die,” she recounted.
Still aggrieved by the loss of her children, these talks began to speak to her inner being, because she began to suspect there could be truth in the gossip that was going round.
“I began to question myself if I could have AIDS, and if I was going to die, but I lacked the courage to get tested for HIV,” she said.
In 1997, Constance suffered a persistent cough that was eventually diagnosed as tuberculosis (TB).
She was immediately placed on the TB trial treatment, which saw her cough cease within three days, but she was advised to continue with her treatment, along with a referral to the local clinic to continue her medication.
Because of her enthusiasm to learn more about this ailment, Constance volunteered to work at the TB center at Mtendere Clinic, where she worked with various TB support groups.
Towards the end of that year, she suffered a bout of herpes zoster on the left side of her chest and part of her back, but this was also successfully treated, and she was back o her usual self within no time.
Shortly after that, her husband also suffered a bout of herpes zoster, and this again got Constance thinking-‘could these be the symptoms of AIDS?’
At the time, she watched her husband’s health continuously deteriorate, and this sparked some form of depression for her.
This saw her seek both conventional and non-conventional methods of trying to solve they mystery, but she was still not prepared to go for an HIV test.
In 2002, the couple shifted to Kanyama, and in 2003, her husband’s condition worsened- he was in and out of hospital.
At the time, some of the couple’s friends and neighbours were shunning visiting them, while the few that visited, mostly had malicious motives to spy on the health of her husband in order to have something to gossip about.
“Because he was so frail, the neighbours would cease all opportunities to stare at him, whenever he would come out of the house,” Constance added.
In 2004, when Martin finally gathered enough courage to test for HIV, his only condition to have his wife tested with him.
“For me going for the test was not voluntary, but I accepted to do the test because of my husband’s failing health. I knew that if I declined to do the test, he would have completely lost hope,” she said.
Even the day Constance and Martin were going to UTH for the HIV test, the neighbours watched their every move as she assisted him into the taxi.
“Some of them even plucked enough courage to ask me where we were going, and when I told them we were going for HIV testing, this made latest gossip headlines in her neighbourhood,” she explained.
“It is like people could not wait, they were so anxious to hear the outcome of our visit to the testing centre,” she said.
However, Constance used such situations as a point of strength to ensure that she was not a victim of stigmatisation.
Fortunately for this couple, they were extensive counseled by a person who is living with HIV, and this gave courage to Martin, who was on the verge of giving up hope.
“When we returned home from UTH, I found my neighbours seated on the veranda next to ours”.
“Everyone wanted to see the patient, and when they asked me how the testing went, I gave them a response that none of them expected”.
“I bluntly told them we both tested HIV positive, and this was a shocker because there was a lot f stigma then,” she explained.
“My response just shut them up, no one could say anything anymore,  the gossip about our health was watered down, because their HIV status was no longer juicy when almost everyone in the neighbourhood got to know,” she explained.
At the time the couple went to get the results of their CD4 count, Constance’s was about 395, while her husband’s was very low-54, meaning that he needed to begin ART immediately.
Fortunately, this couple only bore the costs of buying ARV’s for less than three months prior to government’s move to introduce free ARV in all public health centers later that year.
Because of her enthusiasm to want to learn more about HIV and related issues, Constance became the first volunteer to work at the ART center in Kanyama clinic, where she learned about adherence, treatment, care and support.
Constance, who was very instrumental in the formation of Musayope support group in Kanyama Township, also gained knowledge on Prevention of Mother to Child Transmission (PMTCT) strategies.
She even encouraged women to opt for prevention of mother to child transmission (PMTCT) of HIV in order to have healthy HIV negative children.
Although she was working with many women on PMTCT, and that the results of the intervention were encouraging going by the numbers of HIV negative babies being born to HIV positive women, Constance was still not convinced it could work for her.
She began taking ARV’s on October 13, 2004-on her birthday, at the age of 34 years, and today, this was after her CD4 count dropped to 170.
At this point I time, Constance continued working at the clinic, and a lot of women came to her for advice on how to maximise PMTCT interventions in order to have HIV negative children.
“We would advise them to seek audience with health practitioners, and through that information, I saw women have two to three children who were HIV negative,” but I never had the courage to try,”.
“At the time, my CD4 count reached 1300, and the doctor who was reviewing my results advised me try to have a child because I was in good health, but my immediate reaction to that advice was NO!”
“I told him I did not want to have a child, and he asked me why not, when I was able to encourage many women to have HIV negative children,” she explained.
“My response was that I had cried enough after losing three children, and for a longtime after that, my mind was made up not to have a child,” she added.
In 2008, she even tried to convince the doctors to surgically remove her uterus after being diagnosed with pre-cervical cancer cells, but again this was met with resistance from medical personnel on account of her age.
In 2011, at the age of 41 years, her CD4 count was at 1329, and this was the third time her CD4 count had recorded such impressive highs.
“And again the doctors asked me to re-consider trying for a baby looking at the history of my CD4 count which was on the rise from the time I began her medication, it had never dropped below 500 from the time I started.”
This can be attributed to her ardent adherence to her medication, whose benefits are plain to see.
“I have never been bed-ridden from the time I began medication, let alone be hospitalised,” she explained.
“So, the doctor asked me to re-consider having a child before my biological clock stops ticking,” she said.
It was only then that reality hit her-“I looked at my biological clock and realised that I was almost at the sun-set of my child bearing years,” she said.
This made her begin to panic, and she consulted a specialist on how to plan for a pregnancy.
“It was not easy, because I was stressed, and trying to rush against time, it took me a lot of tries before I finally conceived,” she said.
However, her tries were not in vain, because in February 2012, her home- pregnancy test results confirmed she was pregnant!
Although the pregnancy was not an easy one, with threats of a miscarriage only two months into her pregnancy, she was closely monitored throughout the duration of pregnancy.
After this storm calmed, Constance was assured that because of the optimal health she was enjoying, she would have a natural delivery because she was not in any danger.
At 37 weeks, when she was now psychologically preparing herself for a natural delivery, the situations changed-the HIV specialist suggested that she delivers via cesarean section (C-section)!
“I was not ready for this, they feared that I could not be able to handle the natural delivery due to unpredictable conditions of labour, as well as my advanced age,” she said.
“They explained to me that the longer the labour, the longer the exposure of the child to the HIV virus, and the doctor was not willing to take any risks, meanwhile, they explained to me that in the c-section, the exposure to the virus is very minimal,” she added.
Although these explanations made sense to her, Constance still had inner resistance because of the fear of having an incision on her body.
She was booked to have the c-section could be done, and she was given November 22, however, a day before this, she began to experience signs of labour, and she immediately rushed to the hospital.
She was immediately rushed into theatre, and within a matter of minutes, she was able to hold her long awaited daughter-Lubona in her arms.
“I was able to watch the whole process because I was given the spinal anesthesia, meaning I was awake throughout the process.  Today, she is here with me and now she is my bundle of joy,” she blissfully narrated.
Baby Lubona was first tested for HIV at six weeks, and this was a very trying moment for Constance.
“When I was told to go back after two weeks, it felt like two centuries for me, the anxiety of not knowing that the outcome of the results would be-the feeling was beyond what words can describe,” she said.
She was so stressed during this waiting period because only one thing was running through her mind-“I would have never been able to forgive myself if I infected my daughter with HIV,” she said.
“When I got the results, I could not even control my emotions, tears were just running down my face, and I could not hide the joy,” she explained.
However, if only she had as much courage as she did in 2012 to try for a pregnancy, she would have probably had more than one child by now.
“I am now 44 years, and there are a lot of complications in pregnancy as one grows older, if I had tried earlier, I could have probably had three or so children by now,” she explained.
One thing that Constance desires is to have every pregnant woman tested for HIV.
“Reason being that it is not just about the pregnant woman knowing about her status, but it is to protect her and the life of her unborn child from being infected,” she stressed.
“If someone can say it is not mandatory to test pregnant women for HIV, then they are abetting the spread of HIV to children,” she said.
“I think my mother was really empathetic with me because I had no child, while all my other sisters had children of their own. I think this really bothered her a lot more than it bothered me, and in her old age, her greatest wish for me was to have a child to call my own,” she recounted.
“The first thing my mother said when she saw my daughter was ‘now I can die, because I know I am leaving you with a friend’, and only seven months down the line, she passed on,” she narrated amidst sobs.
Constance who currently works as assistant project coordinator for the Zambia Prisons Health Systems Strengthening, an EU funded Project under CIDRZ, and she is currently pursuing two degree programs in Development Studies and Public Health.
When she was pregnant, her greatest desire was to have a child born free of HIV, and now she will continue to mentor her daughter to ensure she is protected from acquiring HIV.
It has been ten year now since Constance began taking ARV’s, ant till this date, she has never been bed-ridden or even admitted to hospital, except during deliveries of her children.
Although she and Martin eventually divorced, she will stop at nothing to be the best mother she can for her daughter, and no amount of stigma or discrimination will make Constance shift her focus.