Caring for HIV/AIDs orphans in Uganda.

At 680 grams, Ava was the tiniest baby received as of last January by the Bulrushes baby home in Kampala, Uganda. Abandoned in this bustling city of 1.4 million, she was covered in bugs when she was found a few hours after her birth and taken to a local hospital, where staff called Watoto Child Care Ministries, the church-based organization that runs Bulrushes. No one was sure the scrawny infant would survive. Only one hospital in Kampala has a ventilator, and most hospital incubators don’t work well, says Annie Duguid, team leader for three Watoto baby homes in Uganda. Ava arrived jaundiced and cold, with a body temperature was 34.5 degrees. “Usually a 1.5-pound baby ends up on oxygen and on a ventilator (in North America),” Duguid says. Bulrushes has working incubators but no ventilators. They also have a one-nanny-to-four-babies staff ratio and a commitment to provide each of the 2000 children in their care with a family for life. Watoto Child Care Ministries was established by Canadians Gary and Marilyn Skinner after they arrived in Kampala in 1983 and encountered impoverished grandmothers caring for multiple grandchildren who’d been orphaned at the height of the HIV/AIDS crisis, then-epicentered in Uganda. “We had the highest infection rate in the world at that time. I just felt so strongly God say: ‘Look after my children’,” says Gary Skinner. Within 10 years, the couple had taken on the task of parenting HIV/AIDS-affected children. They now run three villages populated by 260 mothers they have hired to care for up to eight children each, as well as three baby homes (including one in Gulu, in northern Uganda). Each village has schools, a medical clinic and homes, often built by teams of volunteers from North America, Hong Kong, and Australia, and equipped with electricity, running water and flush toilets. Uganda has little in the way of a public safety net, so dozens of churches, charities and nongovernmental organizations run orphanages and baby homes. It’s a necessity — there are an estimated two million orphans in the East African country. About 1.2 million of those have lost one or both parents to HIV/AIDS, according to the AIDs Commission of Uganda. Most baby homes, though, are not equipped to care for extremely premature or sickly babies like Ava, whom Duguid estimates was born at about 28 weeks’ gestation. “They’re very costly to keep alive, and some will die, and people don’t want that on their statistics,” she bluntly notes. “We don’t really want that on our stats either, but we’d rather try to keep them alive.” Ava received oxygen, intravenous therapy to remind her to breathe, and phototherapy to clear up her jaundice. She is now a chubby, smiling eightmonth-old, close to meeting developmental milestones for her adjusted age. But regular feeding, oxygen and working incubators don’t save all babies. Topping Duguid’s wish list is access to pediatricians, neonatologists, ventilators and the respiratory specialists to support them. Sometimes, the Bulrushes staff can’t do anything for babies who won’t make it without ventilators, so “we hold them and love them,” says Duguid. “If they get to that point, it’s pretty much over.” Watoto’s baby homes receive an average 15 infants a month who have either been abandoned or had their mothers die in childbirth. Initially, many are HIV-positive but that status often changes once they are given antiretrovirals and their mothers’ antibodies