Laura Fitzgerald, CNM

Of course it bothered me that we were embarking on a busy clinic day without the "spirits" in which to soak the torn strips of fake-snow cotton that we keep in a screw-top plastic jar and use as alcohol wipes.  But the nurse I would be working with in the Voluntary HIV Testing room assured me that we would collect a bottle of the bright purple disinfectant from the dispensary first thing the following morning.  "Don't worry" she laughed. 

She is convinced that I exist in a perpetual state of nervous concern.  Her opinion about my anxiety is probably both as false and as accurate as my belief, based on a month's exposure, that she is prone to clinically questionable short-cuts and works with all the swiftness of a particularly leisurely snail.

It was a grueling day.  As soon as one pregnant cohort was counseled - their blood drawn, their tests run, and their results given - another bored and increasingly irritable group took their place on the congested, hard wood benches outside.  My colleague applied rubber-glove tourniquets and carefully wiped down popping, pregnancy-flooded veins with dry wads of cotton before puncturing and filling lavender-topped tubes with bubbling blood.  I ran the HIV and syphilis tests. 

It was 3 p.m..  We'd been at this since 7:30 in the morning.  The clinic was set to close, but we still had a horde of antsy women waiting outside the door.  My fellow nurse and I hadn't eaten a thing since breakfast and I'd had just about enough of her long-winded, redundant explanations.  Still, we'd made it through twenty-five patients without a single positive HIV test which made it a happy anomaly of a day.

I could blame what happened next on hypoglycemia or cross-cultural stress, but the truth is that the clumsy spill was entirely unprovoked.  I was probably rushing.  One minute, the uncapped vial was securely held within my gloved hand and the next minute, there was a Tanzanian woman's blood splattered all over the shin and calf of my bare right leg.  I felt its temperature before I looked down to assess the damage.  My first thought was this, "I shaved this morning."  The red bumps, miniscule nicks, were plainly visible, as were half a dozen furiously scratched and freshly scabbed-over mosquito bites. 

Lined up on the countertop were the "completed" HIV tests, the plastic strips on which I'd already placed one drop of blood and four drops of diluent.  These cumulative five drops issued forth wet, slowly emerging test results.  My head snapped downward to look at the last wet result in the line, the result that presumably emerged from the same vial of blood now drying on my own skin.  Two lines.  Positive.  The first of the day.

  "Just clean it off.  Don't panic," I thought. 

I've heard that there once was running water in the Counseling and Testing room although I've never seen anything actually flow from the faucet.  We wash our hands from the half-full jug of water that sits beside the dysfunctional sink.  Paper towels have not yet arrived on the Tanzanian clinical scene.  My coworker, bless her, rushed out of the room to gather some precious American-style alcohol wipes from the Childhood Immunization clinic while I mentally planned a post-haste departure to Dar es Salaam to avail myself of a high-tech ex-pat clinic and its well-stocked HIV prophylactic meds. 

As I set a greedy pile of alcohol wipes on the counter, I glanced once more at the half-finished line of HIV tests.  This time, the last completed result was negative.  The second to last one was positive.  The test drawn from the offending, slippery vial of blood had not had enough time to soak through to its eventual result when I, terrorized by the spill, had sought to identify the culprit from the line-up. 

My co-nurse did not make a fuss out of my mishap.  Perhaps she was already picturing the meek-looking woman who would go home from her first prenatal visit today with the knowledge that she is HIV positive and that, even if she does everything right over the course of this pregnancy, her child may still be born with the virus. 

When this news was eventually delivered, our patient dabbed momentarily at her eyes with the colorful cloth that covered her head and her shoulders and then stared at the gleaming linoleum floor, silent and still.

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