Since 1987, Foster has diagnosed 600 cases of AIDS in children in his 36-bed ward. Few live longer than a year after the diagnosis. New cases are appearing at the rate of 15 a month, and the ward's death rate has leaped from one in 20 admissions to one in 10, solely due to AIDS.
If a child has AIDS, the mother must have AIDS, and the father may well also have the disease. For most mothers and fathers, the child's diagnosis is the first time they learn their own fate.
"It's very disheartening work," says Dr. John Sanders, a pediatrician in Harare's Parirenyatwa Hospital and, like Foster, a father of three. "When you see a 2-year-old with AIDS, and the mother is already pregnant again, it's depressing."
HIV-positive mothers, experts have found, will pass the disease along to at least 30% of their children, and almost all of those will die before their fifth birthday. The remaining 70%, although free of the disease, are certain to lose their mothers to AIDS--and possibly their fathers as well.
Throughout history, Africa's orphans, whether created by war, natural disasters or disease, have been comfortably absorbed by families, usually cared for by grandmothers or aunts. But AIDS has created a burden beyond the capacity of most families. A UNICEF-funded study of 10 central and southern African countries has predicted that, during the 1990s, between 6% and 11% of the children under 15 will be orphaned by AIDS. Zimbabwe researchers predict nearly 2 million AIDS orphans by the end of the decade, and the first signs already are appearing.
"These days, you go to a man's funeral, and you see children 3, 4 or 5 years old who have been left behind," says Marowa, the National AIDS Control Program coordinator. "Then, six months later, you go to the mother's funeral, and you see the kids, and of course they haven't grown an inch in such a short time."
The most difficult part of Foster's job comes after the rounds, when he closes the door of an anteroom in the pediatric ward for private talks with his patients' mothers. He asks permission to test some for AIDS and gives HIV test results to others. The task never gets easier.
Goodlaw Muchimika, 9 months old, is folded into his mother's arms as she listens to Foster. Goodlaw was losing weight and had pneumonia when he was admitted to the hospital a few months ago. He and his mother were both tested for AIDS.
"We have the results of your blood tests," Foster says, waiting for a nurse to translate his English into Shona. "Both you and baby are positive for AIDS," Foster continues. "It's because of AIDS that your baby has not been gaining weight."
Tears well up in 22-year-old Chipo Muchimika's eyes, and two drops streak down her cheeks. She lifts the baby's yellow towel to dry them away. Seeing his mother's distress, Goodlaw begins to cry softly. She pats him absently, her thoughts far away.
"What we can do, we can give you some medicine to stop his symptoms," Foster says. "We can try to keep the child as well as possible."
The mother says she is worried about telling her husband. The counselors will later urge her to bring her husband into the hospital, so they can explain it to him.
"Have you explained to her that the child is not ever going to be well?" Foster asks the nurse.
"She's avoided mentioning death," the nurse says. "But she understands."
ZIMBABWE, A LANDLOCKED NATION the size of California, emerged from white-minority rule just 12 years ago, when it changed its name from Rhodesia. The new black rulers inherited, and have largely maintained, one of Africa's more stable and industrialized economies as well as a modern road network, a high literacy rate (74%) and a good standard of living. Zimbabwe's economic engine is fueled by 14,000 companies operating with a work force of 1.2 million in agriculture, mining, manufacturing, construction and the service industry.
And yet, herbalists, spiritual healers and witch doctors outnumber modern doctors 15 to 1, polygamy is legal and practiced, and most brides are purchased with a \o7 lobola \f7 of cattle or hard cash.
The first AIDS case was discovered here in 1983, several years after cases in the United States. In the beginning, Zimbabwe wrestled mightily with accusations in the modernized West that Africa was the birthplace of the worldwide AIDS epidemic.
No one in the government was more reluctant to recognize the significance of Zimbabwe's AIDS problem than the minister of health. He contended that the HIV virus in Africa was a nonfatal variety and that results of the blood tests for AIDS were skewed by the high incidence of malaria.
The country's blood bank, which began screening donors for the AIDS virus in 1985, drew the special ire of the health minister, a former army brigadier, when it banned the country's 50,000 army soldiers from giving blood after discovering that well over half had tested positive for AIDS.