Maura Porricolo and the other mentors set the chairs up in a circle at St. Mary’s hospital in Durban, South Africa. Then, they spoke to and interacted with the 35 students who sat in them, students one step away from becoming “sisters,” the South African term for a nurse. The topic: disclosure.
Disclosure is the term for someone publicly declaring they have HIV. Porricolo and the sisters-to-be practiced with role-playing exercises about how to help their patients through such a monumental step in an area stricken by the AIDs virus.
“The word, everybody struggles with it, even here,” said Porricolo, rapping her fingers on her desk as she spoke.
Porricolo, 45, the assistant director of nursing in children’s health at Jacobi Hospital in New York, recently returned from South Africa, where she took part in a mentoring program put on by Georgetown University to educate nurses in South Africa, Lesotho and Swaziland on how to better combat HIV/AIDS.
“It was very inspiring work, the ability to share my expertise in something that I’ve lived through and really believe in, and then to go to a place where they haven’t experienced it and haven’t had a chance to believe in it—it’s cool,” Porricolo said.
Porricolo became a specialist in perinatal, or mother-to-child, HIV transmission care at her previous job. She was a pediatric nurse practitioner at North Bronx Healthcare Network’s HIV program, where she combated the disease from its onset in New York City during the 1980s.
Porricolo recalled visiting Bellevue Hospital during the epidemic’s first days. She went to see and hold the “border babies,” infants without parents healthy enough to be caregivers, usually a result of the city’s rampant crack problem.
These infants were some of the first children born with HIV.
Despite the many unknowns surrounding the virus, Porricolo said that she had no fear when providing care for the newborns—something she can’t explain now.
“We were never scared,” she said. “I had held those babies, and hugged them and fed them so many hours it was like, ‘well it’s too late now, don’t worry, if I’m doomed I’m doomed.’”
“She’s very creative, not easily intimidated,” said Joanna Dobroszycki, 48, who started working with Porricolo at the HIV treatment program in 1991.
Porricolo recalled at least a couple infant deaths a month in the early years of the HIV program. At that time, with no successful ways to combat the transfer, the perinatal transmission rate was 25 percent.
Over the years, with the advancement and implementation of AIDs medication, Porricolo has witnessed the transmission rate fall. Now, with the use of combination treatments specialized for the individual mother, the rate has dropped all the way to 2 percent.
The transmission rate’s decrease has changed the program’s patient demographic: most patients Porricolo sees are now teenagers and young adults. They are the success stories, babies who have grown up with the virus in the care of the NBHN treatment team. At its largest, Porricolo estimated the program served more than 250 patients. Of those, she approximates nine had pregnancies of their own.
Thanks to the care of the HIV program, none of them passed the virus along to their own babies, Porricolo said.
Those results are not isolated to the patients at NBHN. Only five babies were born with HIV in all of New York state last year, she said.
“How many nurses and doctors do you think you need to take care of that?” Porricolo said.
Porricolo said she knew that as a pediatric nurse practitioner with a heavy focus on perinatal transmission, her department would be one of the first to experience cuts. She is not one to wait for bad news.
So last July, Porricolo took her new position as assistant director of nursing. She called it leaving proactively, a move she made because she didn’t want to harbor ill feelings.
Porricolo still stops in once a week to provide continued care for her own patients, but the nurse practitioner staff at the HIV program has been reduced to just one full-time staff member from the five it used to carry.
Finding themselves lacking an outlet, the displaced nurse practitioners were left searching for a way to use the knowledge they had amassed.
“We sat around thinking, ‘What could we do? Should we make a manual? What could we do?’” Porricolo said.
Rather than wait for an opportunity, Porricolo followed her own credo: she created one. She started looking for international opportunities to utilize her skills and soon found Nurses SOAR!, the three-week program that provided her the chance to mentor nurses in southern Africa.
South Africa has been drastically affected by the AIDs epidemic. A 2007 World Health Organization survey found that one in five adults and children (ages 15-49) lived with HIV, nearly six million people.
Although Porricolo said she felt more of a challenge when HIV hit in New York City, Porricolo had never encountered the sheer volume of people she witnessed in South Africa.
Patients traveled for hours to reach the clinic at St. Mary, the area’s largest hospital, either for lack of care in their community or to preserve their anonymity.
“Intellectually, I had prepared myself for what I saw, but to actually see it—I was exhausted by the first day,” said Porricolo.
Daily, more than 1,000 people waited for treatment in lines so long they seemed never-ending. Some died waiting in those lines.
Many of the deaths were children.
“Of course we experienced deaths here in this country early in the epidemic when I started, but never that many in a week’s time,” she said.
The number was high enough that Porricolo tried her best not to notice.
“And after a while, you stop looking. Because, you know, there’s only so much you can do,” she said.
Porricolo spent her first week in Africa working closely with three sisters in the maternal child health department at St. Mary’s where she focused on learning the system.
She spent the next two weeks at Hlengisizwe Community Health Centre, an outlying clinic in nearby Hammersdale. Porricolo mentored 10 sisters, teaching them better ways to provide treatment and how to set up a system like the one at St. Mary’s.
Porricolo also gave speeches to students in their early twenties at St. Mary’s College of Nursing, covering topics like changing the HIV/AIDs stigma and the practice of disclosure.
Porricolo said the enthusiasm of the students left her with a sense of hope for South Africa’s AIDs epidemic.
“It makes my job here feel so boring,” said Porricolo, who keeps herself busy studying for her doctorate at Drexel University.
“I’m certainly empowered to create another unique job,” said Porricolo.