Thursday, October 26, 2006

Much better now. Had a lovely weekend reading and sleeping and eating and going for little jogs. Its Eid so officially a public holiday today so there was no HIV Clinic. I decided to go to the medical ward instead. I was amazed to find that 2 patients who I’d given up on the previous week and had expected to die over the weekend were looking, well not exactly healthy, but alive and better that they had on Friday. One had bad malaria and a horrible secondary pneumonia after being unconscious for 12 hours prior to admission. The other had SJS with loss of all her skin (from septrin) and came in with septic shock.
As we arrived on the ward there was a young woman on a mattress on the floor who looked like she was about to die from blood loss (at one point we thought she had died). We managed to galvanise the nurse into going to at least look for some fluid and blood for her. After 2 litres of fluid and a bag of blood poured into her in less than an hour she looked a little better. Two hours later she was able to smile and shake my hand! Not out of the woods by any means, but it’s amazing how resilient people can be.
My pidgin medical Runyankore is improving and I’m getting more confident about having a go. I can ask quite a lot of questions. The problem is that I can’t really understand the answers! Quite understandably people assume that if I’m asking I must be able to understand so they gabble away in answer and I just stand there looking baffled.
Two days in the HIV clinic this week. It really is a different world. It’s well funded because of involvement from multiple NGOs. There are loads of them. MJAP, TREAT, FTF, PAPFER. There seems to be a real hierarchy of care. If you are ‘lucky’ enough to qualify for help from one of the NGOs funded to provide HIV care, you get everything paid for. TREAT seems to be ‘the best’. It covers all blood tests, drugs and any investigations that are needed. But you have to be HIV positive, female, widowed or with dependent children etc. It feels great to be able to do at least basic investigations without a major discussion about whether or not patients or relatives can afford it. I’m not sure if it’s an unusual week this week as everyone seems to be preoccupied with med student exams, but by the afternoon of my first day in clinic I was seeing patients on my own, and by day 2 Mark and I made up over 50% of the workforce. We keep frantically looking things up in books to try to keep on top of what we’re seeing. It’s a great way to learn, both African medicine and Runyankore but I’m not sure its right. Again taken aback by the tolerance and good humour people show.
Yesterday there was 1 doctor, a nurse practitioner, an HIV expert from the US, Mark and I in clinic. Over 200 patients. One died whilst being seen. Several were very sick. Everyone turns up first thing and gets a scrap of paper with their number on. The last person was seen at 5.15, still smiling and saying thank you. No apologies for waiting times, no explanation when we stopped to eat or drink. People everywhere, on the floor and lying on benches. Some had travelled 80 miles to be seen. By mid afternoon the lab had stopped doing CD4 counts so people had to stay overnight to get it done the following day. Amazing!
Day 2. Expert from US poorly in bed. Nurse Practitioner not feeling great but there. 2 doctors plus Mark and I so we were put to work. Mark was lucky enough to have an interpreter AND a BNF AND a pocket textbook of tropical medicine! I had to rely on pidgin runyankore, bits of english, a medical student who spoke runyankore but buggered off when she got bored, a very unenthusiastic pharmacist who helped out when I was really stuck, and nipping in to look things up in Marks BNF or textbook when I needed to.
But the striking thing is that many people are completely well and functioning normally on their ARVs. It's an indication of what can be done when the commitment to healthcare exists and the resources and infrastructure are provided to at least partly meet the need. More of the same with the care broadened from its focus on HIV would achieve so much....

1 comment:

Karsten said...

I was very sorry to hear that the pharmacist happened to be unenthusiastic... Thank you for giving us so many details of your life in Africa. Is it not interesting how much people can put up with and still be friendly? I stand in awe.
All the best
Karsten Berg MRPharmS