Ka Wareba

“Ka wareba” means “I’m sorry for your troubles”. It’s used when people die or when you’re breaking really bad news. I’d just seen a woman with a threatened miscarriage in outpatients, to be told by Jeffrey the medical student sitting in with me that in those circumstances ka wareba would not be appropriate. Its use would imply that the situation is hopeless and that the baby was already dead. He explained that it used to be said when people were diagnosed with HIV (here the disease is called ‘silimu’ because of the weight loss associated with AIDS) but that now ka wareba is no longer appropriate. With routine prophylaxis for opportunistic infections, and with ARV treatment people can live a healthy and positive life after diagnosis. It seems to be perfectly OK to ask people if they’ve had syphilis, or been treated for it recently. Syphilis is startlingly common and probably even overdiagnosed. I don’t bat an eyelid asking anyone about it, mothers about whether their children have been tested, priests etc. They expect to be asked and don’t mind being tested at all, or so it seems. It’s not unusual for someone to have tested positive for syphilis or gonorrhoea but not even thought about HIV testing. However, as soon as I follow up the syphilis question with the inevitable (to me) question about HIV testing, the staff roll their eyes and look embarrassed, and the patient shifts about uncomfortably as though I’ve committed a terrible faux pas and accused them of loose morals. Many people diagnosed still don’t disclose their condition to friends or family. There’s clearly a stigma and an understandable fear attached to the diagnosis.
Despite the church and politicians banging on all the time about abstinence, sex is everywhere here. Family planning is rarely used, large families are the norm, infidelity is common and polygamy is not unusual. Two days ago I saw a prepubertal 12 year old boy with full blown gonorrhoea. I’ve seen 2 people this week who have waited until they are dangerously ill with AIDS before coming for testing and treatment.
With our everyday experiences we’re still not really sure how Uganda has achieved its remarkably low HIV prevalence of about 6% (down from around 30% in the early 90s). There are plenty of billboards everywhere encouraging testing and access to ARVs is improving all the time. Unlike in many other African countries at least there has been a political will from the outset not to ignore or, worse still, to deny the crisis. Health education has focused on the ABC programme of Abstinence, Be faithful and use Condoms.

Last Friday 10 prisoners from the local jail pitched up to outpatients in their stripey yellow pyjamas and chains. 9 of them had syphilis so we are trying to get a team of 30 healthworkers together to go into the prison on the 9th feb to screen all 528 for syphilis and hiv......
The pictures are of the outpatient department at Ishaka Hospital, and snaps from the local Queen Elizabeth gamepark (half an hour and a wonderful drive down into the rift valley away) of a colobus monkey and a kob probably the most ubiquitous of the antelopes around here.