Before the advent of antiretroviral treatment (ART) most African hospitals were full of patients with HIV and AIDS who were just not getting better.
In my time at Kagondo we have generally only about 2-4 patients with known HIV status. However in the last week we have had five. Two are not that sick and will go home maybe to start ART later.
However one arrived in a very sick state. A 30 year old woman who registered last June then disappeared only to emerge in Nairobi with TB and very sick. She started treatment in early January but despite TB treatment and ART she became jaundiced, deteriorated and died last week. Another was diagnosed antenatally last September but as she was an orphan and had no surrounding family and would not tell her husband ( for fear of being divorced), she disappeared and had her baby at home. She was admitted 3 weeks later with puerperal sepsis and has not responded to conventional treatment. She is very sick and will probably die leaving an orphan. The third one is an 18 year old who was diagnosed early last year and started on treatment. She defaulted and was again started on treatment in Septmeber. She again defaulted and arrived here just skin and bones looking like a forty year old. She is so ill it is difficult to know where to start and if she can tolerate the powerful drugs for TB let alone HIV and will she persist with treatment and how much resistance has she got already and do we risk furher resistance by her defaulting again.
These three contrast with the amazing response of many with a lady with a big cheerful smile coming in to the clinic on Friday with a weight of 60 kg , up from 45 kg just two and half months ago and full of energy and a great appetite.
Saturday, 28 February 2009
Builders, HIV and us
About 15K down the road from here lies Katoke, a Teachers Training College, part funded by an Australian charity. Don Corban, a New Zealander oversees the building of a new secondary school now being built there as part of expansion plans. He and his wife are a charming couple who came back to this area 30 years after having lived here in the 70s as missionaries. We met them through a friend and VSO colleague. Don invited us to consider testing his workforce for HIV; we didn’t need to be asked twice, as testing in the community is a large part of our remit.
So Winifreda and Sister Renatha and I (Annie) set off one morning in February to the site, complete with enough kit to test 100 people. Winnie is a nurse/midwife, fully trained in the skills of Voluntary Counselling and Testing and Sr. Renatha is a qualified pastoral care counsellor, also with full VCT training. Both are very experienced and excellent at their jobs.
Don was bemused at the sight of 3 women, one a nun, climbing out of the car and wondered how we were going to be able to talk about “sex and condoms and stuff” to his labourers, but soon saw how good Winnie and Renatha were at it. We first gave them information about HIV/Aids etc, then a long Q&A session where my redoubtable colleagues fielded all manner of questions from sexual practices and transmission to condom use. They all then declared their readiness to be tested. Loudly.
I had a few copies of an excellent magazine about HIV/Aids in my hands and on the way out of the room was mobbed (very politely: “Madam, please may I have.”). The last copy in my hands was torn in two by a couple of chaps both unwilling to relinquish their grasp!
We set up our table in a (very) recently finished house, still dusty builders rubble everywhere, and found a long snake of people coming to be tested. Winifreda took the venous blood and Sr. Renatha tested the samples, whilst I registered everyone with my rather shaky Kiswahili, which they all found amusing, though some very politely encouraged/congratulated me for trying.
128 tests and 4 hours later, (Winnie had packed a few extra tests) we were shattered and were very grateful for the soda and deep-fried doughnut on offer from the builder’s canteen, high sugar and fat content were just what we needed! It was a very hot day, 28’c and humid.
We were impressed and pleased to have had only 3 HIV+ve people out of all the men and women we tested. The youngest was 18; the oldest was 65, with about 15 women on the workforce. Not all wanted to be tested; some probably knew their status already, some may not have wanted to know.
There was a poignant moment when a young man of 24 returned after everyone had gone and we were packing up. He didn’t believe his negative result, saying his wife had died 10m ago from HIV and he was convinced he had the virus too. He was terrified, and no amount of gentle assurances from us would sway him, so we tested him again to show him his negative status, at which he was so relieved he had to sit down. He cried and we feel he can now fully mourn his loss and begin to repair his life.
We spoke little on the way home and all slept well that night. The following Saturday in Bukoba, I was hailed by a crowd of 4-5 strong young men, who all crossed the road to greet me and shake hands. I was bemused, until someone mentioned Katoke, and all became clear!
So Winifreda and Sister Renatha and I (Annie) set off one morning in February to the site, complete with enough kit to test 100 people. Winnie is a nurse/midwife, fully trained in the skills of Voluntary Counselling and Testing and Sr. Renatha is a qualified pastoral care counsellor, also with full VCT training. Both are very experienced and excellent at their jobs.
Don was bemused at the sight of 3 women, one a nun, climbing out of the car and wondered how we were going to be able to talk about “sex and condoms and stuff” to his labourers, but soon saw how good Winnie and Renatha were at it. We first gave them information about HIV/Aids etc, then a long Q&A session where my redoubtable colleagues fielded all manner of questions from sexual practices and transmission to condom use. They all then declared their readiness to be tested. Loudly.
I had a few copies of an excellent magazine about HIV/Aids in my hands and on the way out of the room was mobbed (very politely: “Madam, please may I have.”). The last copy in my hands was torn in two by a couple of chaps both unwilling to relinquish their grasp!
We set up our table in a (very) recently finished house, still dusty builders rubble everywhere, and found a long snake of people coming to be tested. Winifreda took the venous blood and Sr. Renatha tested the samples, whilst I registered everyone with my rather shaky Kiswahili, which they all found amusing, though some very politely encouraged/congratulated me for trying.
128 tests and 4 hours later, (Winnie had packed a few extra tests) we were shattered and were very grateful for the soda and deep-fried doughnut on offer from the builder’s canteen, high sugar and fat content were just what we needed! It was a very hot day, 28’c and humid.
We were impressed and pleased to have had only 3 HIV+ve people out of all the men and women we tested. The youngest was 18; the oldest was 65, with about 15 women on the workforce. Not all wanted to be tested; some probably knew their status already, some may not have wanted to know.
There was a poignant moment when a young man of 24 returned after everyone had gone and we were packing up. He didn’t believe his negative result, saying his wife had died 10m ago from HIV and he was convinced he had the virus too. He was terrified, and no amount of gentle assurances from us would sway him, so we tested him again to show him his negative status, at which he was so relieved he had to sit down. He cried and we feel he can now fully mourn his loss and begin to repair his life.
We spoke little on the way home and all slept well that night. The following Saturday in Bukoba, I was hailed by a crowd of 4-5 strong young men, who all crossed the road to greet me and shake hands. I was bemused, until someone mentioned Katoke, and all became clear!
Saturday, 14 February 2009
St Valentine's Day
We celebrated the day with a 2 hour Kiswahili lesson then a relaxing afternoon round the swimming pool.
Later that evening we went onto the steps to look at the magnificent stars and Milky Way. As I closed the door,dressed in T shirt and sarong and heard the latch lock, I asked Annie if she had a key. NO! The only 2 keys for the house were inside. All windows barred. But the backdoor was still open to the enclosed courtyard.
So finding a couple of convenient sacks filled with sand I put one on top of the other and standing on them I could just reach the top of the 12 foot wall. With a heave and a helpful push from Annie I struggled to the top of the wall shedding my sarong on the way. Annie collapsed in helpless giggles as she saw my bare bum disappear over the wall. Dropping down the other side was not too comfortable in the dark and a gurgle of giggles coming from the other side.
Mission safely completed , doors were opened!!
Later that evening we went onto the steps to look at the magnificent stars and Milky Way. As I closed the door,dressed in T shirt and sarong and heard the latch lock, I asked Annie if she had a key. NO! The only 2 keys for the house were inside. All windows barred. But the backdoor was still open to the enclosed courtyard.
So finding a couple of convenient sacks filled with sand I put one on top of the other and standing on them I could just reach the top of the 12 foot wall. With a heave and a helpful push from Annie I struggled to the top of the wall shedding my sarong on the way. Annie collapsed in helpless giggles as she saw my bare bum disappear over the wall. Dropping down the other side was not too comfortable in the dark and a gurgle of giggles coming from the other side.
Mission safely completed , doors were opened!!
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