HIV

Before coming to Uganda I hadn’t worked with many HIV positive patients in my time at Wake or known many friends who were HIV positive. That changed as soon as I hit the wards in Kiwoko. My first day in the hospital started off pretty routinely as we saw a number of fairly stable patients and discharged a good number before going to lunch. On our return from lunch however, I quickly was hit with the reality of medicine in rural Africa. While we were eating lunch, a 7 year old girl had been admitted with some vague symptoms of fever and diarrhea and not feeling very good for a few days. In this part of Africa, malaria always springs to mind as well as a few other things, one of which is HIV. The mother said the child hadn’t been tested for HIV but that she was negative. We ran some tests and went off to see other patients.

Later in the day, a nurse came up to us and said a patient of ours was ISS positive. I didn’t know what ISS was so I asked Phil, who I was working with, and he explained that it was a pseudonym for HIV positive that made it easier to discuss with patients in front of others. I asked him which patient was positive since we had seen a number of patients and I couldn’t remember who we had tested and what their names were in the busyness of learning a new hospital system. He said that it was the little girl and my heart sank. Her life had changed in an instant with the diagnosis by no fault of her own. Suddenly she was facing a dramatically altered life expectancy, social stigma by some, the need for lifelong daily medications, potential difficulty finding a spouse and facing difficult questions about having kids to name just a few of the issues that accompany HIV. It was tough for me to wrap my mind around the injustice of a seven year old getting that kind of sentence so undeservedly. On further investigation, it was also revealed that her mother and father were HIV positive as well, but the mother had known about her status previously but had been dishonest when questioned.

Unfortunately that little girl is not an exception among our patients here. Since that first day I have seen numbers of patients here who are HIV positive, some of whom are clinging to life by their fingernails while being racked by opportunistic infections trying to take their life. Very commonly in the morning when we round, we’ll hear about another one of those patients who was on the brink who didn’t make it and died overnight. It is really heartbreaking as you see the life and death struggle played out on an almost daily basis with these patients who you get to know as you treat them, pray for them, encourage them and hope strongly that they will recover only to see them lose their battle with the disease.

Not all of the patients who have died since I have been here have been HIV positive but a huge number of the patients seen at Kiwoko are HIV positive (close to 60%) and have an uphill battle when they get sick. This battle is even harder if they forget to take their anti-retrovirals for a few days or don’t have the money or time to get to the hospital to pick up their medications in time and allow the virus to develop resistance to their medications. Once the first line drugs are no longer effective, there is one second line drug that is provided free of charge and after that they are out of options. It becomes a waiting game until they die since there are no free third line drugs available to them.

In spite of this tough reality, circumstances are much better than they were in the early days of HIV when there were zero options for the people of Uganda. Now, if they are adherent in taking their medicines and coming to their clinic visits they can experience a much longer and fuller life as a result of the free anti-retrovirals provided by foreign aid. Still as a health care provider and human being, it is hard to watch these patients die while still only in their 30’s and 40’s because of the effects of HIV.