Day 22 - July 27

I hope that Nick and Pamela enjoyed today. We returned to the HIV clinic that I went to at first with Gloria. We were supposed to meet her at 8:00 to go to the meeting for failing patients at IDI. Jozeph came to get us in the morning, but he was a little late and then the jam was more intense than usual so we ended up being almost a half hour late! I don’t know if I can really say late. Since everybody works on African time, it’s almost impossible to ever start anything when you are supposed to. The traffic is awful in the city so some days it can take an hour or more to go a distance that should take 15 minutes. We walked into the meeting late, but the person in charge waved us to some seats in the front.

I was surprised at how much more I was able to figure out what was going on today. The last meeting I went to, they might as well have all been speaking Luganda, because I wasn’t catching any of the points they were making. After spending a couple of days with Gloria and talking about HIV/AIDS and all of the complications, I was actually understanding what they were talking about with each patient. I felt like I had learned some relevant information that I will be able to take with me as I learn more in the future. The world probably learns a lot from the data that comes out of the IDI center about infectious disease. There are not many other places outside of Africa that have the number and high concentration of HIV positive patients. Each patient is put into a profile and then given treatment based on guidelines set up here. The biggest problem is the sheer number of patients. The CDC has a set budget on what money is available to purchase ARV drugs to give out to patients for free. The more patients that show up, the more money they need to spend. In order to try to cut costs, they patients are being started on the medicines later and later. This means that the patient’s immune system may be very weak by the time the drugs are started so they will end up with more complications. It’s so unfortunate to see that there are drugs that will prevent severe sickness, but they are not being used because there is not enough money to make them go around.

At the clinic, I decided to help out with the triage of the patients which is basically taking weight, height, temp and blood pressure. Being a first year medical student and working at the HOPE Clinic qualified me to be able to do it! However, I think the most important factor was that I have my own BP cuff, which is a limiting factor for the number of people that are able to take blood pressures. Pamela and Nick split up with Gloria and her friend Joane, who works with management of pregnant woman and children who are at risk or have HIV.

I tried to help call out the names of the patients that were waiting as the files were placed on the table. When I called out the names in my English pronunciation, nobody really paid attention. There were three nurses and a counseling student at the table, and they didn’t seem to interested in helping me at first. I knew it was going to be a really rough day if I wasn’t able to make a connection with them. Lucky for me, I had resources to help me out! The best was the tiny beanie babies. Our neighbors our extremely generous and had given us over 400 of the little toys to pass out wherever we saw they would be appreciated. We decided to hand them out to the children at the clinic as they went in to see the doctors. I never got the student’s name, but he was my biggest help. I wasn’t sure how to use the thermometers. Everybody here takes temperatures under the armpit. It might be a little less invasive and more sterile than anywhere else, but I don’t really think they are that accurate. Most of the patients were 35 degrees Celcius or less, which means that they are a whole 2 degrees below the average normal temperature. I just have a hard time believing that everybody is that low. Maybe there is something I don’t know about people in the country and core body temperature. I’ll have to try to figure it out some day.

The nurse sitting across from me was especially stern. She was probably in her mid thirties but you could tell she was in charge of what was going on. She was always telling people what to do and grabbing things away from people in disapproval. Any time I even reached for a file that she wanted, she would shake her head and give me some other file. I realized after a few patients that she had a system and I was interrupting it when I took the files that I was told to take by the man bringing them. Once I figured that out, things went much more smoothly. The nurse was even calling out the names of patients and directing them to me! While we were sitting around waiting for more patients, the stern nurse picked up my pen to figure out how it worked. I told her she could have it and she grinned ear to ear! She was finally happy and it was directed at something I had done! Ross had taught me on the first trip that “pens make friends”, especially when it comes to nurses who are generally in short supply of them. I think he was right. From then on, she was even more friendly and was helping me out more with patients.

In the 4 hours that I was there, I must have taken at least 50 blood pressures, and the other two nurses did even more. Partway through the day, I stopped and thought about the patients and I was amazed at the fact that every patient that I had touched was HIV positive. When am I ever going to be in a place that 100% of my patients have such a complicated disease with such a serious prognosis? When I was with my preceptors in Minnesota, I don’t think that I saw any HIV positive patients. In a day we would maybe see 15 patients, but most of them had high blood pressure or an acute injury. There were only a couple each day with really complicated histories, but very few of them had anything that would compare to HIV.

High blood pressure must not be that big of a problem. People here are generally not overweight and their diets are very healthy. The only two patients that I had that were overweight both had very high blood pressure. I remembered the first man because he was the first person that actually filled up the chair when he sat down. When I took his blood pressure, I thought that I heard the first noise around 185, but I wasn’t positive until about 175 (the normal should be about 120). It ended up being 175/120 that I wrote on his chart. A little while later, a counselor/nurse interrupted me to borrow my cuff. When I looked over, she was re-checking the blood pressure on the man that was really high. All I could think was that I had taken it wrong and they were trying to fix my mistake! Then another nurse went over and took his pressure again. They were gone with my cuff for 20 minutes. When the nurse, Sylvia, brought it back I asked her about the patient. She said she got it as high at 190. I think back home somebody would have sent him to the ER. Instead, the nurses set him up with counseling about his high blood pressure and hopefully got him started on ways to reduce it.

I finished a little earlier than Pamela and Nick so I joined in on a counseling session with Gloria’s friend Sylvia. She is the one who had given me a tour last time. She is so feisty and very expressive when she talks. When I sat down, they were speaking Luganda, but I could tell she wasn’t happy with the patient she was speaking with. There was a man sitting in front of her and a women next to him. Sylvia was asking him questions and he kept avoiding them. She stopped to explain to me that this man had stopped coming to the clinic about a year ago because he felt better and didn’t think he needed drugs. Then he started getting sick so he wanted to come back. She was trying to explain that he needs to stay on the medicine all the time or else he would keep getting more and more sick. It was interesting that even though I didn’t understand the words, I still understood the conversation. At one point, after the man refused to answer the questions to her liking, Sylvia sent him away. The woman remaining was his sister who generally helps out with his care. She was trying to explain to her the importance of the drugs and then get more information about the man’s social history. He had claimed he left his wife because of his HIV, but it didn’t make sense to Sylvia, so she wanted to know more about other women in his life. Before I could find out the conclusion of the story, Gloria came and informed us it was time to go! I think Sylvia probably talked to the patient for a lot longer after I left. She wasn’t going to stop until the whole situation was sorted out and sometimes that means spending an hour with one patient!

There was more jam on the way back, but probably not anywhere near as bad as the morning. Gloria dropped us off at a mtatu stand and we got a ride back to Ntinda. Since I haven’t walked anywhere long in a few days, I convinced them we could walk back home. I was hungry and hot, but I figured it would be better to walk now and then take a shower and nap when we got home. It sounded like Pamela and Nick had learned a lot and enjoyed the experience at the clinic.

When we got home, my mom had just finished with some laundry and cleaning at the house. Even though we are guests here and there are cleaning people that come to the house, she still wants to do all the work she can to contribute to the clean house. I wonder if that’s something that happens when you become a mom or if I should already have the urge to clean all the time. My philosophy is that if there is already somebody doing it, I shouldn’t take their job away from them, so I haven’t really cleaned at all since I’ve been here. Hopefully that’s not too upsetting or offensive to anybody.

We ate some snacks and took naps and just relaxed for a while around the house. We called Jozeph 2 to come and get us and bring us to Javas for dinner and so we could use the internet. It’s hard to keep up with all of the emails and messages from home, but I really don’t miss them! I like not having the expectation that I can be contacted any time by anyone and be expected to reply within 24 hours. Sometimes it’s nice to just work on things at your own pace and be able to get them done when you can. I will be happy to have the internet back on a regular basis and I’m sure I’ll find a million and one ways to waste time on it, but for now, I’ll be content without it!