My day in the ARV clinic

Kun & I in our house: 7.10.07: Today was a wonderful day. I spent the day observing a doctor see patients in the HIV/AIDS ARV (antiretroviral) clinic. It is an outpatient clinic & patients line up outside beginning early, but with the longest lines forming in the early afternoon. Many patients travel far to be seen at the clinic. The patients are either starting ARV therapy or are already on it and are being seen for follow-up & for other concerns. It is hectic: employees open the door in the middle of the doctor's visit with the patient to ask questions, there are anywhere from 1-3 employees around to translate Zulu for the doctor, there are no sharps containers, doors have to be open when a patient has multidrug resistant TB, no biohazzard bags in sealed metallic bins, and patients waiting outside, all in all it was invigorating. The doctor worked straight through until he had to break for lunch at 3pm and I was right there with him enjoying learning all that I could from his interactions with the patients. There is a system in place so that before a patient starts ARV therapy, aside from the medical attention they get such as baseline liver functions, CD4, & viral load counts, the patients also spend time in adherence classes & counselling to help them really undertand what medicines they will be on, the extent of the side effects and the importance of the careful administration of the meds. True attention to these details helps the patients understand more about what their treatment is and the significance of continuing the treatment to the improvement of their health. The doctors & nurse assistants took this very seriously, making sure the patient was ready to begin what will be a life long treatment endeavour. There are so many complicated factors that are difficult to wrap one's mind around: patient's are not eligible for free ARVs, so starting therapy at all b/c no one has the money, unless their CD4 counts are below 200. The lower the count the more sick the patient. This is difficult for patients with higher counts to understand because it can be perceived as a punishment for being well. The doctor said that he has heard of some patients trying to get sick so that they can start the medications. This is different of course than someone in the States with health insurance, b/c they would start the medications for treating HIV while still healthy (with CD4 much higher than 200). The patient's on ARVs do get all these expensive medications for free, as well as any medications they need for the numerous opportunistic infections accompanying AIDS. The beauty is that this clinic has seen many patients near death get well from the drugs. I loved being there, working in this context & interacting with the patients despite my severe language deficits. Did I mention it was a great day...