NB: I wrote this 3 days ago and have spent hours trying to figure out how to transfer it to the blog, and in the end have to just retype it. Sorry for the delay; my postings may be infrequent given the problems I am having.
3/26: Dr Serrem, the acting medical officer in charge, gave me the new call schedule yesterday, which had me on call that night (my second day here). Perhaps he thought being on call would help me get over jet lag. But I am not about to complain: he has been here alone over most of the last 3 months. (He was joined the week before I arrived by Dr. Mark Waithaka, who just finished his internship at a nearby district hospital and was posted here by the government; he is the age of my sons...)
One of my admissions during the day was Jacob, a 42 year old policeman, admitted with shortness of breath and difficulty swallowing, worsening over 3 weeks. A look in his mouth showed the telltale thick white crust of oral thrush, a certain marker of advanced HIV. His chest x-ray was suggestive of PCP pneumonia, a complication that used to be common in the U.S. but is now rarely seen. The nurse whose job it is to counsel patients about HIV testing found out that in fact he had known that he was HIV positive for over a year, but had resisted the pleas of his wife to seek treatment. So despite the now readily available and free treatment for HIV (which his wife is on), the results for this man were distressingly familiar from my previous time here: inability to swallow pills, worsening respiratory status overnight; and then today delirium (probably from low oxygen in his blood), increasing air hunger, coma, and death just 24 hours after admission. This despite the availability of medicine to treat his thrush and pneumonia; he had simply delayed too long.
A welcome contrast to this was an invitation from the HIV clinic to come greet a group of 15 or so preschool and primary school children, along with their mothers (or grandmothers, as many were orphaned), members of a "Children Living with HIV Support Group". These are some of the 400 or so children (and 2500 adults) receiving HIV care through Friends Lugulu Hospital's Comprehensive Care Clinic. The care is free, and ultimately funded through PEPFAR by your tax dollars. Whatever disagreements we may have had with George W. Bush, this is his legacy in much of Africa.
The good and the bad; hope and despair; the promise of life and the specter of death: seems it's all here, everyday.
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Tom, thank you for these sentences in the airport.
ReplyDelete"Perhaps we can generalize to say that those with much to lose think in terms of being careful, while those with less to lose know from whence their protection comes. ...Traveling can involve giving up some of our security; but in turn we may gain that experience of protection. May it be so." And may it be so with special force for you. I will miss you at the Outreach Committee meeting Thursday. Thank you also for the example of your gentle writing.
In peace, Gray