HIV: The Good and the Bad (Take 4)

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.

HIV: The Good and the Bad

testing testing testing.Having trouble with internet connection, so far have not figured out how to post. This is a test.

Arrival

Arrived safely in Lugulu late in the afternoon of March 23, after an 8 hour bus ride from Nairobi. I am still not adjusted to the 7 hour time difference, so am wide awake at 3 a.m. writing this.
The journey here involved an overnight flight from Philadelphia to London, then a 3 hour layover and an eight hour flight to Nairobi. I stayed 2 nights and one day in Nairobi with my friend Bruce Dahlman, a family physician from Minnesota who has been living in Nairobi while working to support family medicine training programs throughout East Africa. I had just a few errands to do in Nairobi, including a brief stop at Friends International Centre, where Nairobi Yearly Meeting and FWCC are both headquartered.
The rains have started just in the past few days; an hour of heavy rain this afternoon just as I was arriving, and then on and off all through the night. After two dry years and poor crops, everyone is happy to see the rains start. The fields have been prepared, and soon farmers will be planting. The rains bring the vegetation back to life and allow the crops to grow, but of course the rains will also bring more malaria. My friend Jan (who along with her husband Ray replaced us in Lugulu in 1995, but now works at the government hospital down the road in Webuye) says that at the government hospital they have 95 children in their 40 bed children’s ward. The government heavily subsidizes hospital care for children under 5, so Lugulu will not have many children here, as it would be much more expensive for families.
Some things seem new and different: in Nairobi, lots of big new shiny buildings; cell phones everywhere; and at least here in the hospital, many computers. But other things stay the same: the power was out overnight and much of the morning; and even though it has started to rain, there is no running water in the house (hard to know why, but I suspect the water table dropped enough during the prolonged dry period that the borehole that was drilled when we were here in 1994 is not longer reliable).
Today was taken up largely with meeting new people and renewing old acquaintances; tomorrow I start work in earnest.

Nenda na Mungu

Waiting to depart for the airport: This is a story I have told dozens of times over the years, mostly for the benefit of people preparing to travel to far-off places where they will be without the conveniences of home, and perhaps into situations where they may find themselves totally dependent on the kindness of strangers. Today I tell it for my benefit.

Twenty years ago, I heard Gordon Browne (who died this past year) give a plenary address to New England YM, on the occasion of his retirement after many years of service as the executive secretary of FWCC / Section of the Americas. In that position, he would from time to time travel to visit Friends in out-of-the-way places, like the Alto Plano of Peru and Bolivia. He observed that when he was preparing for such a journey, his Anglo friends would invariably say to him, “Gordon, be careful.” But his Latino friends would say, “Gordon, vaya con Dios” -- “Go with God”.

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. Or, to quote Friend Bill Kreidler, “Protection comes from God; security is from the devil.” Traveling can involve giving up some of our security; but in turn we may gain that experience of protection. May it be so.

So, vaya con Dios. Or, rendered into Swahili: Nenda na Mungu.