Yesterday I had a patient come in with bloody diarrhea, usually caused by Shigella in these parts. I put her on the appropriate medications but she never seemed to get better. She couldn’t keep anything down and her blood counts kept dropping.
When they dropped to a critical level I typed and screened her for blood. All donors are screened for infectious diseases like HIV, syphilis, and hepatitis B and C. If the blood donation comes back positive for HIV, or hepatitis B or C the donor is simply told that their blood is not compatible. MSF doesn’t have the resources to treat HIV in family members here, and hepatitis B and C treatments are equally prohibitively expensive. These donors are all directed to the Ministry of Health for testing for “infections” although they are never told the results of our tests. I’m sure that most of them never follow through and get the appropriate tests or treatment.
I told you all that so I can tell you this: I unintentionally ordered screening tests on the patient who was to receive blood and her screening test for HIV came back positive. We are not supposed to draw blood for HIV screening without the patient’s consent. So I had to approach her and tell her that I was concerned that she wasn’t getting better as quickly as I would have expected and I would like to do a screening test for HIV.
I answered her questions and eventually she consented, thank goodness. Then I was able to wait a brief period (supposedly waiting for the lab results) before I informed her that she tested positive and needed to be seen by the Ministry of Health for treatment. They came by this morning to counsel her, although their counselling doesn’t always turn out to be helpful. Last week they told a mother that because she had been cheating on her husband her newborn baby was going to die from HIV. I hope that was a fluke and not the standard.
My patient was in shock after I told her that she tested positive for HIV and her husband wasn’t handling the news very well either. He, of course, needs to be tested too. It’s likely that he’s the source of her infection although based on his behavior he’ll probably manage to place the blame on her. The Ministry of Health is supposed to provide the medications. They did provide her with medication for the first month and have instructed her to follow up when the medications are almost finished so she can get medication for the next month.
It’s been hot all week, over 110 degrees (and we’re still not at the hottest part of the dry season yet). It’s hard to get to sleep at night and I wake up every hour or two, soaking wet even with the fan turned directly on me. I take a 1.5 liter bottle of water to my room every night and it’s always gone in the morning. But yesterday we got a little break from the heat. When I got up Friday morning the sky was sepia-colored, like the first half of The Wizard of Oz, before Dorothy opens the door into Oz. Everything had a brown/orange tint from all the dust that was in the air.
You could taste it and breathe it. But damned if it didn’t block the sunlight and cause the temperature to drop 10 or 15 degrees! Unfortunately it also stopped all air traffic to Aweil so two of my colleagues who were supposed to head home spent four hours at the airport only to be told that the flight was cancelled. The airplane actually flew to Aweil but couldn’t land; they heard it circling overhead. There are no instrument landings and visibility was so poor that the plane just had to turn around and head back leaving my colleagues to try again another day.
Today is a little clearer and they’re at the airport now hoping they have better luck.