Tessa11: Healthcare Outside the Clinic

dsc03137.JPGSorting through ARVs at Vuvulane Clinic

Photos Above: 

1. Vuvulane Clinic

2. A nurse from Good Shepherd Hospital and I are sorting through a container of ARVs

Wednesday, June 27 to Friday, June 29

               After two days of WFP work, I was able to escape the clinic and see a bit more of the healthcare facilities outside of the Baylor world. Wednesday, I went with Carrie and Julia to Vuvulane, a rural community about 2 hours from the COE. The clinic was run by nurses, and the only doctors ever out there were the Baylor doctors once a month. We met up with Good Shepherd (hospital in Manzini) nurses who have been going to these outreach sites before Baylor got involved. They provided the connections and the ARVs. We provided the medical expertise. I spent the day with one of the nurses. I was “helping” with pill-counting, but really I was just watching. The nurse was super nice and seemed to think I was just great, so we had quite a bit of fun while we worked.

              As I watched her work, I kept noticing things she was doing incorrectly (as she filled out the adherence sheet). The whole point of pill-counting is to see how well a patient is adhering to their drug regimen. It is very important because if a patient has poor adherence, then their virus will build resistance to the drug, and the patient’s viral load will increase. Basically, they will get sicker, and they will be much harder to treat in the future.) So, I started asking her questions about why and how she did what she did. Like, when she wrote down 56 for the expected number of pills, I asked why. She said that the patient needed 2 a day, and since there are 28 days between visits, they should’ve taken 56. Looking at the records, I could see that there were 30 days between this visit and the last. When I asked her about that, she said, “We always do 28. That’s just what we do.” And that was that. There were quite a few other major problems I observed with the system, but ultimately, it was all meaningless, since they never calculated their adherence percent. And even if the person clearly had terrible adherence (one man had 50 extra pills!), they never counseled them or took them off the ART (anti-retroviral treatment). Drug resistance has implications for not only the individual who isn’t taking his meds correctly, but also anyone he passes the disease onto will suffer from drug-resistant HIV.

            On the way to and from Vuvulane, we drove byHlane National Park, where Carrie was lucky enough to see a lion. I was rummaging through my bag and missed it completely! L On the way back, we stopped at the private Mbabane hospital, which was much nicer than the government hospital but still had much to improve upon before it would ever meet American standards. We were checking up on a premature infant that was born at 28 weeks (I could be off a few weeks there). I had never seen a preemie before and wasn’t quite prepared for it. The mother even asked me if I was afraid of the baby because I stayed by the door and stayed there throughout the visit. The baby was miniscule—the diaper engulfed its entire body, and its leg was the thickness of my thumb. What I was afraid of was giving the baby some germ from the outside world that would do its premature immune system in. Carrie told me that a neo-natal unit in the states would be 10x quieter and darker to simulate the conditions in the womb. This poor baby had a bright beam of sunlight pouring over him, in addition to a symphony of construction sounds reverberating from somewhere nearby in the hospital. Julia said that if the baby had been in the government hospital, there is no question that it would be dead by now.           

            On Thursday, I shadowed Dr. Eileen at the government hospital. Although I’ve never been interested in clinical medicine, and I never will be, I found rounds to be quite interesting. She and Dr. D (doctor at that hospital) went from bed to bed examining patients, asking the mothers questions, and looking at x-rays. One of the biggest challenges was deciding whether they had a weakened immune system due to AIDS or TB or both. Sometimes the x-ray clearly indicated TB, but with some patients, it was more difficult to tell.           

             One of the most exciting things about our visit was the fact that, when we arrived, Dr. D and some nurses had sat down all of the patient’s mothers (this was the pediatric ward) and were discussing the importance of washing hands and boiling water. This may seem insignificant, but in fact, if they can effectively communicate these messages to the mothers, they could more than halve the number of patients that needed to be there. They plan to do a lot more of this sort of doctor-patient interaction, and they were also trying to make signs to accompany the campaign. In that respect, I was able to help. Making those signs is one of the smaller projects I’ve been working on.

                On Friday, I presented an updated plan for WFP. Thursday, we had a volunteer come in, and Dave started training her. The plan for the following week was to transition from the old system (where Dave and I are very involved) to the new system (Dave and I won’t be here to do anything). A lot of the doctors weren’t there, so that kind of caused problems, but nothing too big.           

                Friday night, Lindsay and Rachel (two Rice students working in Botswana) arrived with Talia and Chris, two Canadians they had met in Botswana. They’d been traveling since 4 am, so we all just ate dinner and hit the sack.

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