Last night we watched the superbowl on a projector in the very posh backyard of the american ambassador's house. We had a giant bucket of KFC so it was pretty awesome.
Today was my first day in the clinic, though this entire first week will be glorified shadowing, "attachment" with different providers. Today's provider was an older Basotho woman who used to be an opthalmologist before taking on this cause. She's the kind of MD who decides with the patient history whether or not to even bother with the physical exam- we probably touched 2 patients out of 15 today. But she was by no means cold, just grandmotherly and wise. It took the whole morning to realize that every patient, and most caregivers we saw today are HIV +. Actually, the two times today we confirmed an 18 month child as definitively negative everyone in the exam room clapped, the mom's were so proud and it really hit home how prevalent HIV is here. Every patient on ARV meds has a monthly pill count, and if the numbers are off then intense counseling is undergone to emphasize the importance of adherence to medication. Little kids, infants, take ARV's, toddlers swallow multiple pills a day like champs. A common statement in the halls here is, "African children are so much better than Western children."
Our lecture today was about disclosure- which entails informing a child about their disease and supporting them to tell the people in their lives. Children are informed about their disease through a flip book that shows your immune system/CD4 cells are soldiers, HIV as a lion and ARV's as really big lion shooting soldiers. But they don't kill the lions, they just put them to sleep for 12 hours a time, which is why you always have to take your meds morning and night. And if you skip your meds, the lions wake up and are extra hungry and will kill more of your immune soldiers and you will get sick :( Disclosure also covers ARV side effects and how the disease is transmitted. Partial disclosure, without using the name of the virus, is done at 6 yo and full disclosure by 10. Parents often oppose full disclosure because it begs the question, how did I get HIV?, which the parents worry will hurt their relationship. The woman who gave our talk is the health literacy teacher at the clinic, and works to disclose to all the children who are patients here. She is HIV +, and told her amazing story of her husband passing away without ever acknowledging his status, claiming TB as his illness. His parents denied it, and denied the woman and her son when they tested positive. She disclosed to her son at 4 years old, and now he is in standard 7 (7th grade ish) and disclosed to his entire class to great support. She was incredibly inspirational. Perspective is the name of the game here.
After work we decided to climb the hill/mountain we've been seeing out the clinic windows. Walking from our cottage, we had noticed there was a big party going on right next door all day. Apparently it was the opening of a new TB clinic in Lesotho, sponsored by Partners in Health and we are most certain the pale white guy in a grey suit we saw was Paul Farmer!!!! Celebrity sighting!!!!
On our walk up we met multiple Basotho, one of whom decided to join us on our hike. Her name is Soloa, is 18, and hoping to polish her French and go to university there!/or here. She currently works on a bridge in town. She was great company, keeping us out of trouble, teaching us Basotho words, and making us look like wimps as we huffed and puffed our way up in hiking clothes and she sprightly followed us in jeans and work shoes. We got to our first rock (pride rock in my mind) and decided to head to our second rock. We walked through people's yards essentially, greeting everyone (Dumela me or ntate (women/men) seeing their sheep, dogs, cows, pigs, laundry lines, outhouses. This gave us good insight into our patients, who predominantly answer no electricity/no fridge in their initial visit social history. Also we walked by a school, where lots of boys called us "Mahoa!" which means "White people!" Ashish is Indian, and I am not so white myself, so we were amused and vowed to speak better Basotho and try to be more legit. The end of our ascension was pretty intense, lots of crawling on rock faces on all fours- definitely no trails here. Our walk was pretty easy on the way down, and when we got back to the cottage we exchanged #'s with our new friend.
Finally tonight we went to the mall to dinner, get groceries and watch the hobbit, since tuesdays are half price VIP seats (20 maloti) On the taxi bus ride down (which is so much cheaper than the taxi and a welcome discovery due to our new friend) a random Basotho man commented that, " I would like to marry a Chinese or Japanese woman. But not one like you, because you have lost all your culture." Don't know how to take that...
Pictures in next post- gotta let them upload overnight.
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