Orientation

Last night, I stayed up all the way to 8pm here and very happily succumbed to sleep until 6:30 am, with only brief wakings at 1am and 5am. Hopefully I'll get on schedule quickly. But the clinic sent me back to the cottage (a whole 20 seconds from door to door, I can hear the children playing from my living room) for the afternoon so I could sleep/study/blog!

Everyday at clinic starts with prayer, which is done at the front desk/waiting room with all staff on deck. There was fantastic hymn (which is different every day apparently, so much for my plans to look up the lyrics) with harmony, sung by all staff and patients. Prayer is brief, then daily announcements. I went on a clinic tour with Marcia, a first year med-peds attending who did residency at Mt Sinai in NY.  She is also Asian. (and married to an architect in ny who may or may not relocate here. I don't know if there's much work for architects here) The facilities here are gorgeous, probably the nicest building in Lesotho?! 8-10 exam rooms, an on-site pharmacy, lots of consultants- nutrition, SW, and lot of outreach which can mean going to patient villages if patients are not adherent to treatment, or visiting satellite sites around the country. After the tour, we sat and learned about the Electronic Medical Record, which was created just for BIPAI and is actually pretty excellent. And then we (me, an Italian cardiologist turned public health/tropical disease MD who is running a satellite in Lesotho, and a brand new just out of internship physician from Lesotho who did her training in South Africa since there are no medical schools here) grilled Marcia all about BIPAI and what it does. Which I will now explain:

So, sometime around 2001, Mark Klein (sp?) a Baylor physician, went to Romania, worked in an orphanage and realized there was rampant untreated HIV. Apparently pediatric HIV just wasn't treated outside the realm of western medicine. So he decided to create Centers of Excellence (COE) and a model for treatment of peds HIV, which has spread to Africa from Romania. These programs are funded by Baylor (mostly American MD salaries), UNICEF, UNAID, PEPFAR and local ministries of health (for example, the Ministry provides all the antiretrovirals for this site.) These centers are apparently the only model for pediatric HIV in developing countries. They set up a COE in the capital of a country, and then satellites throughout the country which get visited by a MD from the COE once a month. The satellites are run by nurses and nurse assistants. I believe satellites are meant to be within walking distance of a hospital, but this can interpreted to mean within a 3 hour walk. Lack of MD's is a major problem here, Americans and Zimbabwe trained MDs are most of the force- app Zimbabwe actually has a physician excess that ends up serving much of the region. The long term goal of these clinics is to become self sufficient and run entirely by the local people- Romania and Botswana have achieved this. They can remain teaching sites, but will mostly employ local physicians once they are well established.

The children here are either HIV+ or HIV exposed ( + mother). Children who have been exposed can be definitively ruled out at 18 months when lingering antibodies from the mother are finally cleared, and a true look at the child's HIV status can be determined. Mothers with HIV infected children are seen together, in fact the whole family can be seen together as long as there is a + child. There are lots of interesting treatment priorities at the clinic, which I will comment on after I start seeing patients (like medication adherence %, disclosure, teen club, breast feeding and nutrition...)

Nap time!