Week Two

Having completed our tours of the primary schools in the local area I have now begun my exposure to the Kenyan health system. I have been reading a book called 28 by Stephanie Nolen. The book is a compilation of 28 biographical stories of people who have been affected by AIDS in Africa. 28 for the 28 million people who suffer from the disease on the continent. Whilst AIDS is a very real disease in the UK, it is much less prevalent and is also very well treated with the necessary drugs. The IcFEM mission is based in the Bungoma district of Western Kenya and this district has an HIV prevalence of 7%. Having spent a week here, in schools, walking around bustling markets and visiting the rural areas it seems inceasingly unbelievable that statistically, 7 in 100 of those people have HIV. I must walk passed tens of people each day who have had their lives turned upside down by the disease.

Today I went spent the day on an outreach with AIDS relief from Lugulu friends mission hospital. We departed the hospital at about 8.30 and sped of in the awesome 4WD at high speed to our destination. We stopped on the way to pick up a ‘snack’ for the day. I presumed this meant a mid morning snack. It was an error not to realise that I was meant to be buying to keep me going until sunset! Once we had arrived at the field station the truck was unpacked: mainly TB treatment, antoretrovirals and some USAID food rationing packs for the undernourished. Then begun a very strange day for me. The purpose of the clinic is to offer Voluntary Counselling and Testing (VCT) to anyone who turns up suspecting that they might be ‘positive’. The combination of lack of education about the progress of the disease, economics and prevailing stigma surrounding the disease mean that people resist coming for testing. In reality, people only turn up when they feel very ill and are in a very bad way, which inevitably effects their ability to respond to treatment.

Meeting the first patient was surreal. This middle aged man was healthy looking, had a broad smile and seemed so intrigued to see a mazungo that there was certainly no hint of embarassement on his behalf. I felt relieved. Possibly the hardest part of the day to stomach was seeing mothers who were HIV positive come into the clinic with their babies who had also been recently diagnosed as positive due to mother child transmission. This was particularly gruelling as it is totally unecessary if only the mother is given the right treatment from 28 weeks of pregnancy and is educated about breast feeding. One child I met had lost his mother and was with his grandmother. This boy looked dreadful. He was five years old, but looked like a 2year old. He also had a dreadfully swollen belly due to malnutrition. I cannot imagine what will become of him as the years progress.

Huge progress has been made in the treatment of AIDS in Kenya. Anti-retrovirals are now free for all who offer themselves for VCT. As a result the prevalence of the disease is at last starting to decrease. Nevertheless, there is a big worry. First line retrovirals have been rolled out across the country, but it is not clear how long the virus will be kept in check by this. Huge amounts of resources and energy are poured into counselling to improve adherence to the drug regimen so as to minimize the risk of resistance. Nevertheless, surely there is a limit to how long the first line drugs will be effective. In the developed world there is plentiful access the 2^nd, 3^rd and maybe even 4^th line drugs, but that is not so in the developing world. In fact it would be impossibly expensive for most Kenyans to afford second line drugs.

Today is the sort of day that I will continue to be reminded of even if I end up in some cushy GP practice somewhere in middle England. I am sure that the faces of some of the patients I met today will still be piercingly clear in my mind. Training to do medicine or not, this would be an experience for anyone.

Lugulu hospital

2 days in Lugulu hospital and I have seen far more than I might see in months in England. The sorts of diseases that our text books quote as ‘vanishingly rare’ are not quite so rare out here! Ward round is exciting and the Dr’s are great fun and gave me the opportunity to examine some patients after them. Lunch in Lugulu town added to the authenticity as we struggled to find a place serving more than sweet chai. We landed upon a hotel which had stray chickens wandering in and out of it and we thought it was the best we would manage. The chapati’s looked lush anyway. Unfortunately it emerged that chapattis were finished, but ‘cuckoo’ was available as we eyed the stray chickens still wandering around. In the end we settled for a ‘sconce’ which is in fact a scone. Sadly no clotted cream and jam, but geen veg and hot chai to wash it down. All in for 60 bob. It can’t be bad!