HIV Care and Nutrition Program (UKUN)

 
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Jul 28, 2014

UKUN Volunteer Diary (Week 24)

 The past two weeks at home-based care in Bagamoyo were busy with new and old patients. Bjarne; a Swedish student nurse joined our team for couple of weeks, which was great help for us. Kirstine our Danish volunteer said her goodbyes to us last week. She was a great asset to us and will be missed. Unfortunately sad news was delivered to us in the first week; our long term patient Mariam had passed away. We also discovered that Hadija was suffering from Malaria as well as Abdallah. People say that this is the worst season for Malaria as it rains often and mosquitoes love it. Patient ZZ, a new patient of us was admitted to the hospital and spent a week there to recover. We also received a new referral from CTC, a newly diagnosed HIV but already a very sick patient; RSM.

Update on patients:

Patient JJ:

Juliana is our fairly new patient (one month now) who is suffering from high BP (blood pressure) and reduced mobility. We have been monitoring her blood pressure every few days since she was started on BP medication couple of weeks ago. It all started well but then her BP was raised again last week. We added another BP medication that we had omitted the week before. We will have to wait and see if this will work and keep monitoring her. We cannot start physiotherapy until her BP is stable. She lives in a very basic house, sleeps on a stone floor with a very thin mattress. The room is too hot but she is not mobile to go out and she is a quite a large lady to transfer. It makes as really sad that all her family had abandoned her. However she is very lucky to have Oliva, a local mama who feeds and washes her every day.  

Patient AH:

Our 18 year old orphan boy AH called me on Sunday morning and told me he was sick. First I thought maybe he was hungry as Charles had gone away from the office for few days. I found him at the office with a fever and a headache. I took him to the local clinic in town (instead of queuing all day at the hospital lab) to rule out Malaria first but unfortunately it came back positive. He was only suffering from Malaria two weeks earlier. He got medications again and I took him back to the office, collected his lunch and advised to drink lots of water. He told me he has been sleeping at the office now for a while because his family circumstances were bad (again). Unfortunately a big stigma exists in his auntie’s house where he is supposed stay since his parents and grandmother died. He got HIV in birth from his mother and has suffered twice from TB (Tuberculosis) too. He has been very unlucky. There is no protection from mosquitoes in the office and I gave him my mosquito repellent cream. Very soon (January) he will start his school in Mbezi (Dar Es Salaam) and hopefully this can be a new hope for him for a better life. We will need to find him a clinic near to the school where he can pick up his HIV medication monthly and he needs to take responsibility for it.

Patient MP:

Patient MP our long term palliative care patient who had been in the last stage of AIDS for years now passed away at her home. It had been expected for a while now. She had almost no quality of life left since she had a stroke five years ago and her husband had died two years ago too. We hope she is in peace now. I and Bjarne attended to her funeral. There were a lot of people sitting on ‘mkekas’ (big floor rugs made of basket) and food as a typical funeral here. Most funerals last three days here in Bagamoyo. All the men had gone to bury the body. Her daughters were very sad and mourning. We showed our respects and left. It will be strange not having Mariam around anymore as I had cared for her almost a one year.

Patient CP:

Bjarne and I took patient CP to his monthly appointment to hospital CTC (Care and Treatment Clinic). Patient CP is wheelchair dependent and needs transport every month. He received good news as his CD4 count had gone up by one hundred to 461 in six months! We were all really happy. He has grown physically stronger in a year and is in much better spirits too. We continue to bring him extra snacks and clean drinking water. Big stigma exists in his family and living surroundings and he gets no help at all. None of the family members wants to co-operate with us either. We do the best we can to maintain some quality to his life. We continue to give him two weekly showers, laundry and clean his room. He is such a character and loves volunteers visiting but the same time all volunteers get fond of him too.

Patient ZZ:

Patient ZZ our HIV positive very frail lady has had a bad chest for a while and we were suspecting TB of course. Hospital had lost her sputum results so I took two new samples from her to the hospital. After two days I picked up the results and they came back negative. I was very surprised. The lab told me she can still have TB as it doesn’t necessarily show for HIV patients or if she has extra pulmonary TB. We took her to the hospital with Bjarne last Tuesday. By this time she was very weak and kept couching and producing sputum. Zena’s mother stayed home with her three children.

Patient ZZ had an X-ray done first that Mr. Charles had booked for her the day before. After this we went to see doctors-all 3 of them! They told us she did not have TB, it was PCP (Pneumocystis Pneumonia), which is common pneumonia for people with weak immune system like HIV patients. Patient ZZ's PCP was severe. She was admitted to the female medical ward. We were told the treatment should be IV Septrin but it was very expensive and not even available here so she would have to take it orally 9 tablets a day. She was also given fluids with glucose and strong antibiotics injections for 5 days, which were not available and we had to purchase them from the pharmacy in town. She had oral thrush too and found it hard to eat. She was prescribed oral gel Miconazole for that, which we purchased from the pharmacy in town again. We visited her for three daysand also brought food to her home for her three children. On Sunday, when we went to visit her again she had already been discharged home.

We will visit her at home next week and hope she is better. Doctors told us she has few years’ history of not being compliant with HIV treatment and doctors are reluctant to give her again. She has not always attended her appointments and has no family support. Her mother refuses to come to see the doctors together with Zena. Also because of this doctors won’t give her the treatment for HIV. Her next appointment will be at New Years Eve. I have asked our boss Mr. Charles to go with her for support and counselling. She needs to start treatment if she wants to live and take care of her three children, which one of them 8 year old Dotto is unfortunately also HIV positive. Dotto has his appointment on the same day with patient ZZ.

 New enrolled patient:

Patient RSM:

Last Tuesday a lady came to our office and asked for me. She had been told in CTC to find me for her sick brother. We went for a home visit together with Bjarne to assess the patient.

Patient RSM is 38 year old man who was diagnosed with HIV last July when he started to feel sick. He refused to accept these result and went to see a witch doctor. Months later he got really sick and with the encouragement of his family he was enrolled to CTC to seek treatment. This was early November this year (last month). He was started on Septrin (antibiotic) only. Then a week later his CD4 was checked and he waited a week for the results. The CD4 was only 144. By this time he was very sick. His Haemoglobin (Hb) was very low 6.9, and to start HIV treatment it must be 8 or above. Doctors sent him home and gave him medicines to boost his Hb (Hemovit), Paracetamol, B vitamin and multivitamins and told him to come back a week later.

We arrived at his house the day after he had been to the hospital. We found this tall man who looked very malnourished. His family was there; 2 brothers and a one sister who all seemed really friendly and caring for their brother. Ramadhani the patient told us he has been eating. He told us he was still walking but only short distances. He was breathless. We checked his physiological observations; BP 90/70, heart rate 110bpm, respiration rate 30 and temperature 37,5 degrees. He had no cough and there were no crackles when listening to his chest. He reported no diarrhoea or any other problems with elimination. We advised him and his family to relieve his pressure areas with changing position and using pillows. We gave advice on iron rich diet to boost his Hb quicker and told him to drink plenty. His next appointment will be next Monday 23dr of December and we will go with him to the hospital. We hope his Hb will be increased so he can start on HIV medication.  

Patient HD:

Our blind HIV patient HD got sick with flu and tested positive for Malaria. She received treatment and we visited her at home with volunteers Kirstine and Bjarne. After couple of days she was already better and back to her cheerful self.

It was Kirstine’s last week and she took us for a nice meal including Abdallah. Kirstine taught me how to update the patient CD4 graphs that she had created. We are so grateful for all the hard work she has put in and will miss her a lot!

Next week is Christmas and we have great plans to bring some Christmas spirits to our patient in Bagamoyo. My father did a Christmas collection from his friends to our patients and the total came over 300 euros! Christmas is surely the time for giving.

Jul 14, 2014

UKUN Volunteer Diary (Week 23)

The past two weeks in Bagamoyo I continued working with volunteer Kirstine. I got flu for few days but luckily it was not serious illness. We had a great success at World HIV Day and continued home-based care with our old and some new patients.

Kirstine created patient record system with Excel program to record all the people who come for testing at the office. She also collected all history of CD4 counts from our home-based care patients and we weighed most patients with new scales we purchased (some of the immobile patients we were not able to weigh). From the information she created a graph so we can see and monitor the progress of our patients. This is something that was planned long time ago but it was Kirstine finally who followed it through and she made a great success.

World HIV Day 1st of December was a great success too. Godfrey came from Dar to help us and together with Charles set up a spot to the middle of the bus station and test people for HIV. Chanzi also gave a hand with setting up posters and we had lots of stickers and red ribbons that were donated from UK based HIV Charity through Debbie; our faithful sponsor and volunteer from the UK. 54 people, young and old were tested on that day! One older man tested positive and was referred to CTC at the hospital for a follow up and more counselling. He had a strange reaction to his results; he was happy and said ‘It is OK because now there is good treatment for it.

Couple of weeks ago Kirstine organized to have testing for pre- school children at our UKUN/PHI office. Two groups of 10 came in two different days. No one was found positive. This was a great idea and something we should expand to the other schools at Bagamoyo too.

Update of patients:

Patient G from Morogoro family:

We have been visiting patient G weekly and every time we see him he looks healthier and he is getting stronger. He had his hospital appointment for refill of ARV medication. He still reports dizziness and doctors told him he has a low blood pressure. We have been checking it ever since and it is within normal range. Otherwise he has no other problems. He has gained even more weight and his mobility is almost back to normal. I gave him multivitamins for a month and we give him porridge and fruit every week. He is missing his family greatly but soon he will be fully recovered and go back home to his wife and baby boy Michael. Hospital still has not received results for HIV test from the little boy Michael. This sample was taken about two months ago now and sent to Muhimbili Dar Es Salaam. I wonder if we will ever get them. I will attend his next hospital appointment with him on New Year ’s Eve.

Patient Z and her daughter Hadija we visited both weeks but found that they were not home. Apparently Hadija works now near the beach every day and her mother Patient Z had gone to the farm. Last time we saw them was a month ago and luckily Patient Z had recovered from her stomach ulcers and had got back her mobility. We are not concerned and they have our number if they need us.

Patient A & Patient H - Tanga family

We visited Amina and her brother H to talk and help about plan for future and getting out of poverty. Their health is stable now and patient A continues her physiotherapy with exercises and walks with her frame. Hamisi has fully recovered from his operation and we helped to restart his cigarette business few weeks ago. Now he reports that is going OK. Patient A had been keen for a long time to sell something too outside her house and we supported her with bagging and selling bags of charcoal. A big bag of charcoal to start the business with cost £12. If this business works out well for her we will increase the business and add firewood too to sell. Due to her mobility she can only sit down (and walk short distances with a frame) so selling things outside works well for her. They are both very grateful of our support and we will review them next week.

 

Patient MP:

Patient MP, our palliative care patient was supposed to have her monthly hospital appointment on the 6th of December but family did not want to take her that day. This has been continuous problem the whole year. We visited them with Kirstine later that afternoon to assess her condition only to find her in a very ill health. Patient MP appeared to have had lost weight again after last hospital admission (she had Meningitis), which was last month. Family reported that she is only eating very small amounts and not taking medication. In my opinion she looked like she did not have many days left in this world. Family said they did not want to take her to the hospital again for feeding with nasogastric tube. I understood their decision and said it was up to them. She has been on this stage of ‘suffering’ for many years now (stage 4 AIDS). Her eyes looked almost black and had no ‘life’ in them. She was not responding to voice or pain. I held her hand and wished that she would feel no suffering. She did not look agitated or uncomfortable. Family had already spoken to Patient MP's sister Mama Kizenga and she had told them that patient MP has suffered for too long. Her daughter asked me why is she like this and if she will die now. I told them I think patient MP is tired of life. I told them to call me if they get any worries. We went back few days later and MP looked a little better again. She did not look like she was in any pain or was uncomfortable. She had little temperature so we gave her liquid Paracetamol, which she swallowed. That day her daughter told me that she had had porridge and juice. We will visit every few days to assess her comfortability. I feel really sad as I have grown very close to her this year but I know that she has almost no quality of life. The smiles have now gone.

 

Patient ZM Ramadhani and her children:

This frail 29 year old lady called Zena came to our office few weeks ago with her three children. Patient ZM and Ramadhani Dotto her eldest son of 8 years are HIV positive. They had not been taken medications ARVs because of lack of support and nutrition. Now the hospital gave them to restart again. The family fled from their home a week ago due to stigma. Now they stay in another small house with two rooms.

We went for a home visit last Friday to assess their needs. Patient ZM is very malnourished, 35kg only. She has been coughing blood, has diarrhoea, stomach pain and has ulcers in her mouth. She was dehydrated, her blood pressure was low 90/70, heart rate 120bpm and temperature 38 degrees. She was also breathless. Two weeks ago she went to Bagamoyo Hospital for a TB sputum test and they gave her medicines for her mouth. Now she went to get her result but they could not find them. We gave her Paracetamol and promised to go to the hospital to find her results. Her last CD4 count was done one year ago and it was high 1291. Ten months before that it was only 195. It must be very low now too. She really needs a new one done. Her son’s last CD4 count was done one year ago too and it was 1282. They have both attended their monthly hospital appointments regularly but why has the CD4 not been checked. This is a big failure from the hospital. They both have their next clinic appointment at New Year’s Eve 31/12/2013 and I will make sure to go with them to get it done.

One of the children at their house was lying on the floor holding his stomach and saying he was hungry. All the children appeared small but not as malnourished as their mother Zena. We gave them 1kg of porridge and sugar and told the little boy to get up and start cooking it. He started to make a fire inside the room with firewood and washed a pan for cooking. They do not have a local cooker even. One of the children asked for a bicycle. They have no food but of course those things can seem more important to a child. They have no money or income. They were waiting for Zena’s mother to return in the evening to bring food and cook for them. On Sunday I went back with Chanzi and took lots of foods for them; bananas, rice, potatoes, vegetables and drinking water. First thing we need to do on Monday is to find her TB results so she can start a treatment if it comes back positive.

 

New Patient JJ:

We got our first referral from CTC with our referral forms we created. This was Patient JJ, 56 year old lady who is HIV positive. She was referred to us for physiotherapy and transport to hospital. Charles from our office said he knows her and this lady apparently cries a lot.

I went for a home visit with Kirstine last Friday morning. A local lady who is taking care of her took us there. Shew told us that JJ's family had abandoned her so she was alone otherwise. We found her lying on the floor and she started to cry when we came. She was not able to walk and had lost her mobility about one year ago. She was able to speak a little through her tears and said her legs were painful. She seemed anxious too.

We checked her physiological observations and her blood pressure was high 170/120. I checked her other arm and it was even higher 170/130. Her pulse was 120bpm and respiration 28bpm. She had no temperature. She had been to the hospital last September (2.5 months ago) but they had not checked her blood pressure. She was not on ARV medication; in fact the only medication she had was Vitamin B tablets. Her CD4 count was done September too and was 451. We decided to take her to the hospital to see a doctor for her blood pressure. We had to carry her into the bajaji (three wheeled small car) and she was not light! Once we arrived at the hospital and got through to the doctor he did not seem happy because it was not her ‘appointment date’. I explained about her blood pressure and he asked me to check again there at the hospital. It was still high. Doctor asked questions about her history and started to be helpful. She was started on two different blood pressure tablets, Diazepam for anxiety and Diclofenac for pain. Doctor told me to go to check her blood pressure the next day. We took her home and explained about her medications. I went back next day and her blood pressure had dropped to 140/80.

She appeared tired but that was possibly due to having been started on Diazepam the night before. I omitted one of the blood pressure medications as the doctor had advised and she continued with the other. We will monitor her every few days at first. When her blood pressure becomes stable we can assess her mobility and possibly start physiotherapy.

 

Next week we will be busy with new patients and luckily we have a new volunteer Bjarne to join us. He is a student nurse from Sweden and will be with us for ten days. Kirstine has another two weeks left with us. It will be my first Christmas here in Tanzania in two weeks time and I am looking forward to it!

Jun 30, 2014

UKUN Volunteer Diary (Week 22)

 The past two weeks at Bagamoyo we had a great team of 4 volunteers. I was away the first week in Zanzibar but Debbie, Godfrey, Kirstine and Charles took good care of the patients. We continued home-based care, did regular visits to Mariam at the hospital, did testing at the office and put out posters to promote our office HIV testing. Unfortunately we were sad to see Debbie and Godfrey to go last week as they were such a great asset to us but they have both promised to come back soon. We were fortunate though to receive help and medical supplies from Kirstine’s boyfriend who is visiting here. He is a doctor specialized in surgery and will give us plenty of teachings on medical assessments!

 

Patient MP:

MP was put on a drip at home for couple of days but we knew it was not enough as she was not swallowing any medicines at all. Her diarrhoea continued. We obtained a blood sample from MP and took it to the clinic to check malaria and it came back negative. Finally the next day Mariam’s family agreed to take her to the hospital for feeding. I was relieved as I was going on a trip to Zanzibar the next day. She was put on Sodium Lactate drip (that was almost impossible to get from Bagamoyo, luckily found one in our office!) and they discovered that she had meningitis. They treated her with IV Fluconazole for few days. She had nasogastric tube inserted and was fed porridge and medicines through it as she was unable to swallow for several days. After a week she was better and discharged home. Mariam appears just the same as she was before this illness. Peter Kirstine’s boyfriend assessed her on a home visit and also said there is not much we can do for her, only palliative care to keep her comfortable. We put on some new medicine dressing to her pressure sore and it appears to be healing. Debbie’s gift Sudacrem is also a great help for her. She appeared comfortable but we will get some small cushions to put between her limbs for pressure care. Mariam is able to swallow again but is eating only small amounts of porridge. She is refusing to drink ORS (oral rehydration salts). Family were grateful for all our support; we gave them more gloves, disinfectant and juice for Mariam.

 

Patient AB:

Unfortunately AB got sick at the office for couple of days. We all assumed that it was due to him missing out three day of his ARV medications! We told him off for not being compliant with ARVs and the consequences that can follow. We told him he is throwing away his opportunity to start the art school in January if he will not be well enough.

The second day evening we took him to the hospital to see a doctor and after some blood tests they discovered malaria. He was given medications for three days. He appears already better from it. He needs repeat medications for malaria this week and then next week to retest. Peter brought him a present from Denmark; a pillbox with weekdays written on it! We can keep proper check on his medications and it will be hard for him to miss again. He has understood how it works and is all motivated again to get himself healthy for GOIG School for January 2014 J

 

Patient CPT:

CPT continues to get our support for two showers a week, laundry, cleaning and exercise. Debbie and Kirstine took him for a walk on his wheelchair whilst I was in Zanzibar and he really enjoyed that! He received a new ‘mohican’ haircut and a shave from Godfrey and a new bucket that is easier to empty for his toilet chair. Peter assessed his mobility a little last week and told us to continue with the chair exercises. The exercise pole he said would be so great for him but after the family took the last one down we are hesitating to waste our time to build another one. Peter is not the first doctor to tell CPT that with some exercise and building more muscle to his thighs he could walk again. Peter also discovered that CPT has scrotal hernia, which Captain was aware of already but as he experiences no pain it should not be dangerous. CPT was showing of his big arm muscles as usual and his ‘pot’ belly but Peter told him his swollen stomach was not fat, just ‘air’ but his arm muscles are real at least.

  

New family :

A family that was known to UKUN/PHI office a long time ago came by the office last week. It was a mother with her three children. Her husband had died. Mother is HIV positive and her eldest son of eight years of age. Both of them are not taking medications (ARVs) due to lack of support and nutrition. The other two younger children fortunately tested negative. Mother appeared severely malnourished and weighed only 37kg. Debbie and Charles gave them some food at the office and we bought 1kg of porridge if they come back next day. The mother went to the hospital twice in two days but we never saw her again at the end of the second day. Therefore we do not know what the doctors had told her and if she was given any medications. We need to go for a home visit this week to assess their housing situation and assess all the family members’ needs for support.

We had a lovely ‘Thank you & see you later’ meal for Debbie and Godfrey at Poa Poa restaurant here at Bagamoyo. Both of them will be back soon to volunteer with us.

We have been doing a shoe and necklace campaign with two local artists; Chanzi and Zakaria to raise funds for our patients. Debbie has taken the order to Europe; 20 pairs of shoes and 11 necklaces. With this we managed raise over £100! We also received another £60 for Kathy’s cake sales from Plymouth! Great stuff!

This week there are no volunteers working with me but luckily none of our clients are critically ill this moment. Kirstine and Peter are coming back from their trip from Zanzibar at the weekend. Sunday this week, 1st December will be the ‘World HIV Day’. We are still finding out where it will be happening in Bagamoyo but certainly we will be joining in with testing, information, free condoms and red ribbons!

Jun 16, 2014

UKUN Volunteer Diary (Week 21)

The past two weeks with HIV project in Bagamoyo were busy with visiting patients and introducing new volunteers to our team. Volunteer David left our team and Charles was still away for another week.

Debbie, an ex- volunteer from UK came back to help us again; for the third time. She is staying three weeks this time and has been a great worker and fundraiser for couple of years now. She just keeps coming back! I have been lucky to have her living at my house and she has become a great friend to me. She loves helping people and brings great new ideas to our team. Another lovely volunteer joined us last week; Kirstine from Denmark. She is staying here for a whole two months! Kirstine came through Action Aid Denmark and stays with a local family with another Danish girl.

That is a great way to learn about the local culture and language here and to understand our patients’ life in Bagamoyo. She is also very keen and full of ideas. We completed our referral forms to UKUN/PHI and gave some to the hospital already. We have also designed a poster to raise awareness about our office HIV testing as the numbers have been down. This is also due to our ‘new’ location so we need to take action to make people more aware. Kirstine also has an idea to advertise in a local HIV magazine or some newspaper here and to paint a big red ribbon to outside on the office wall. Bot girls with Godfrey are also keen to do big promotion day at weekly TopTop market (Mondays) for a free testing. It was done once before few months back and we managed to test over 40 people that day! We have been busy visiting our home care patients and introducing them to our new volunteers with Godfrey.

Morogoro Family:

Newly diagnosed family from Morogoro had some changes for the past two weeks. Mother A left home with baby M to Morogoro for ‘few months’ and G and his 7year old son remained here to be looked after by Mama Ponda’s family.

Apparently there was not enough money to support the whole family in that household so the most sick stayed; father G. We visited him couple of times to give porridge and extra snacks and physiotherapy. He is still malnourished and feels dizzy occasionally but appears a little ‘healthier’. He is now able to mobilise quite long distances without his walker and seems happy in himself. He finally received his referral letter from Morogoro to be able to receive his ARVs here regularly. We will continue our support with him.

Patient HT & AM:

Patient HT and his sister AM appear both in good health. HT came back to Bagamoyo finally after fully recovering from his operation in Dar. We organized a little welcome party for him at his house with coffee and cakes! He received a nice new shirt from Debbie and looks like a new man! He restarted his cigarette business (not such a healthy thing but it was his income for a long time with a good profit before he got sick so he wanted to continue), which we supported with a little capital. AM is keen to start some business too which she could do from home and we are working on the idea. Unfortunately her mum who lives with them, lovely old lady of nearly 80 years got sick with flu but she is on her way to recovery. We gave her medicines for two weeks. Next week we will review her and HT's business. The family really needs an income to survive.

Patient Z:

Patient Z, our new patient, who is suffering from peptic ulcers and reduced mobillity has majorly recovered since we first met her few weeks ago. Her abdominal pains have lessened and she continues to take Ranitidine to stop acid production. She can walk long distances now with her stick and has no problems with toileting. Constipation has also resolved now. Seems like another successful story for our home-based care team. We will continue nutrition support with weekly porridge and review. All physiological observations are stable. She complained a little tight chest but it seemed clear when listening and her respirations were 22bpm but she had done exercise. She has her monthly CTC hospital appointment next Monday and her daughter Hadija will go with her but we will pay for transport (bajaji).

Patient MP:

Patient MP had a good two weeks without problems until today (Sunday) afternoon when I received a phone call from her family. They reported she had diarrhoea. When I got to the house I discovered she had a fever and severe diarrhoea. She had had watery stools several times. Family refused to take to hospital as Mariam was too sick to travel. Blood pressure was 90/70 and she appeared dehydrated. Family found it hard to give any drinks as Mariam was not swallowing properly. I gave liquid Paracetamol and she managed to swallow that. We gave ORSs (oral rehydration salts) to the family to give to Mariam and left them with more liquid Paracetamol and nappies to wear over night. We went back later with Debbie and Chanzi to cannulate her and put up a saline drip over night. She was not swallowing any of the ORSs. We will review tomorrow morning and try to get a blood sample to rule out Malaria.

 

Jun 3, 2014

UKUN Volunteer Diary (Week 20)

We were busy with groups of students from Dar Es Salaam in both weekends. I went to Dar for medical stock and patient Hamisi’s appointment and we did a trip to GOIG School with Abdullah. We lost one life here unfortunately and another life that I witnessed in Dar in motorbike accident. We got a new patient for home care and took Mariam to the hospital for her results.

 Updates of patients:

Patient AHM:

I was very lucky and to meet and live with a wonderful finish girl called Minna for almost two weeks. She is an artist and was studying sculpture here in Bagamoyo. Fortunately she had many contacts and also studied in GOIG Art School in Mbezi Dar Es Salaam. Once I told her the story of our orphan patient AHM, Minna had a great idea to take him to visit that school. So together with Minna, Chanzi, AHM and Zakaria (artist from Bagamoyo) we went on a day trip to Mbezi. First GOIG School followed by a lunch and afternoon relaxing at Mbezi Beach J

GOIG School is sponsored from my country Finland and they teach many kinds of art e.g. batik, drawing, making rugs, carpeting, stone art, jewellery etc. They also teach basic skills of Swahili and they offer English language classes, which Abdallah is really keen to take. After meeting with the teacher AHM was offered a place starting from January 2014 for one year. It was all too exiting for him and soon after he fell asleep at the beach! They told us that they will find one skill from him, which will probably be drawing/painting and they will concentrate to teach him that for the whole year so he can become very good at it. He has a big passion for drawing already. His fees and accommodation will be free because he is an orphan, which is so nice of them. All we need to fundraise is his meals and little expenses like phone. Once a month he can come to Bagamoyo to take his medications from the hospital (ARVs) or one of us will bring them to him. The school is aware of his HIV status but there is no worry about it as long as we keep close contact with him and the school from UKUN/PHI.

His health is pretty stable. Abdallah was due to stop his TB medications last week but the doctor gave him couple of weeks extra due to cough and his CD4 being as low as 159. He has started to exercise (doing push ups)at the office to get some muscles to his new built body; he is 45 kg now, which is 11 kg gain in seven months! He is feeling happy in himself because he knows that finally this will be his chance to a new different life at GOIG School.   Since the trip Abdallah keeps asking EVERY DAY: ‘When do I start the school?’ He is driving us mad but we could not be happier for him!

The same day after Mbezi trip I went to Dar in the evening. It was the EID celebrations (islamic holiday). Unfortunately I witnessed a very bad motorbike accident. A car drove into the motorbike and then drove off fast leaving two people injured; young boy and a girl. The motorbike was in pieces. When I got to the injured girl someone was already taking the other less injured to the car and they drove off leaving the girl lying there. Why could they not take both of them? - I was thinking. There were lots of people shouting and pulling it was a total chaos. My friends helped to push people away so we could go to check her condition. She was still breathing and I begged to get her to the hospital in a car as I realized there will be no chance of getting ambulance (no one knows numbers and apparently they could take hours). People were pulling her from every direction; I have never seen anything like that. She was unconscious but people tried to put her on a motorbike panicking, and she kept falling off. I felt helpless, in shock and angry same time. I shouted to put her down and I saw her head bleeding. When I checked her again she had no pulse and was not breathing. CPR, CPR CPR! - I thought but before I knew people had pulled her again and this time dragged her into a backseat of a car. I was shouting ‘but she is dead she needs CPR’. I begged them to let me into the car at least to the backseat but they wouldn’t and drove off. From over 100 people there were NOONE who knew even little first aid or how to deal with injured people and RTAs (road traffic accidents). The main thing was that she was alive before all the pulling and dragging. She could have possibly survived, never know. I felt massive failure from my part and so sad with the lack of knowledge of these people. There is a MASSIVE need of educating people for basic first aid.

I could see panic in those people’s faces and most of them wanted to help but didn’t know how. Some kept asking what I want them to do. They were also lots of thieves taking their opportunities. One girl was checking the pockets of the ‘dead’ girl. It was disgusting. Next day there was another death from motorbike accident in same area. The third day finally road traffic police arrived to supervise. There accidents are too common here. Most drivers and passengers do not wear helmets, some ‘drink and drive’ and some just drive crazy stupidly wanting to ‘show of’. I taught those local friends who witnessed the accident some basic tips when they arrive into an accident and how to resuscitate someone who is not breathing. This issue need to be more addressed and I surely want to do more about it. It was the biggest shock to really understand how lucky again we are with our health care and ambulances in the developing world. All the government workers have luxury cars but they cannot spend some money for an ambulance. Many people also told me that once you take someone to the hospital it is not easy to enter, the police wants to question you, possibly money and often they do not let the injured inside until they go to their home first to get their hospital card and number. That is too crazy. I have probably been here too long as I was not shocked at all when I heard that.

And to happier things…

 

Patient HT:

The day after witnessing the RTA in Dar I went to Muhimbili Hospital with our long term patient HT for his booked appointment. That day he was finally discharged from Muhimbili Hospital and he is now on his way back to Bagamoyo.

For many years he was suffering from painful and embarrassing gynaecomastia (enlarged male breasts). He finally had his operation; Double Mastectomy one month ago and now his both wounds have healed. There were no need for more stitches or even a follow up appointment! His sister had done an excellent job of dressing his wounds daily. Both Hamisi and his sister waved goodbyes to the hospital with huge smiles on their faces. I even shed a tear from happiness. He appears in good health now and is extremely grateful for us at UKUN/PHI for making all this possible for him. I will go for a visit tomorrow and to see his sister Amina; also our patient, for physiotherapy. She is doing well but there are always issues of poverty as they have no income. We need to look into investing in a small business for them. I am hoping we could organize a small welcome home party for Hamisi this week!

 

Patient MP:

Mariam, our bedridden patient, who had a stroke six years ago, paid another visit to Bagamoyo Hospital last week as we had planned. This time family were very co-operative and were all ready to go when I came to pick them up with bajaji. MP looked much improved from the previous week and she was ‘glowing’. The family had fed her porridge and those build up bars as well as all the vitamins and Septrin. We received her blood results and they informed us they were ‘ok’.

The biggest shock was that her CD4 had almost doubled to 288! (Last one 149). That was excellent news and we knew with the daughters that we must be doing something right even we get shouted from the doctors every time we come to the hospital. The daughters said that those doctors just don’t know how hard work is it top look after someone who needs all care.

She was restarted on ARVs and her daughters received some counselling. She needs to be back in two weeks time to take more medicines. Since then we visited her again without informing them advance and we saw that the family are taking care of her better. We bought them some maize to prepare porridge for Mariam and disinfectant for clothes and cleaning. We can reduce our visits now to one a week but we need to make sure to keep her comfortable and support MP's daughters for caring for her.

 

 New Patient ZB:

 When at the hospital with MP one CTC patient approached me. Her name is Hadija and we have

helped her previously with supporting to grow her food selling business. Hadija told me that her

mother was very sick and she could not come to the hospital. We with Godfrey went to visit her at

their home in Bagamoyo. Her name is ZB and she has been HIV positive for many years like

Hadija too. They both were unsure how many. Now she has been suffering from Peptic ulcers for

few months, she is also treated for UTI (urine infection) and has really poor mobility. She was not

able to speak clearly due to the abdominal pains. On the assessment she was breathless; respiration

rate 26, Blood Pressure 120/65, pulse 80bpm, and temperature 37 degrees. She was in a lot of pain

and had no strength in any of her limbs. She reported no cough and her chest appeared clear when

listening. She reported pain when urinating and complained of constipation too. The abdominal pain

was severe when eating but she still had been eating. Two weeks ago she went to the hospital and

said doctors gave her one saline drip, stopped her Omeprazole – as it was ‘not working’ and gave her

Amoxicillin and Furadantin for UTI. We left her with some Paracetamol and milk and promised to

come back with more medications later. We advised her and Hadija about non acidic diet she should

be following.

After doing some research on the internet and asking nurses and doctors from UK, two days later

we went back and took her Ranitidine (stops the production of acid), more painkillers and laxatives

for constipation. I was also advised that she should continue Omeprazole. She appeared much better

than previously and was sitting or her bed eating ugali! Her arms had got better and with a help of

two she could mobilize to the toilet. We gave Hadija half kilo of porridge to prepare for her mum.

We would visit them again after five days.

After doing some more research on the medications; many state that she should be taking others

and more antibiotics to eradicate the ulcer in case it is H.P (Helicobacter Pyroli) e.g. Clarithromycin.

 

Patient MSH:

 

Unfortunately there was one death of a patient in Bagamoyo. He was not apparently one our

UKUN/PHI patients but a relative of our patient Sulemani who informed us about this sick man

MSH (not 100% of the name!). Charles and Godfrey had gone to see him and reported that he

needed a surgery to his arm. When I came back from Dar we went there to see him with David and

Godfrey. The way we found him was horrific; gasping for breaths, spitting blood, severely

malnourished, he looked like he had just been left for a long time. The family reported that they had

had no money for hospital transport ( 2000Tsh= 1 euro) and it didn’t seem right. After quick

assessment we called bajaji and took him with one family member to the hospital. We had to carry

him with sheets and there was diarrhoea all over. Once we got to the hospital we went to the

admissions (there is no emergency department in Bagamoyo Hospital, very common thing in

Tanzania). We put him on the trolley and went passed the entire queue direct to the doctor’s office

and people were helping us to get there. The female doctor started to ask questions and do

paperwork instead of checking the patient. Despite of her ‘bad’ attitude, after ten minutes we were

on our way to a medical ward to admit him. Doctors there told us he had life threatening

Cryptococcal Meningitis (infection and inflammation of brain and spinal cord). The only treatment

for that is IV Fluconazole but it costs 7000Tsh (£3) per bottle and this patient will need fourteen of

them, seven at least. This is a HUGE cost for local people in Tanzania and the doctor explained that

most people die here for that because they cannot afford the medication. The family bought one

bottle (and they did not have 2000Tsh for the hospital transport before!) and we bought another

one. The doctors also told us he had Hypoglycaemia (very low blood sugar). We also bought IV- fluids

including IV-Glucose, Septrin tablets, gloves and syringes (those were the requirement from the

ward.) I promised to come to check on him the next morning and we felt a moment of hope when

leaving with David and Godfrey. However two hours later I got a phone call that he had died, we had

come too late.

 

As a result of this, we have decided to start a search- campaign next week and find as many old

UKUN/PHI clients as we can; those that are ‘lost follow up’ to avoid something like this happening

again. We need Charles for that but he is away in Arusha. Once he comes back we can start as he is

the only one who possibly knows some of the addresses of our old clients.

 

I have also made referral form to UKUN/PHI home-based care in English and Kiswahili. I plan to put

them in hospital CTC clinic (for HIV patients) and put it into all the doctors’ rooms with a box to post

them so they can refer patients to us. We collect the forms ourselves and visit the patient referred

to see if they fit our criteria for home-help or help with referrals to a bigger hospital.

 

Students:

 

For the past two weekends we had four different groups of HIV counselling students from Dar Es Salaam. They were from that same school that David and Godfrey have now both finished. They wanted to do some field work for two days visiting and seeing how the patients live. They also brought many presents for our patients like soap bars and ugali flour, which was very gesture. They visited four families (5 students for each family); Captain, Mariam, Morogoro family and our new patient Zainabu and Hadija. Patients were very grateful for the gifts and were happy to discuss with them about the history of their disease. Many of them were very keen to come back next year to do their field placement with us for three months, which would be excellent news to us!

 

And finally we have been very fortunate to get new donors! We have our main regular donors;

Debbie and Tarek who keep contributing for our patients care. Now Debbie’s friend Cathy has had

several cake-sales in UK to raise money for us and Debbie’s doctor colleagues donated £100 for us.

We have now also regular donors from Finland and UK donating in total of £30 every month through

‘Every Little Helps’ and we should be getting more of their friends to donate! Also Minna is helping

to find the donors for Abdullah’s school meals for next year. I am still waiting for the email of the

costs for that from GOIG School. We have made a new shoe album with Chanzi to raise money. This

time it also includes a necklace from an artist friend Zakaria. Orders are coming in fast; 6 necklaces

and 12 pairs of shoes sold already!  

This coming week two volunteers are arriving; Debbie- ex volunteer and big fundraiser from UK and

Kirstine- student from Denmark. We will have a great team of volunteers for a month. In December

we are possible getting a student nurse from Sweden for two weeks and one of our musketeers

Mathilde will be coming for a month in January. She has become the contact person for Action Aid

Denmark volunteers, valuable work for our future here.

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Where is this project located?

Map of HIV Care and Nutrition Program (UKUN)