My fifth week was spent with moving to our new office and visits to Mariam and Mr Captain. I also got to know about one of UKUN’s long term client Mr Hamisi Tanga and his sister.
I arrived back from Dar Es Salaam on Tuesday as I spent Easter there (Sun /Mon). We moved to the new office on Wednesday. We hired removal van and Abdullah was also helping us and Charles really enjoyed the exercise! After two trips we were done. We had to put all the furniture to the second room of the building as the room we have rented needs cleaning and painting before we can move in. I can use some of my sponsor money for the paints and we can do it with my two new volunteer friends Mathilde and Sofie as they have experience of painting. They have decided to work with me and I could not be happier about that! We are planning to work on the new office from Monday next week.
Mariam had her appointment date for hospital for Friday but we did not take her as the CD4 machine is not working and that what she needed to have done. I will take her next week (if it is back on working!). I picked up more medications for her (ARVs) and for Abdullah.
Charles and previous volunteer Debbie told me about Mr Hamisi Tanga who has been UKUN’s client over 10 years now. He has been suffering from gynaecomastia (male breast enlargements) since 2008. I was told that it could be a side-effect from one of his ARV medication. He needs to go to Muhimbili hospital in Dar Es salaam to see specialist as this problem has become unbearable to him. I was told he used to go to Muhimbili regularly but due to lack of money he had stopped going and now he came to the office and showed Charles that the breast have grown even larger. He is too sick to use local transport and will need a taxi as a transport. At Muhimbili they need to find out which medications are causing this. Charles said he will need several visits, approximately one per month but does not know how long for. I could use my sponsor money to take him but the transport is not cheap (around £40 per trip) and if this will be on-going thing we will need more sponsors.
I visited Hadija and her family asI was supposed to be escorting her to CCTRB hospital in Dar to see eye specialist. However they told me they could not get the car now.
My fouth week began badly as I was sick with bad stomach for three days. Once I got better I continued Mr Captain’s visits and got introduced to another family of UKUN’s clients by Charles. This was our last week also at the old UKUN office.
I visited family that all three generations are infected with HIV; grandmother, mother Hadija and her two children Mohamedi and Farida. Hadija is a very cheerful lady who has been blind for three years now. Doctors said this was due to pressure in her head. Her mother (the grandmother) looks after the household and she does it really well as far as I can see. She cooks and cleans and all the family appear really well looked after. They do not appear malnourished and are in very good spirits. Hadija hopes to go to see specialist in Dar Es Salaam Muhimbili Hospital to find out why she cannot see and if there is any treatment for her. She really hopes to be able to see again. The family told me that they have their cousin who can take them to Dar Es Salaam next week and want me to go with them. Both of Hadija’s HIV positive children appear well and go to school. I will visit this family weekly and give them support if they have any issues arising. At the moment they seem fine. I do worry for the grandmother as she is probably very worried what will happen to the family if she gets sick. She seems like a‘supergranny’!
Mr Captain was his usual self. He is eating well now and has already gained some ‘meat’ around his stomach. My friend Chanzie visited from Dar Es Salaam and volunteered to give Mr Captain a shave and a haircut- he looks ten years younger now!
In the weekend we started packing UKUN’s old office with Abdullah to move into the new office next week. It is located in Old Huruma Dispensary and also near to town. We need to get sponsors for the rent so I need to take a lot of photos I have not seen the place as the landlord is away but Charles said it was very nice and easily accessible. I am looking forward to the new office and a new start.
At the weekend I also met two really nice girls Sofie and Mathilde from Denmark who were looking for volunteer work! They are staying here two more months. I will meet with them end of next week (they are going now to Zanzibar!) and hopefully we will work together.
Today we took Hamisi one of our clients to Muhimbili Hospital in Dar Es Salaam. He has been suffering from gynaecomastia (male breast enlargements) since 2008. This could be side-effect from one of his ARVs (Antiretrovirals) and now the problem has become unbearable. His breasts have become very large and he is suffering from a lot of pain.
We started our trip at 6:30 am from our office in Bagamoyo where the driver picked us (Mathilde, Micu and Sofie) up from. After this we went to pick up our client Hamisi Tanga who lives in Bagamoyo town. We arrived at Muhimbili Hospital around 9:30 am. There were a lot of patients waiting for appointments, as Muhimbili is one of the biggest governmental hospitals located in the center of Dar Es Salaam. Hamisi is not really able to walk long distances so we got him a wheelchair from the hospital and pushed him to the new surgical building. We got our client registered and then waited for his file for an hour. After this we had to wait for him to see a doctor which took another hour. He was seen by a surgical specialist who took his full medical history. We discussed the possibilities for surgery which he said would be double mastectomy (removal of both breasts). He informed that it could be done at the governmental hospital, which would be a long wait and would cost around £40, or privately straight away at the cost of £600-£2000. Hamisi would now need to have his Hb and CD4 checked and have a x-ray done. The doctor also prescribed medication for his tremor which is another side-effect from his ARV-medication.
We split up in three; Mathilde went to the pharmacy, Micu went to register with the new appointment and Sofie stayed with Hamisi to wait for his blood-test to be done. This took about two hours. After this we went to the x-ray which took full three hours because they lost his file in between! The x-ray was never reviewed because the doctor had gone home. Therefore we brought the x-ray pictures home, so it can be taken to his next appointment which is in two weeks time, 16/5 2013. At the next appointment they will inform us whether he will be fit for surgery, this will depend on the CD4 and Hb results. Finally we were done, just before sunset (6 pm) and driver picked us up at Muhimbili. Unfortunately we were stuck in the traffic in Dar Es Salaam and got home around 10 pm all exhausted and tired.
This week I continued my home care duties and visited new clients. I bought Mr. Captain a sheet, a mattress, towels and a new mosquito net. I also made a plan to buy him extra snacks to start building him up. His family only gives him one small meal per day. I am also giving him money for his daily porridge he can have for breakfast (150Tsh/day-10c/day).
Charles also took me to see two other clients. On Wednesday we visited Mariam, a 57 year old HIV positive who had a stroke 5 yrs ago. She does not speak or walk but can do some facial expressions like smile and nodding. Mariam has stage 4 AIDS now so the care for her is palliative to keep her comfortable. None of her daughters are positive or the grandchildren.
Mariam appeared to be itchy all over and has small skin lesions/small cuts also all over her body and looked very uncomfortable. I gave her Piriton tablets and cream to help with itchiness. She lives in a house with her four beautiful daughters and some of them have children too. They all look after Mariam and it seems to me that stigma does not exist in her household, which makes me so happy. Mariam’s husband died two months ago and she has not been taking her HIV medication ever since because no one was buying her Mango juice. Her husband used to do and she will only take her ARVs with that. I guess it is too expensive for the family to buy so I will provide it for her from my sponsor money. She had not seen a doctor for 15 months so we took her to the hospital CTC centre on Friday. Her sister is a nurse in Bagamoyo hospital so it surprises me that she was not taken to be seen before this. The doctor was angry with Mariam’s daughter who came with us to the hospital. She had to have adherence counselling, get new appointment for CD4 check and she got new medications (ARVs).
A malnutrition is an issue but I have not figured it out yet as I need to see more. There is a problem especially with Mr Captain. He is malnourished you can see that. His family says they give food but Captain tell it is very little and sometimes nothing at all. He is not able to cook for himself. If I give the family porridge ingredients to cook, they want it for the whole family. We are not here to feed them all and all his family appear well nourished. He gets cup of porridge now daily. He does not like the family to see that we give money but Charles and volunteers in the past have had several meetings with the family and explained to the family that we are only giving him little money for porridge and that we are here for extra support and not to replace the family support. I take him extra things in every visit e.g. bread, cakes and bananas and water for drinking. Last week I asked him what he likes and he said he likes rice. His family only give him half portion of ugali (maize meal) a day.
He asked if I could buy some rice and his sister will cook it (she lives outside and is the one who gives/cooks ugali or whatever the family eats). I suggested buying half a kilo. Captain did not like this and said he would rather eat with the family and I should buy one kilo. I did this and they had the meal on Saturday so I do not know a solution for this. For sure we cannot keep buying the family food but how do we feed 'just' Captain as he relies on them? I did explain to him last week this is a problem.
Abdullah is also very underweight; only 35kg. He reports that he does not get food at home and that his auntie once tried to poison him! Charles buys him meals when he comes to the office. The stories never seem to end.
He appears to be a clever boy and knows computers. I want to help him by giving him money (from my sponsor money) to start a small business. He used to share a business with a friend. He wants to sell some food stuff in his street like ugali flour, sugar etc. He says that is where the good money is. We are going to find out now the costs for these items from the wholesale shop. He seemed very happy. Now he has been confirmed with TB and I went to the hospital with him to be trained to give injections to him daily for 54 for days so he does not need to walk to the hospital every day.
Abdullah’s housing situation is also a disaster. He does not want me and Charles to have a meeting with his auntie and the chief of the street (I was told by Charles this would normally be the procedure) because it will cause more conflict and bad atmosphere at his family. We have to respect his wishes but how can we find a solution to this? Maybe the small business could be a start to a better future. When I mentioned about it his face really lit up!
My second week was very busy with trip to Dar to get supplies and learning about UKUN’s clients. This week was also told by Charles that UKUN needs to move into a cheaper building by end of the month, which is in 2 weeks time (we need to leave this building by 30th March!).
I went to Dar Es Salaam to pick up medical stock of supplies for the office. These were things like; gauze, dressings, medication and gloves. The money was donated from a donor from USA through East Africa Aid and sent via Western Union. I had a friend to help me to bring the stock to Bagamoyo in a local bus. Now we have supplies at least for few months!
This week I met Abdullah who is one of our clients. He is 17 year old boy, with the appearance of about 12 as he is very underweight. He was born HIV positive. His both parents died of AIDS 5 years ago. After their death his grandmother took care of him until she died too just over year ago. Now Abdullah lives with his auntie but there is a lot of stigma within the family against HIV so Abdullah doesn’t feel welcome there. He has been coming to the clinic daily all week. He watches TV, sleeps and sometimes eats when we give him something. He never asks for anything. He has been complaining of cough for a while so we took him to the hospital for TB investigation.
When we arrived to the TB investigation unit we needed to find his file first. He is known as the ‘lost of follow up’ as he doesn’t turn up to his appointments at the HIV department. After finding his file he was seen by a doctor straight away. We reported his cough, gave history (he has had TB in the past) and the doctor requested chest X-ray. The X-ray showed some shadowing right lung spread to the left lung so they were querying if he has pulmonary TB. After this we went back to the doctor who then examined him from head to toe and listened to his chest, which he said was fine and he let me to it too. He said to confirm TB we need a sputum sample for AFB but unfortunately Abdullah is not producing any at the moment. He was started on strong antibiotics Septrin 960mg twice a day for 7 days and given 2 sputum pots in case he produces any cough. He has to bring them to the hospital to be able to confirm TB. If those antibiotics do not clear the possible chest infection after 7 days he will be started on TB treatment anyway. Abdullah is a quiet boy, he doesn’t say much but I can see his sadness. I hope we will become good friends.
Few people came for HIV testing at the clinic too this week, about 2 a day. I was told that I will not be able to test people because of the language barrier. Whoever does the testing, need to do the counselling too.
We went to see 2 clients in their homes: Semeni and Captain. We travelled to Semeni’s house first by Tuc Tuc; small 2 seated taxi that has originated from India. She lives close to Bagamoyo town with her parents and other family who all look after her well. I did not recognize any stigma at all. Semeni is 33 yrs old, she has 2 daughters (plus she has lost 3) and no husband. She has been diagnosed with HIV about 5-6 yrs. Last year she lost a baby due to very low CD4 count; her CD4 was 9 at the time! Now her CD4 has come up to 325 (last Sep 2012) and she has put on weight. She has a ‘drop foot’ her left leg and finds it difficult to mobilise.
She reported that she has had Malaria now since the 27th Feb so around 2 weeks and she is on medication and recovering. Before her illness she was able to mobilise 0.5km independently with just a stick but now she can do only very small transfers and needs help as she has weakened. On her appointment with malaria investigation, she was also given her Antiretrovirals (ARVs) for two months. I gave her my number just in case she needs to contact with anything but at the moment she seems fine and she has all her family to support her. Her story really is a success and a good example of been able to recover with great support and doing physiotherapy (exercises). She seems to have a lot of motivation and she is very much loved.
After that we went to see Mr Captain. He has been a client for many years as well. We found him in his room that was in a bad state, the smell was disgusting. He hadn’t had a wash for over a one month. His urine can was full, bed sheet ripped and almost black colour. I do not know how he was able to live there but obviously he had no choice. Unlike Semeni Captain’s family does not help or support him. Stigma exists there very much. Lots of his family live around him but no one helps with anything. This is very sad. I have to come all the way from Europe to clean his room and give him a wash! Captain appears thin, he is not able to mobilise and uses a wheelchair but no one had pushed him outside out of his room for over a month! He smells bad and does not look happy.
I gave him a good wash in a shower and then we did his laundry with Charles. Charles got him clean clothes to wear and I bought soap, washing powder, water to drink and Dettol to disinfect his dirty clothes and the bed sheet. He was very happy.
Next day we went back to him and took him to hospital to his appointment for HIV centre. He was given more medication (ARVs). After hospital we took him back to his house and I cleaned his room and finished his laundry. One of his neighbours cut his nails (at least!). I will be going there to visit him regularly now and to shower him every 3 days. I am happy to have finally found ‘famous’ Mr. Captain and I am so happy I am able to help him. I wish his family would be more supportive but maybe I will find a way somehow to do that.
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