HIV Care and Nutrition Program (UKUN)

 These last two weeks (15th-29th of September 2013) I spent between here in Bagamoyo and Dar Es Salaam Muhimbili Hospital.

We got introduced to a newly diagnosed family, Hamisi finally had his operation at Muhimbili and a week was spent in a Bagamoyo Arts Festival testing and giving information of HIV to all people.

Patient HT:

Wednesday 18.9 we left together with Hamisi and his sister to Muhimbili, once again. This time we were determined not to leave until the operation; double mastectomy was done. He has been suffering from gynaecomastia (enlarged male breasts) since 2008. He was operated Friday 20.9. I visited just after operation at the hospital and he was in a lot of pain. However, he was so happy and smiled through his pain and kept pointing his flat chest! He was discharged on Wednesday evening and Friday I and David (local volunteer) visited him in his sister’s house in Dar where he will be staying until he has recovered. The family in Bagamoyo has no money so they want to keep him in Dar where he can be looked after. On Friday he looked already much better and was eating and mobilising. We left them with all dressing supplies and Waterguard to make clean drinking water. His dressings appeared clean and dry and they were changed last Friday at the local health centre. I will be visiting him once a week in Mbagala. The only problem is it takes 6 hours to there and back in local bus ‘daladala’! His follow up appointment will be in two weeks time.

 Patient S:

Patient S was discharged from Ocean Road Hospital Dar Es Salaam where he was treated few months with radiotherapy for his anal cancer. He is now back home in Bagamoyo and he was in a lot of pain and had forgotten his hospital card and medications in Dar Es Salaam. I went to pick them up from Dar but the nurses informed me that he was not due any medications, only pain relief. Luckily Mama Kizenga a nurse at the hospital here has a supply of Morphine for patients discharged from there and she paid a visit to him. Patient S has follow up appointment in Dar tomorrow (Tue) but he only just informed us today. I am trying to organize funds and the transport for Wednesday same day as I will visit Hamisi there. Charles informed me also that patient S wife is not well so we need to pay them a visit too.

 Patient MF:

For the past two weeks I have been visiting Patient MF several times. Her family has lost her hospital card so we do not know the date for the next appointment. Two weeks ago I discovered a pressure sore (grade 3) in her hip, which I have been redressing every few days but every time I arrive it has come off. I gave some dressings to the family too to make sure it will stay covered at all times. Her skin was also in a very bad condition. I went to the hospital to talk to the doctors at the clinic and mama Kizenga. They informed me that the family is her problem; they do not take care of her and do not give medications properly. They said there was no point to keep bringing her to the hospital because it is the family that is the problem and no one can go there every day to make sure she takes them. I organized a meeting with mama Kizenga and local volunteer to try to go to speak to the family together about her care. When the day came (last week) Mama Kizenga never called me like she had promised. She also promised to organize a new hospital card but that also still is not done. I went again to the hospital last Thursday to see the doctors about her. I told them I will just bring her here without the card as she is due CD4 test too. Today I was going to pick her up but the family (one daughter) refused to take her with me as there were no other sisters there to take care of the house. I felt so frustrated as I had informed them two days ago that I will be coming today. Where were the other 4 sisters?? You need two people to transfer her and the family should also be involved. I gave them another two days to get ready and I am taking her on Wednesday now. I gave them three different creams to use for Mariam’s skin and Floconazole tablets for a month (Mama Kizenga gave me) and it has little improved in two weeks time. Also patient MF has been smiling on my last two visits, which is great as facial impressions are her only communications tool. We just need to keep working together with the family and support them as much as I can so that we can take of little burden from the family. I feel that they are tired of looking after their mum. It is so sad.

Patient CP:

Patient CP is doing well. He has had his two showers per week. His arm muscles are so big now and he looks bigger all over. Family must be giving more food too. His legs are still week and his family used his exercise pole to build another kitchen, typical! His appointment for CD4 is in 10 days time and I have a strong feeling it will be much improved. His family still never takes him out of his room that is why he loves us visiting so he can get some fresh air and to see life around him.

New Family:

This lovely family comes from Morogoro and the father Gidioni & his wife Aloisia were diagnosed with HIV last July 2013. 

They are in their mid 30s. They arrived to Bagamoyo less than week ago to stay with Mama Ponda (Gidioni’s sister) because they had 4 hours drive to the nearest clinic in Morogoro and no support.

Gidioni got sick already last January when it all began. He got fevers typhoid and malaria that made him really weak and reduced mobility.  His CD4 was 50 in July and he was started on ARVs (combination therapy one tablet at night). He has had difficulties taking them because of nausea and malnutrition issues. His diarrhoea has resolved now. He can walk short distances but is very unsteady with feet and feels dizzy, however he is alert and orientated. He is also on Septrin (in the mornings). He appears severely malnourished. He also reported to have had low Hb in July.

His wife Aloisia had CD4 616 in July and was put on Septrin only. She appears well but complained to have had a cough for few months.

They have a son Michael 1,1 year old who has TB. It is not active anymore; he has been on medication for it since May 2013. His mother has been breastfeeding Michael until now but Charles told her to stop now. The baby appears well, but the mother complained the baby has a fever.

They have 2 other sons; 7 year old who is also in Bagamoyo and not been tested yet (he appears well) and older one in Morogoro 12 years of age who also has not been tested for HIV. Family reported that he is not sick. This family has no income now as the father was the main bread winner. 

All family was taken to the hospital and registered with CTC. Father was checked for Malaria, which came back negative. Haemoglobin was within normal range. Two TB sputums were taken and we are now waiting for the results. We got him a walker to help with his mobility and supported the family financially to buy nutrition. He was given ARVs for another month.

Baby was checked for Malaria and unfortunately it came back positive and he was started on medication. Dry blood sample was taken from the baby Michael and sent to Muhimbili in Dar to test for HIV. We are waiting for the results. Mother was also screened for TB and we are now waiting for those results. Doctors informed that the source for baby’s Malaria must be somewhere and is suspecting the parents. Both young boys still need testing.

Charles did some counselling and explained the family everything of the process and living with HIV. He gave them real motivation end encouragement. He explained about nutrition and ARVs. The family has a great support around them from Mama Ponda and Pili and from each others. We will be visiting them regularly. I can only hope that the children will test negative. We will work on Gidioni to get his strength back and his CD4 up in the next few months so he can become the breadwinner for his family again.

TASUBA BAGAMOYO ART FESTIVAL:

Last week we were given a big room for testing and counselling at the Bagamoyo’s yearly music and arts festival. We had four local volunteers to do the testing and the first couple of days many people were tested; around 30 per day. We also gave information and free condoms. These kinds of events are a great opportunity to get people tested and it was a great fun too!

 Next week I will visit Hamisi in Dar again and continue to see my patients here. We are really running out of sponsor money and medical stock so I will be concentrating on fundraising. David and Godfrey have come back to volunteer for a month at the office for testing and counselling and we have alocal girl there too. Next month we will have two volunteers coming; Debbie and Kirstine and will have a great team together for homecare and other new ideas!