HIV Care and Nutrition Program (UKUN)

September 30th to October 13th 2013.

These last two weeks at home-based care in Bagamoyo were really busy as usual. I spent half of both weeks in Dar Es Salaam with patient H who is recovering from his operation and the other half with patients here in Bagamoyo. Electric was off for four days last week! President came for a visit and Bagamoyo town wanted to build some streets wider for him. Someone cut several trees over the electric wires while doing that!

Here are the updates of the patients;

 Patient HT:

It is three weeks now since Patient HT had his operation; double mastectomy in Muhimbili Hospital. I visited him in Mbagala to change his dressings and the wound to his right chest has already healed and does not require being dressed anymore. The left side wound appeared to be septic and had ‘opened up’ a little. He had his follow-up appointment last week in Muhimbili and the doctors advised to re-dress it daily and then come back after a week for few more stitches. HT’s sister was happy to do the dressings at their house and this coming week we are going back to the hospital. Otherwise Hamisi is recovering well; all physiological observations are stable and he is in very good spirits. The pain to his wounds has lessened and he has started to mobilise around the house. He has also finished his course of antibiotics and according to the doctor he does not require more.

 Patient S:

Patient S had his follow up appointment in Ocean Road Hospital in Dar Es Salaam and was advised to come back in January next year. He has now completed his full course of radiotherapy for his anal cancer. He reported that his wife is feeling well now too. We will be visiting them this coming week.

 Patient MF:

I visited patient MF several times and again the family refused to take patient MF to the hospital in two occasions even everything was pre organised and they had promised. We cannot do anything without their consent and it has been very frustrating for us. Last week I and local volunteer David went to see them and we talked to the family about the care of patient MF and their feelings about her care. Patient MF daughters reported that they feel that they have lost their hope for their mum to get better and half of the daughters have left home now and do not involve in her care anymore. We explained the importance of adherence of medication, palliative care and keeping their mum as comfortable as possible. They finally agreed to take her to the hospital with us. I went together with three of the daughters, all in one ‘bajaji’, which is a three wheeled scooter! She got given a new hospital card (family had lost the old one), had her CD4 checked (last result was 149 done in March this year) and had various other blood tests including haemoglobin. She was not given ARVs (Antiretrovirals) yet as the doctor wants to wait for all the results first but she was prescribed Co-Trimoxazole (Septrin), iron, folic acid and multivitamins and was given more creams to her skin problems. Mama Kizenga, patient M's sister was organizing everything for us and also bought some porridge, gave gloves and some packets of supplementary meals (made of peanuts, sugar and fat) that only hospital gets for patients that are malnourished. No wonder I had never seen them before. I asked her for more of those to our other patients but she refused to give me today and told me to come back another week. I guess there is limited stock of them and I was told that they cannot be bought anywhere as they are donated. Patient MF blood pressure is within normal range now. Pressure sore has been static on her hip; no improvement but no worse. I have now taught three of the daughters how to clean and dress it and given them supplies. We will all go back to the hospital next week same time to receive results and adherence counselling for the family. She will possibly given the same ARVs that she had been on previously. The highlight of the week was the laughter on her face when we all (four of us) were carrying her in the wheelchair above our heads over all the too many obstacles that came on our way in the hospital. There was definitely a feeling of hope in the air, literally.

Patient CP:

There is nothing new to report with patient CP. He was so happy for Chanzi’s visit on both weeks and we took him for a little walk. He had his monthly hospital appointment and next month he is due his six monthly CD4 test. He had his two showers a week, laundry done, few extra snacks and clean drinking water. Family still do not want to help or get involved in his care. I asked someone to just change his sheet while I was showering him but they refused. His uncle though who is the practising ‘witch-doctor’ in their house asked me for painkillers for his back! I said I thought he was a ‘doctor’ himself with plenty of ‘medicines’.

Morogoro Family:

Giliano and his family are doing better. Giliano continues to use his walker and reported to have improved. TB results for Giliano were negative, which was good news. He still reports dizziness but is eating his ARVs well now with anti-emetics. We are still waiting for results for the baby (for HIV) but she is feeling better from the malaria. The young boy was supposed to be tested yesterday at his home but Charles and the boys decided to do it next week. My Kiswahili is still not good enough to do the counselling pre and post testing.

I should be getting e-pap this week for the father Gillian to build him up quicker. Now we are supporting the family with porridge. The mother never apparently went to the TB test and it seems that she does not understand the importance of it. Need to discuss again and find out what is the issue.

 Patient AB:

Patient AB got his CD4 results and it was shockingly low 159. We talked him about the importance of medication adherence and nutrition. It could be due to him suffering from TB for the past six months and we hope to get it back above 300 in the next six months. Otherwise he appears really well and keeps asking about starting an education. This week we are taking him to GOIG, which is a school near to Dar (Mbezi) sponsored from Finland. They are happy to talk to Abdullah about his wishes for future education and they can possibly offer free places to orphans. After that we will take him to the beach there so we can have a full fun day out as he has never been out of Bagamoyo.

 This week:

I will make another visit to Muhimbili with Hamisi and Bagamoyo Hospital with Mariam. We are getting 30 students of HIV counsellors from Dar Es Salaam for Friday and Saturday. They will visit all our clients’ families and make needs assessment and on the second day they will try to fill those needs. Godfrey and David (their fellow students) will be in charge of introducing the families to them as I will be in Dar and Charles is away in Arusha for a week. I will get our pharmacy stock from Dar Es Salaam at the weekend and hope to get reply from the e-pap distributor. It will be the week of celebration for Eid.