HIV Care and Nutrition Program (UKUN)

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 1^st 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 6^th 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!