HIV Care and Nutrition Program (UKUN)

 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.