HIV Care and Nutrition Program (UKUN)

In the last two weeks I had my first Christmas and New Year here at Bagamoyo. Work with UKUN/PHI kept us busy over this festive season. We were happy to receive some nice donations that enabled us to give Christmas gifts to our clients who live in a poverty ridden lives. We made several visits to Bagamoyo Hospital with current patients and got referral for a new sick patient too. One patient we lost due to unfortunate circumtances.

We were sad to say our goodbyes for a fantastic volunteer Bjarne who had been part of our team for couple of weeks. At New Year Mathilde arrived from Denmark for the second time to volunteer with us. She together with her friend Sophie had helped me to restart our home-based care program last year and to refurbish the new UKUN/PHI office.

It was so nice to have her back again. We also got a nice surprise of three more Danish volunteers; Kathrine and twins Lina and Nicole that joined our team. Both of them and Mathilde will be volunteering with us for a month. They are all starting studies in health care. Nice start for the New year of having lovely volunteers and a big workforce!

Christmas:

We were so happy to receive some nice Christmas donations that my father had collected from his friends. Christmas truly is a time of giving and with that on our minds I, Bjarne and Chanzi dressed as elfs on Christmas Eve and took gifts to our patients around Bagamoyo! We bought things like soap, food, clothes and toothbrushes and wrapped them into lovely presents. I think the joy we saw on those faces was definately the best Christmas gift we could ever receive. Unfortunately not all of the patients were well that day but we managed to keep the spirits high till the last patient who was Captain. He lives in a very bad housing with awful family who does not care for him at all. We had bought him a big meat pie that he bit into straight away. All in all the day was a great success and I hope I will be able do it again next year and the years to follow!

 Updates on patients:

Patient RMD:

Our fairly new patient RMD had denied his diagnoses of having HIV infection for a half a year and now he was very sick. His Hb (Hemoglobin) was too low 6.9 to start medication for HIV even his CD4 was only 144. We went back to his home with Bjarne to take him to his hospital appointment to recheck his Hb only to find him in an extremely bad state. He was very sick with severe dehydration and he had been vomiting for days. He was not able to mobilise anymore and was in alot of pain. Family called a taxi and after great difficulty of transferring him into the car we took him to Bagamoyo Hospital ’Emergency Department’ (which just a clinic with a one doctor there). We went direct to the doctor’s room passing vast number of patients who probably had been queuing there for hours. The doctor looked at him without any physical assessment and wrote a plan and prescriptions and sent us to male medical ward. We left Ramadhani and his family there to wait for the doctor to see him. He is lucky to have a great family; 3 brothers and a sister who are very caring for him. They later diagnosed Malaria and Miliary TB (Tuberculosis all over the body) and he was put on IV fluids, and Nasogastric tube was inserted through his nose to feed him and give medications. After few days he was moved to TB ward. He could not be moved there before because there was no nurse to take care of him. At the TB ward the care was much better and he recovered faster and started eating again. Unfortunately his Christmas and New Year ware spent in the hospital. After a week and a half he was discharged home. We will do a home visit next week. We can only hope that this young man will fully recover and understand the importance of taking charge of his own destiny by eccepting his illness and taking care of himself with support from us and his family.

Patient JJ:

We had been visiting patient JJ over a month monitoring her blood pressure regularly as she had been started on antihypertensives to lower her blood pressure. Unfortunately she lost her life this Christmas. Patient JJ had no family to take care of her due to stigma of HIV virus she had. Oliva, a local lady took care of her as patient JJ was not able to mobilise or to wash herself. On Christmas Eve I arrived to her house with volunteers Bjarne and Chanzi to give gifts only to find that she had had a stroke few days ago but Oliva had not informed us or Mama Kizenga (charge nurse for home-based care in Bagamoyo) or taken Juliana to the hospital. This was too late now as the critical window to treat her is immediately after one has had a stroke. That was something that we knew with Bjarne having experience in health care but we did not feel that we knew enough to make decisions of planning her care. She did not appear much different than she normally was as she had been a bed ridden patient for a long time but she had a ’droop’ in her face that is a typical sign of someone who had suffered from a stroke. We wanted to take her still to the hospital but her family and Oliva refused. They said someone needs to sleep there with her due to her anxiety but noone was willing to do this except Oliva but not until the next Monday (6 days away). We felt so helpless in this situation. We contacted Mama Kizenga if she would see her or get a doctor to see her at home and she said she would do so. We left to continue our Christmas round not knowing what would happen to her. Next day, Christmas Day, I called Mama Kizenga again and she had not been to see her but said she is talking to Juliana’s family to help her. Boxing Day I called her again and asked her to inform the family that the next day we would take her to Muhimbili Hospital in Dar es Salaam so she could have scan done to her head. Patient JJ would have to have family or friend to escort or have some relatives in Dar that can come to take care of her. I was told that if you take patients to the Muhimbili Hospital you need to have family to take care of them and visit daily to bring food, do laundry and help with hygiene as the hospital staff will not help you. Mama Kizenga said she would ask the family again. In the meantime we were trying to see if there were any doctors in Bagamoyo who would do home visits but we did not find any. Mobile doctors would be great to have here in Bagamoyo where people are having great difficulties to access health care. That evening I received a phone call from Oliva that JJ had passed away. That was extremely sad. I felt a big failure from our part, especially from myself and now it was too late. Maybe she is in a better place away from all the stigma she had to experience. Stigma for HIV exists in large number of families in Bagamoyo and can be only be challenged with more education and awareness.

  Patient Z  and her children:

Patient Z, our frail lady, who was diagnosed with PCP (pneumonia common with HIV patients) has been on the treatment (Septrin) for it now for a couple of weeks and she feels much better. We have been visiting her regularly and given her and her three children food as they have no income. She does not seem very keen to start the HIV treatment and we cannot understand why she is like that as she has three children to look after and one of them is also HIV positive. She appears depressed and needs councelling. Doctors told us that she has a history of not attending her clinis appointments and not taking medications properly.

She had another appointment to the hospital to check her Hb (Hemoglobin) levels and to check her CD4 count. Charles took her at New Year’s Eve. Her Hb was low; 7.4 and unfortunately the CD4 machine was not in working order. Without CD4 results she cannot start ARV treatment. After that results it will be councelling. Last Friday, few days later we went to to collect her to the hospital again but she was not home. We will try again next Monday.

New patient: SN

Charles from the office got referral for a new patient SN. He was informed that SN was very sick and should be admitted to Bagamoyo Hospital. Whilst at the hospital with our other client we found that SN had already been admitted and I and Mathilde visited him in a male medical ward. We did his physiological observations that were all within normal range. He complained having severe diarrhoea for four days and swollen painful right testicle.

Patient SN has been diagnosed with HIV sonce 2007 when he started on ARVs. Last year he missed appointments for a period of nine months and he could not really tell why when we asked him. This is probably the reason why he is so sick now. His last CD4 was only 38 and it was done three months ago.

We collected his medications from the hospital pharmacy; ORSs, Metrodinazole, Septrin, but Zincoxide was not available. We went to the pharmacy in town but they did not have it there either. He appeared dehydrated and malnourished. He was given IV fluids. We will visit him frequently to bring water, food and to liaise with doctors to speed up his recovery. He is waiting for a surgery to a right testicle that will be done in Bagamoyo Hospital but the doctors had told him he has to pay. Charles promised to have a word with the surgeons about that. He also has a swollen painful right leg with few lesions in it. He seems hopeful to get well again. He has a wife and a one year old daughter but they do not live with him. His wife is also HIV positive but the child will be tested later when she is 18 months old.

Future Plans:

 Next week we are looking forward to taking our orphan boy Abdallah to school in Dar Es Salaam where he should stay for a year. We will continue home-based care with our great team of Danish volunteers. We will work on the care plans and patient profiles; it all needs updating after a few busy weeks with the patients. Hopefully hospital gets their CD4 machine working so people can start treatment for HIV before it is too late and lives will be lost.