HIV Care and Nutrition Program (UKUN)

The new year started with a busy schedule for home care. We had some sick patients and some new referrals. The Danish volunteers continued their hard work and organized a testing for school children. It was also goodbyes to Lina, Nicole and Kathrine. They continued their trip to Zanzibar! Patient ABD finally started school and has settled in fine.

HIV Testing and screening:

Our Danish volunteers Lina, Nicole and Kathrine organized testing for BACCA pre-school children at our office.

One three year old girl Sara was found HIV positive. Charles together with the girls went for a follow up meeting and counselling with Sara’s mother Augusta. Augusta told them that the child had been diagnosed since December 2012 but she was too afraid to enrol her to CTC (HIV clinic at the hospital) due to stigma at home. She also reports that her older daughter Suzy of 11 years is not positive. Charles will make another follow up meeting and help to enrol them to CTC ‘in a secret.’ Otherwise the child appears in good health.

Patient ABD:

Patient ABD finally started GOIG School on the 7^th January! He got a room that was shared with another student until his room will get cleaned for him. We visited him with Chanzi and Mathilde two weeks after starting school and Abdallah seemed happy but little home sick. He had been learning to make rugs and had already finished two of them. We were so proud of him and he taught us all how to make them. His room was still not ready and they were not teaching him English yet but things happen ‘eventually’ here in Tanzania. Patience is a key skill. He is very keen to learn English. Unfortunately the school could only promise to keep him until end of March (3 months) because they did not get funding from Finland this year. They might have enough funds to keep him for the full year but they could not guarantee that. In that case he has to continue next year, their new financial year. Patient ABD appears in good health. We managed to get all his meals and pocket money sponsored from donors from Finland. Next month he will come to visit us in Bagamoyo and attend to his hospital appointment to get more medicines.

 Patient RMD:

Patient RMD, our fairly new patient was discharged from the hospital. Earlier he had been diagnosed with Miliary TB and Malaria. He is only 41kg and appears about 180cm tall! He also has painful hips. We visited him at home couple of times; he has slightly low blood pressure 90/70 and he spikes temperatures. We gave Paracetamol, which he takes regularly. He is eating now three meals a day and mobilising around the house for short distances. We brought him a walker/zimmer frame to help with mobilising. We accompanied him to his hospital appointment last Monday the 20^th to the TB ward. His family is always a great support and couple of the family members came too. We requested an X-ray to his hips but there were no doctors available and we were told to come back the following Monday. He received more TB medications. We also have been supporting with peanut butter sandwiches to bring his weight up. He is recovering well and is in good spirits.

Patient ZNB:

Patient ZNB, our elderly HIV positive lady was treated for stomach ulcers and had physiotherapy last month. She had fully recovered. Now we received information from her daughter that she was sick again. I went for a home visit and discovered a bed sore to her upper buttock. I cleaned and dressed it with some medicine dressing and taught her daughter Hadija how to redress it. She did not complain with other problems. I advised good diet and pressure relief for a fast recovery. Few days later I went back with Mathilde and redressed the wound that had almost fully healed. She complained a bad chest and a cough. We took her to the hospital and she gave sputum sample for TB. Next morning I collected the second sample and took it to the hospital lab. We collected results after few days and they were negative. We brought her back to Bagamoyo Hospital to have a chest X-ray, which showed infection. Doctors also wanted another TB sample as the previous ones had been ‘saliva’ like and they were still suspecting this would be TB. We collected the proper one and handed it in to the lab. Patient ZNB was prescribed strong antibiotics for 7 days and was sent home. One of the doctors wanted to admit her to the hospital for proper investigation but she did not fit the criteria. She was too ‘well’ (able to eat and drink). Next week we will collect the 3^rd sample result and visit her at home.

Patient SD

Patient SD our new patient who had been sick with diarrhoea and swollen right leg and scrotum was discharged home from Bgamoyo Hospital. He had spent over a week there. We visited him at home with Mathilde and his diarrhoea had resolved. They had told him to come back the week after 21^st Jan for surgery to his right scrotum (hernia). His physiological observations were stable but his abdomen appeared much distended. I did abdominal examination and could not find anything from that. He had no pain either. His right leg was swollen and he reported to have had that problem for five years now. He had used intravenous drugs in the past and he reports that this is how had got infected with HIV. Now he had been ‘clean’ for 9 years already. We will go with him next week to the hospital and try to get further investigations done. Saidi is full of hope of getting better as he is young (34yrs) has a one year old daughter too.

Patient Z and her children:

Patient Z is our frail little HIV positive lady who has three children and the eldest is unfortunately HIV positive too. She has had compliance issues for years with taking her medication and had got herself into a very bad state. She has now been on treatment for PCP (Pneumonia common with HIV patients) but still has no ARVs for HIV. She finally had her CD4 checked last week and it was 97. The CD4 machine had not been working for a couple of weeks at the hospital that possibly had terrible outcomes for several patients. Without CD4 results patients are not given treatment for HIV.

We have been visiting patient Z and her children regularly at home and we bring food as they have no income. We had a long discussion with the doctors about her adherence and I agreed to be her treatment supporter as her mother kept refusing to help. Z’s mother who lives with her does not want to do it and even refuses to come to the hospital with her. Charles went to see her at home and Zena’s mother finally agreed to come to counselling session with her to the hospital and this was successful.   They will need another session. Hopefully after that she can start ARV treatment. When asked, she was not very keen to start the treatment and we cannot understand why she is like that as she has three children to look after. Her son Dotto was given his ARV treatment for a week but we discovered that he had not been taking it. Mathilde had a good talk with the family with more body language than words J but perhaps they have understood now the importance of him taking them. This family is a big challenge for us but we have big hope for them for the sake of the three young children.

New patient: SAL

Last week whilst at the hospital with Ramadhani, I received a new referral from CTC. This 37 year old beautiful lady called Salima was very frail and ill looking. She had already seen a doctor but was not given any medicine. Her weight was only 40kg and height 160cm. She had no temperature now but reported to have temperature every night for several days. Salima was only diagnosed with HIV few weeks ago and now had to wait for CD4 results and counselling. Adam who works at the CTC asked doctors to see her again and they agreed. This time she was sent to the labs for malaria test and urine test. The doctor also gave her two weeks supply of Plump Nut Bars to gain weight rapidly. She has four children and none of them been tested for HIV. She appears to have a nice family for support.

We visited her at home the next day with Mathilde and Helmi (visitor from Finland) to check how she was doing and she had been diagnosed with Malaria and UTI (urine infection). She had not collected her Malaria medications because hospital did not have them and she did not have enough money to purchase them outside. We went to collect these (cost £1.50), brought ORS, water, peanut butter sandwich and Paracetamol. Her blood pressure was low 80/70 and we encouraged to drink plenty of fluids. She stated that she only eats twice a day and mainly porridge. I asked if it was OK to test her children for HIV and she said ‘we can talk about it’. Two days later I visited her again and her temperature was 41 degrees but her blood pressure had come up to 110/80. She was due to go to the hospital for her CD4 results and she went with her mum. Mathilde and Charles met them at the hospital. After hospital Charles and Mathilde went to Salima’s home to test her children. Only one child was home and she cried a lot for the needle. The result was unknown and she needs to be tested again unfortunately. We will make regular visits to her until she recovers. Next week she will have another hospital appointment. This family will need a lot of support and we hope she will fully recover.

New patient: SWU

SWU, 34 year old single lady came to our office complaining breathlessness and weakness to her limbs.  She was diagnosed with HIV a year ago (Jan 2013). She has no partner or children and unfortunately she had lost a child 1996 when she was only 17 years old. She lives alone close to our office.

She appeared very lethargic. Together with our Danish volunteers we measured her physiological observations were within normal range but she got very breathless on exertion. Her weight was 51kg and she was slightly underweight. Luckily there was a doctor at the office and he listened to her chest and said it was clear. He advised we take her to the hospital for a chest X-ray and assessment. We did this straight away and she got antibiotics for chest infection. She also takes Septrin and Vitamin B. Her CD4 is still high so she does not need ARVs. Her Hb was only 8.3 and she received advice for iron rich diet. Now after two weeks she has recovered well. We did couple of home visits and took some peanut butter sandwiches to give her nutritional support. She is very grateful for our support and says that now she knows we are here very close to her home if she needs any help.

Lina, Nicole and Kathrine took us; me, Mathilde and Charles, for a lovely meal to say goodbyes. They had worked very hard for the past 4 weeks and had been great asset to our team. They also together with Mathilde organized a fundraising project of selling locally made colourful bags for friends and family in Denmark. They also donated mosquito nets and lots of medical supplies to us. Mr Captain got a new pillow and a mosquito net and was super happy. I hope all the best for the future for these girls and our door will be always open to them.

Next week we will have a lot of hospital appointments with our patients. Mathilde and I will have to stretch all our arms and legs to reach to all the work that lies ahead. Bring on the challenge!!