After a month working in Zanzibar and a month in Europe visiting friends and family I was happy to get back to work in Bagamoyo. It was very stressful and busy week, which included sorting out accommodation for me and visiting patients between. This was also the last week for the two local volunteer Godfrey and David.
Updates of the patients I visited:
Patient CP appeared in good spirits when I visited him Wednesday evening. The two local volunteers Godfrey and David had continued to shower him and have done his laundry visiting once per week. Next week I will assess his muscle strength and nutritional needs and do a full physical assessment when I shower him. His family continues to use the kitchen we built and are very happy with it. Patient CP is also happy not getting any smoke into his room. He reported that the bag in his toilet chair had not been changed for two weeks. He also complained about large amounts of insects in his room.
Continue home visits 2-3 times per week: two showers per week, laundry, nutritional support, use of exercise bar to strengthen his limbs, transport to hospital appointments and medicine management. Give a good clean to his room with Dettol and clean the floor from rubbish. Do this every week. Change toilet bag as required and look into solution for his family to do it. Spray his room with insect spray. Possibly changing his toilet bag regularly will get rid of a lot of the insects. Do his laundry possible at home where I have a washing machine, especially his sheets!
Patient MF appears to have declined in her condition. She has been in the stage 4 of AIDS for a while now and needs continuous palliative care. There were only two of her daughters present when I visited (she has 5 daughters or more) and they did not seem to be interested on my concerns and questions about their mother. One kept texting on her mobile phone and the other stayed in the back room. They told me Mariam had not been to the hospital for a while (to appointments) but Charles from UKUN office had visited one week ago. I gave them the usual stuff; gloves and disinfectant as they said they had run out. MT’s skin appeared worse than ever; some lesions, cuts, fungal arms/hands and some very dry areas especially the ears and back. I gave them antifungal cream, which I had with me and advised to use on MT’s hands and arms. I am unsure which treatment is the best for the rest of the skin as it has different conditions. I was not able to do a blood pressure as we do not have a machine that works at the moment. Her pulse and temperature were fine and she was responding to speak with facial expressions and had some grip in her hands. I did not see any pressure sores. She did not smile like she usually does when we visit. She was also covered in urine. Charles told me the family has lost Mariam’s hospital card so no one knows when her next appointment is. Family reported that MT is still drinking and eating. She appears very thin as usual.
Visit hospital asap to get her a new card (on Monday). Ask doctors advice for skin problem; possible needs antibiotics, which ones? and which creams? Take MT to the hospital.
Have an informal meeting with MF’s daughters next week about her care. Talk about palliative care to keep her comfortable; pain free, clean, warm and dignified. Make more frequent visits; minimum two per week and get involved in MF’s care e.g. feeding or showering. Show support for the family to motivate them. Give the family emotional support; talk about death, worries and fears. Possible get pampers for MF to wear if family agrees as she is now constantly incontinent, which makes her skin worse. We hope to make the end of life journey for Mariam as peaceful and dignified as possible.
*Need someone to translate as Godfrey and David are gone.
Patient AM / HT:
AM was in very good spirits and they were having a family meal. She did not show me her walk with the zimmer frame but she said she is doing it every day and doing fine. She had got married two weeks ago and the wedding was at their house. I cannot believe I missed it!
HT appeared a little weak; tired to walk and a bit unsteady on his feet. He did not complain pain to his enlarged breasts. He had not had his operation (double mastectomy) like it had been planned. The date for the operation in Muhimbili Hospital should have been 6th August but that date had been a public holiday. Charles had taken Hamisi to Muhimbili few days after that but the doctors just did more blood tests and sent him home for two nights. Hamisi slept those nights in Dar Es Salaam with some family. After he went back to Muhimbili and was given another date for the operation for later that month (August) but when this date came he was informed that the list was full due to more priority patients who had cancer. Charles informed that after that HT was referred to specialist plastic surgeons who after some more blood tests (CD4 again!) then said Hamisi did not need their specialist care and needed to be referred back to the normal surgeons. He was then given a date 12.9 to go to Muhimbili, once again. So last Thursday 12.9 I and Charles went together with Hamisi. He was seen by a new doctor/surgeon. They refused to give us one of HT’s old doctors that would know his case. This new doctor told us to come back next week to get a new operation date without even assessing his case. This seemed too easy. He said HT would possibly be operated next week Friday if we came to get the date on Tuesday. We took the doctors number and Charles said he will come and call him. We were also told that HT did not have to come until he got the operation date. Before midday we were already on our way back to Bagamoyo with new hope.
Patient AB has grown to be even more handsome and a happy young man. He appears in good spirits and physically in good health. He still spends his days at the office and enjoys playing board games with locals nearby but at night he sleeps at his home now (auntie and uncle). He said he was too scared of robberies when he sleeps at the office. I have not had a good chance to talk with him about home but he did not report any problems. He had sold his mobile phone that we helped him to buy and bought a cheaper one, making 10,000TSH profit for himself! What a business man. He still likes to draw and I got some more colouring pens and paper for him. He is still on the TB medication (tablets) and has also been on ARVs for a while now. He takes them independently without prompting. He has some friends; most of them go to school. He does not go to the HIV children’s group anymore as he never liked it. We still pay for his food weekly for a local restaurant nearby the office. He has been happy with them.
We need to talk to patient AB about education; what he would like to do. Maybe he could study some practical skills with hands as he seems to like drawing and handicrafts. Or maybe he wants to study writing and reading Kiswahili or English. Also soon we should help him to find a job that pays a little as he needs his own money now. He spends his days playing board games and sometimes apparently goes to the fishermen to try to find some work for few shillings. The unfortunate chronic illness (HIV) he has does not seem to bother him much. He really is a great young man with a lot of positive energy.
Sulemani is still treated for his anal cancer in Ocean Road Hospital in Dar Es Salaam. He reported to have had radiotherapy over 20 times now. He will have it again tomorrow and after that doctors will reassess his cancer. He could be discharged home. Chanzi visited him today (Sunday) and took him water, food and credit for his phone. He said could be too sick to travel to Bagamoyo by bus if he is discharged and asked money for a taxi. This might not be possible with the funds we have as we need to fund Hamisi’s trips. The least we could do is to escort him to his bus in Dar with a TucTuc/Taxi and meet him at Bagamoyo station. Sulemani’s wife in Bagamoyo is also reported to be sick and is now staying with her mother. I have never met her but I guess she must be HIV positive too. We should pay her a visit next week.