I have now officially been here 2 weeks.
I didn't expect to become so overwhelmed by the situation here. I didn't expect for it to affect me as deeply as it has...I expected that I would see a lot of hard things, and I would do what I could. But my heart is heavy, and I feel helpless in a gigantic situation.
This past week was hard. The first week, I saw lots of hard situations, but an attitude of hope and encouragement along with the hard situations.
The second week I was presented with a much bleaker picture.
I attended a staff meeting last week at the hospital I was working at. The big topic of the meeting was that the pharmacy was about to run out of anti-retrovirals (lifesaving drugs for people with HIV/AIDS). THey had received a letter from the local medical government official that the new shipment of drugs was going to be delayed indefinitely. Someone from the government had forgotten to pay the bill, and thus, the drug company refused to send the drugs.
Two steps forward and one step back. I want to be hopeful for the situation of HIV/AIDS in this country. This is a disease that is killing people, creating orphans, spreading like wildfire, and infecting 21+% of the population. I want to believe that the people in politics are starting to pay attention. I want to be hopeful about the fact that Jacob Zuma is acknowledging the disease, increasing funding towards treatment, and encouraging the population to be tested. I want to be encouraged by this and feel this is moving things forward.
So here is the process:
someone finally decides to get up the courage to be tested -> they test positive -> they get a CD4 count to determine how advanced their immune depletion is ->if their immune depletion qualifies them, they start on antiretrovirals (ARV).
So when you have a block in the drug supply, here is the problem:
1. For people who are already on ARVs, if they stop while they are waiting for the drug supply to come back, their virus has a chance to replicate and mutate, and potentially become resistnat to the drugs they are taking (and in SA, there are only 2 cocktails available - in the US there are more...But if you become resistant to one, you only have one other option).
2. Do you continue to test people when the drug supply is down? It is good for people to know, so that people can potentially prevent spread. But say you find out you are positive. And a follow-up CD4 count is very low, showing you have likely had HIV/AIDS for a long time, and your immune system is very compromised...Then you are told the drug supplies are out, and you will have to wait until they are replenished before you can start treatment. In the meanwhile, you may develop and overwhelming infection and die. So people are encouraged to test, but if they do, you are telling them you can do nothing about the results?
I had heard before I started, and observed since I have been here, that there is a lot of resistance to change. Resistance to change hospital policies on infection control, resistance for healthcare providers to care for people with HIV, resistance for the people of the country to accept the disease, resistant for people to get tested and acknowledge it is a possibility they are infected...And I have noted this resistance to change, which is both frustrating, and something I don't want to acknowledge is there. All the same, I can understand why the resistance to change occurs now...Why should you care about testing if there is nothing you can do about the results? Why should drs take care of HIV patients when they run into situations where their hands are tied and they have to stop treating? I feel almost as if it is a learned helplessness.
I must say, I admire very much the doctors and nurses at Rob Ferriera Hospital. They have a very difficult job to do, they persevere, and they handled this situation with a lot of grace. Everyone was frustrated, but knew there was no use in blaming or focusing on why the situation is the way it is. They focused on how they were going to deal with it. This is an attitude I have found very rare, even in the US where we run into situations that aren't quite as impossible.
And as usual, some patients stood out to be this week.
One woman was almost exactly my age...Born within a few weeks of me. It is weird to think of how different our births would have been, how different our paths would have been over our 29 years. And both of us born the year HIV was described/identified...Her world, going to be completely changed by this epidemic, mine, only if I choose for it to be.
Anyhow, she had been on therapy for 3 or 4 years. She had never had a good response, her viral load had never been supressed (the mark of effective treatment is that your viral load - the amount of HIV in your body, goes down). And because of this, her immune system was quite impaired. When the doctors were deciding whether to put her on a new cocktail (which has huge implications - if she fails the first, and then fails the second, in this country she has no other options), they discovered that she was only taking her treatment 1 or 2 times a week. Which will make the treatment ineffective, and also potentially create virus that is resistant to the treatment. So the decision was made to take her off treatment until she could "sort herself out."
I saw her later in the waiting room. Just sitting there, expressionless. And I can't even begin to wonder what her experience is, and why she was where she was. Was she depressed? The patients here are so stoic that it is not often a possibility that is considered. Was she hopeless? Did she feel like she was going to die anyway and there was no reason to take the treatment? Did she not have anyone in her life encouraging her to live? I am sad to say that I didnt have the communciation skills in her langugae to be able to ask these questions. Nor do I know if there is a cultural concept for these things. But all I could see was someone born within weeks of myself, on the other side of the world, whose course and environment were so different from mine...And I felt guilty, that in my world, I had parents unaffected by HIV, that they are still alive and available to encourage me...That I haven't seen friends and family die of HIV, while sitting by helplessly...That I have had the opportunity to go to college and med school and have a steady career which is fulfilling...That I haven't had to battle this disease myself - with it's stigma, with it's chronic treatment that may cause side effects, with it's blame, it's ability to change (or fail to start) relationships...