Clinic

Just wanted to mention that I finally got to attend a clinic here -- the HIV resistance clinic -- and was really impressed with how well it was run. Only a couple patients showed up (much like in the RIH clinic at home), however, there were many phone calls placed to track down the patients and make sure they either come in another time or make it to one of the outreach clinics. The AMPATH clinic even has an EMR (although everything is written in paper and then someone types it into the record) and it makes all the patients' info easily accessible which is super crucial to those patients with drug-resistant HIV and those with poor adherence. The clinic became a sort of catch all of conditions when I was there and so we treated a young man with hepatitis B and counseled him and his girlfriend on the contagious-ness of this infection. He was really mature and told her right away that he had hep B and she did a bunch of research on it and started her vaccination series and everything. It was great to see. We also had a young man with HIV since he was 11 who had struggled with the diagnosis and treatment thoughout adolescence and had become a peer counselor in the pediatrics AMPATH clinic. He still struggled with taking his meds because they made him feel weak and nauseous and effectively wasn't taking them at all until 1 month ago when he was switched to a once a day treatment and this was a major game changer. Hopefully he hasn't developed resistance to those drugs in the meantime! He was very eloquent about the problems with having to take daily meds and his friends constantly asking him why he was doing that and the fear of stigma if he told people. Now he tells those he is close to and his roommates so that it is not a barrier to him taking his meds and everyone seems to be fine with it.

Tomorrow I get to go to cardiology clinic and the day after to an HIV outreach clinic. Should be nice to see something different from the wards which is starting to tire me out with the many inefficiencies and the many deaths. I had another one overnight who was just admitted Saturday night. He had HIV and diarrhea for 3 weeks -- at first we thought it was just gastro like cryptosporidium or something, but he was also pretty hypothermic, 33 degrees celcius (like 91.5 F), and was talking very slowly and seemed confused. I am learning the hard way that HIV patients often look much better than they are and can crash very, very quickly.