Rural health clinic

Today I went with Dr. Gardner to a rural health clinic in Mosoriot; it was maybe the best experience I've had so far here. I clinic is really nicely set up and it originally was only for HIV/AIDS patients but now is for the management of chronic disease in general. Hence, the closest thing to primary care I've seen here so far. All the patients we saw today had HIV but I got to see such a wide range of severity. I saw a man in his 30s who has been on the same first line regimen for HIV since 2003, with an undetectable viral load since around that time. He was so healthy, has never been hospitalized, and has always been compliant with his meds. On the other end of the spectrum I saw a 16 year old girl who weighed 28.5 kg (had lost 15 kg since January), giving her a BMI of around 11. She had also had fevers for 2 months and was just overall extremely sick-looking. So we gave her some IV fluids and then took her to the ED at MTRH on our way back. We saw a patient that Dr. Gardner knows well who was hospitalized for 3 months last year with TB meningitis and has been homeless for a while. She was really sick but he has worked really closely with her and she has been staying at the shelter that AMPATH helps fund that is near the Mosoriot health clinic. The photo below is of all her meds, at least 9 meds and she has to take up to 4 tabs for each of the medications. It's crazy! But at least there is someone at the shelter who helps her with all of this and she is doing so much better. I also saw a woman who was just diagnosed with HIV at the end of April after coming in for a family planning visit. She is 29 and she told her husband (of 10 years) and he refused to get tested. She said he didn't looked shocked by the news and so she seemed to imply that he might know he is positive. He is also 20 years older than her. Dr. Gardner was great and gave her an little empowerment pep talk. She seemed very well adjusted to learning she has HIV and when her CD4 came back today at 141, meaning she had to start ARVs today, she was determined to do this and was about as positive about the whole situation as one can be. She was such an inspiring woman -- if only she could get out of her relationship with her scummy husband (in my humble opinion).

Weird thing i've noticed, there are a LOT of DVTs here. 2 of the 10 or so patients we saw today at clinic we diagnosed with acute DVTs. Including the really wasted 16 year old I mentioned above. why is this?

I also learned a few things about AMPATH and HIV in Kenya, including the fact that the AMPATH clinic in Eldoret is (or at least was recently) the biggest HIV clinic in Kenya and cares for 20,000 patients! That seems like so many! Also, according to Adrian, almost everyone in this area has been tested for HIV because of the home counseling visits they did in the past. This is pretty unbelievable.

 one of the clinic rooms. the clinical officers see patients her daily, while an attending (usually Joe Mamlin) comes once a week to see the more difficult cases, read xrays, etc

so many pills!