Sep 27, 2012 - Medical Talk    4 Comments

HIV/AIDS in Zambia

Before arriving in Zambia, whenever anyone heard about my plans to move here to work in a hospital, the conversation would usually move onto the topic of HIV/AIDS.

Non-medics: “Is there a lot of AIDS there?” “Are you sure you want to go there with all that AIDS?” “Do be careful!”
Medics: “Are you taking PEP (post-exposure prophylaxis) with you?” “Don’t forget to double-glove!”

I worked at Ealing Hospital in Southall, London for 3 years, and I thought I had seen plenty of HIV/AIDS there. Since arriving in Zambia, I realize that prior to my arrival here, I knew almost nothing about HIV and the potential devastation it can bestow on a person if diagnosed late or not treated.

Zambia has a national HIV prevalence rate of 15% (compared to 0.2% in the UK). I happen to work in the hospital with the largest caseload of patients on antiretroviral medication in Zambia. There are over 13,000 patients who have their HIV follow-up and management here at St Francis. Over half of the patients that I see in the hospital are infected with the virus.

A very noticeable difference between hospitals in Zambia compared to the UK is that a staggering proportion of inpatients in Zambia are my age (28 if you must know). Back in 2001, Johanna McGeary described the impact of HIV/AIDS in Africa in her sobering article Death Stalks a Continent: “Society’s fittest, not its frailest, are the ones who die – adults spirited away, leaving the old and the children behind.” Her words still ring true, with HIV/AIDS to blame for over 50% of the 1.3 million orphans in Zambia today.

Thankfully, the situation isn’t quite as bleak as it was for Africa in 2001. Health promotion strategies, easily accessible HIV testing and improved access to antiretroviral medications are trying to claw back at the damage done in the early years of the HIV epidemic on this continent.

HIV/AIDS has many faces – there is the full and healthy face of the man who was diagnosed early with a high CD4 count who takes his medication regularly, works hard, supports his family, eats well and cannot be distinguished from a non-reactive person. I tend not to meet this man. A trained clinical officer will see him and follow protocols (check his CD4 count, check medication compliance, ask about certain symptoms) before giving him more medicines to last until his next review.

The patient I get to see is a 6 ft tall man who weighs less than me, with his cheeks hollowed out and his tongue coated with thrush. This man is the one who has the potential to die in front of you whilst you try to put a drip into him as sepsis runs rampant through his body. This man is the one whose wounds won’t heal after an operation because his body’s immune system doesn’t work. This man is the one who needs lifelong anti-fungal medication and repeat lumbar punctures for Cryptococcal Meningitis.

I know the things I learn about HIV/AIDS this year will stay with me forever. I am getting to see and understand what HIV does to a person and to a nation. Zambia is taking positive steps forward in the fight against HIV, but every week I see individuals lose their battle with this terrible disease.

 

4 Comments

  • Hi Nat

    I just started following your blog (I follow Will on Facebook) and was wondering how often you have dealt with snake bite since you’re arrival? What kind of stock do you guys keep of antivenom? I work in a Snake Park in South Africa, which is why I am interested in this side of medicine.

  • Heartbreaking and frightening. Kudos to you for being willing to try to bring patients back from the brink.

  • I think the most telling comment in your blog is the one re ‘thinking you knew about HIV’ . There is a phrase used alot in the field of training and development – lifelong learning, medicine appears to be a prime example. Keep up the good work

  • Good luck to you and your partner on this exciting journey.
    You will have a wonderful and interesting year, but one which will be sad in many ways. I lost a maid to aids and despite my offers of help she chose a different medical route. whilst my gardener got proper treatment and did really well. I learnt a lot about the disease then and a lot from a sister in law who deals specifically with aids patients in a remote clinic in South Africa. (her husband is a photographer as well).

    I will follow your blog with great interest.

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