You win, Kenya

Over the last few days, these have been the top 5 problems that I have faced:

1. An HIV positive woman with a vitamin deficiency
2. An HIV positive woman with a seizure disorder who has been unable to get care or medications for the past 10 years
3. An HIV positive woman who is 8 months pregnant and has received no prenatal care because of the doctor strike
4. A group of HIV positive women who do not even know what HIV stands for
5. An HIV positive, mother who suffered a traumatic brain injury who keeps having kids because she can’t tell men she doesn’t want to have sex

Over the last few days, I thought I could solve the following problems:

1. An HIV positive woman with a vitamin deficiency
2. An HIV positive woman with a seizure disorder who has been unable to get medications
3. An HIV positive woman who is 8 months pregnant and has received no prenatal care because of the doctor strike
4. A group of HIV positive women who do not even know what HIV stands for

Over the last few days, I actually solved the following problem:

1. A group of HIV positive women who do not even know what HIV stands for- After an education session during their therapy group, they have a little more information about the disease that has held them captive for many years.  

Over the last few days, I have felt 100% beaten down by the following problems: 

1. An HIV positive woman with a vitamin deficiency
2. An HIV positive woman with a seizure disorder who has been unable to get care or medications for the past 10 years
3. An HIV positive woman who is 8 months pregnant and has received no prenatal care because of the doctor strike
4. An HIV positive, mother who suffered a traumatic brain injury who keeps having kids because she can’t tell men she doesn’t want to have sex

This means that I was at least able to tell a group of women the name of the disease they have.  Otherwise… Kenya: 4, Megan: 1.  And what do all of these have in common?  The fact that they involve people who are all HIV positive and in this country, that makes your value as a person drop way down.  

Needless to say, it has been a very difficult week.  Paige and I met the woman with the seizure disorder two weeks ago.  Ten years ago, she started HIV treatment and within a few weeks, developed a left-sided tremor and stiffening episodes.  With some further investigation, we determined these episodes are likely seizures.  After a very detailed history with a confounding language barrier and a thorough physical exam, we developed an initial differential.  Often, when patients who have been immunocompromised are treated and their immune system starts to improve, the body targets areas of infection that were not recognized by the body while the immune system was absent.  We think that this woman had an indolent infection that her body was not combating because her immune system was destroyed by HIV.  When she started her HIV treatment, her reconstituted immune system attacked that infection in her brain and caused damage to the area.  The timing lines up perfectly with the start of her HIV treatment.  Luckily, Paige knows a neurologist who specializes in patients with HIV and its effect on the brain!  He confirmed our suspicions and I have to say, it felt really good to realize we weren't totally off base.   

“They nailed the diagnosis… treatment should be no problem,” you might say.  Yeah… nope.

We took the woman to the hospital and helped her explain what has been going on for the past ten years.  She has been to the doctor multiple times but explained that no one ever understood AND not one doctor has ever examined her.  For all of my medical friends, that probably makes you cringe, especially because if you do even a simple neurological exam, you can clearly see her profound cerebellar signs.  After going through the ringer at the hospital, the doctor finally agreed to treat her with broad seizure medications.  We then had to go back and forth paying for the consultation and labs.  We finally got to the counter to get the medications and learned they would cost 60 US dollars.  That is completely unsustainable for a woman who barely makes 5 US dollars a week.  The doctor then told us she could get her medications for free at another hospital but she would have to start the process all over again.  Finally, her husband was able to take her to the hospital on Friday and they did get the medications.  This was a major victory but the poor woman got a stomach bug over the weekend.  She cannot catch a break.  

We truly hope she is on the mend and her neurologic symptoms are under control.  This condition has caused so much stress for her and her whole family.   This whole situation makes me appreciate my medical training and once again, the importance of a physical exam.  

I'm hoping to learn that by next week when I return from safari, this woman's symptoms have improved and that we have found a sustainable source of treatment for her.  I'm hoping for a Philly-style comeback in the final quarter of my trip.