Nothing like jumping in...

Busia _clinic Room

Today was my first full day in Eldoret, and I spent it making visits to two of our rural AMPATH HIV clinics. Bumpy roads where construction forces you to drive on the dirt "diversion" for half of the trip.  Hot dust filling the car. Smiling clinicians and warm handshakes to greet you upon arrival. Crowds of patients lined up on benches. Today, I know I have jumped back in to work in Kenya.

First, I drove about an hour to our clinic in Turbo, which cares for about 1,200 children. Tuesday is not the clinic day for children, so my time there was focused on our research project investigating the disclosure of HIV status to children. Within several of our clinics, we are trying to learn about the process of informing children that they have HIV. We want to know when families are starting to tell the children, and what the impact is on their physical and psychological health, whether they know or do not know that they have HIV. Ultimately, we want to know how to guide families through a process of disclosure that best helps the children transition to taking responsibility for their HIV care -- and transition to growing up.

As is usual when I'm working with the clinicians on the disclosure process, there were lots of stories and lots of questions. One of the clinical officers told me a terrible story about a 13-year-old, HIV-infected girl who had disappeared from their clinic for a while. After several months of trying to track the girl down, she reappeared at the clinic, very sick and having missed her HIV medicines for some time. It turns out that her mother, the only person who had known the girl was HIV-infected, had died. And it wasn't until the girl got a terrible pneumonia and thought to tell the uncle caring for her that she used to get "chest medicines" at the AMPATH clinic, that someone brought her back to the clinic. Yet another reason to help children understand why they are really taking these daily medicines.

From the Turbo clinic, I drove another hour, to another clinic, where I did some work with my same disclosure study and also saw some of their sickest patients. It was the day for pediatric clinic there, and so the benches were lined with children, babies and mothers.  The clinical officers were ready to show me their toughest cases.

My most disconcerting discoveries at this clinic surrounded our ongoing challenges in trying to manage malnutrition. To start things off, I saw a heart-breakingly tiny 13-month-old who weighed only 3kg (6.6 pounds). What made me even more horrified was that this baby was seen in our clinic just a month before and no one did anything about her weight. Not acceptable. After learning that several of the clinics have gone for months with broken scales - and seeing far too many malnourished children like this one -- I have been on a side mission of late to figure out some ways to improve how we deal with children's malnutrition in our clinics.

So, I've jumped back in with my work on this side of the ocean, learning and working on how we can best improve care for children with HIV in western Kenya.  


Posted at 12:52


Post a comment


Latest comments