Parallel Worlds

I put on my white coat today and ventured into the pediatric HIV clinic at our medical center here in the US. (Sometimes, I need to remind myself what it looks like to be a doctor here.)

Dr Vreeman And Dr Miffy

Dr. Vreeman with clinic sidekick, Dr. Miffy

The clinic in Indianapolis offers an interesting counterpoint to the pediatric HIV clinics where I spend so much of my time in Kenya. At first, the differences are the most obvious thing. The clinic here cares for all of the children infected with HIV in our state, a total of 45 patients. In contrast, in Kenya, the AMPATH clinic at the referral center alone routinely sees 90 children in one day and cares for almost 100X as many children in total - 4,355 as of July. In the clinic here, they daily order lab tests we only dream of - viral load measures EVERY THREE MONTHS to monitor exactly how well we are waging the war against the virus! (That's like telling me you buy yourself a diamond every three months!) Viral genotypes whenever you want them to determine just what the sneaky tricks the virus has adopted to resist the medicines! HLA types to see if the child is going to have an allergic reaction to one of the HIV medicines! And, they have a plethora of medicines at their disposal to concoct just the right mixture for a child's age and virus and history.  Almost as extravagant is the luxury of time - an entire morning to see 6 children (and no long lines of families crowded onto benches in the hallway, each waiting their turn).

There are other differences too. I saw some American adolescents grappling with brand new infections, the tragic results of their own sexual encounters. In Kenya, I mostly see children whose infections were passed to them through their mother's blood or milk, and so this is less familiar ground for me. And perhaps the most clear sign that I have been doing clinic in Kenya a lot more than clinic here was that the privacy and spaciousness of the exam rooms caught me off guard. I would give almost anything to exchange my shared, divided-by-a-curtain-if-I'm-lucky exam space for the private comfort of the average exam room here! The exam rooms felt so huge and grand and luxurious.

And yet, despite all of those resources, a children's HIV clinic anywhere can look and sound pretty much the same. There are the same questions: How long do I have to take these medicines? Will I be able to grow up? To have children? Should I tell my friends? Will I be OK? There are children growing up with aunts and uncles and grandparents and adoptive parents instead of their biological parents. There are the stories of rejection and stigma and the stories of acceptance and love. There are the adults - doctors and families and social workers and nurses - struggling with how and when to tell the children that they have HIV. There are the confessions of "No, I'm not really taking all of my medicines." There are the struggles with how to make the medicines easier to take, less likely to make you sick, less likely to be forgotten.

So, we have plenty to learn from each other. As much as I can learn from the array of medicines here (so many protease inhibitors! Fusion inhibitors!), I can also share about how we're working on protocols and materials for informing children about their infection and how we are trying to assess adherence to the medications. Learning on all sides as we fight together against this blasted virus.

Posted at 14:42


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