"Your drawings help patients and their parents understand
After a morning seeing patients together in the HIV clinic, this
was the lesson the pediatric resident remembered from our clinic
I do like to use drawings while I am explaining to a family how
HIV attacks the body or counseling an adolescent on why it is so
very, very important that they take their medicines every single
day. The resident saw me draw the same picture over and over again
(with slight modifications to make the child in the picture look
more like the child in front of me.)
And my patients here seem to really like the drawings. They
always want to take them home. This may be largely the novelty...
Too often, the other clinicians do not take the time to explain
these ideas to them. Plus, in a setting where much of the learning
is done by rote didactics, lecturing and demanding memorization,
learning with something visual -- something that I keep changing as
we talk -- stands out. Of course, I hope that it improves their
Tomorrow morning, I am training pharmacy technicians on how to
counsel families and children about HIV medicines, so I have been
giving extra thought to my usual drawings and words. They don't
need to make a drawing like I do, but they do need to be able to
use words and concepts that families understand well enough that
the families can grasp why we want them to take these medicines in
the way we do.
Here is my spiel and what I would draw for you on the
back of a lab request form….
This is you! Otieno! And this is how I want your body to
look - healthy and strong and growing. I want you to be healthy and
strong so that you can do anything that you want to do. I want you
to be able to run and play. I want you to be able to go to school.
I want you to become an adult and have a family if you choose. I
want you to have a good job.
For all of us, we must be concerned about the germs that are
around us. We sometimes call these germs "bacteria" or "viruses."
Germs are tiny little things that can come into our bodies and make
us sick. It is germs that cause problems like diarrhea, pneumonia,
malaria, and TB. We don't like these germs that can make us
Thankfully, our body has soldiers to protect us against
these germs. These soldiers are very small, but there are many of
them throughout the body. Our body has an army of soldiers to try
to protect us against the germs that want to make us sick. This is
called your immune system. These are the soldiers of your body. We
will give the soldiers guns that they can use to kill the germs. We
want your body to have many, many soldiers to protect it and to
keep you healthy and growing. The name that we call these soldiers
is CD4 cells.
Unfortunately, as you know, your body does have one virus
living inside of it that cannot be killed by these soldiers. This
is the HIV virus. I am going to draw it as a snake because I hate
snakes. You do not have a real snake living inside of your body,
but we will think about the HIV virus like a very bad snake that is
inside the body.
This snake is so bad because it wants to kill the soldiers
of the body. It tries to kill the soldiers, and then you have no
army to protect you from the germs that can come in and make you
sick. This is how the snake tries to defeat you. It is very, very
sneaky in how it tries to kill the soldiers of the body. When it
destroys the army of your body, then the germs can make your body
weak and sick.
We do not have medicines to kill this snake. We do not have
treatment to remove this snake from the body. I wish that we did,
but there is no treatment anywhere in the world right now that can
remove this snake from the body. If scientists find such a
treatment, I will try to bring it to you right away.
What we do have is sleeping medicine for this snake! We have
medicines that will keep this snake sleeping, so that it cannot
kill the soldiers of the body and so that your body's army can
become strong again. This snake is so bad that one medicine cannot
keep the snake sleeping. Even two medicines cannot keep the snake
sleeping. But when we use three medicines, we can keep the snake
If the snake is sleeping, then your body will remain healthy
and strong. You will grow. You will be able to do all of the things
that you want to do - go to school, become an adult, get married,
have a family. We must keep the snake sleeping so that you can be
strong and healthy.
These medicines that keep the snake sleeping, they only last
for about 12 hours. But we want the snake to be sleeping for all of
the day and for all of the night. So, we must take these medicines
in the morning to keep the snake sleeping during the day.
And, we must take the medicines again in the evening to keep the
snake sleeping during the night. I know that it is
difficult to take these medicines every day and to take them in the
morning and then again in the night. I know that this is a
challenge for many. But this is how we keep the snake sleeping. And
we want to keep the snake sleeping so that you can be healthy and
If you miss to take the medicines in the morning or in the
evening, the snake can wake up. Whenever the snake is awake, it
starts to kill the soldiers of the body. If the snake keeps
waking up again and again, then sometimes it becomes stronger than
the sleeping medicines. If the medicines can no longer make the
snake sleep, then your body's soldiers will be defeated again. We
want to make sure that this does not happen. (We call this the
virus becoming resistant to the medicines) This is why it is so
important for you to take the medicines in the morning and in the
night. We want the sleeping medicines to continue to work and to
keep the snake sleeping.
I have high hopes for YOU. I want you to be healthy and
strong, Otieno. I want you to be able to live positively. I think
you will be able to meet this challenge of keeping the snake
sleeping. I think you will GO FAR.