Home Visits: Back to the Heart of Medicine

Last Friday we visited homes of AIDS patients too sick to make it to clinic on Rusinga Island. I was not quite sure what to expect. As I entered each home I was faced with a different adversity, but a few common things: AIDS and Poverty.

Patient 1: a 34yo male who was diagnosed 1 year prior and had been in and out of the hospital.

As we walked into the mud hut, a man sat on the floor with only a mattress and mosquito net. He was surrounding by bottles of pills and a container of urine. He appeared extremely thin and had little energy. He stated that he was recently in the hospital and is “having the TB”. I swiftly pulled out masks for all those in the room and the translator looked at me with concern. She too is HIV positive and had no idea she was at risk of contracting TB. As I went through his medications he told me he was diagnosed with TB over 9 months ago, but he has continued t o cough and lose weight. He has little appetite as well. He is unable to take his medications every day so he likely has a resistant strain of TB. I also found a medication called Lasix in his bag and he was unsure why he was taking it. He states he does not urinate often, which Lasix can make you do, so he is likely too dehydrated and has some kidney failure. He did have swollen legs, so we deduced this was the reason for his Lasix. He states he has Kaposi’s Sarcoma, an AIDS related illness, on his Left lower extremity. We sat with him for 30 min discussing nutritional concerns, clean water and sanitation. We also gave him a TB mask to wear when visitors come into his home.

Patient 2: a 40yo male diagnosed 1 month ago with AIDS with a CD4 count of 1, now on ARV’s x1 month.

We walked for over 40minutes to reach this remote village where we found an extremely thin, ill man preparing to eat his lunch of Rech and Ugali (fish and millet mash). He was just recently diagnosed despite his 2^nd wife having been diagnosed with HIV several years prior. She had been taking ARVS for 1year and appeared healthy. We discussed the importance of medication adherence with this gentleman and he told me he understood. However, he states he is unable to swallow because of pain in his throat. Thus, he cannot take his medications or eat. He was a tall man, but likely only weighted about 130lbs. He told me he thought he had heart burn and wanted medication f or this. After examining him, it seemed likely he had a fungal infection in his mouth and esophagus as a result of having AIDS. However, we were unable to carry the proper medications with us to each visit as we were not sure what we would find in the different villages. I wrote out the medication he would likely require and instructed his wife to go to his HIV center and speak with his doctor. It is difficult to see this and feel so helpless. He would likely improve if only he had the proper medications to improve his swallowing. After returning to Kageno, I spoke with the nurse. She told me she was going to get him the medication. She knew his first wife and sent her to me in the clinic. I gave her the medication and she will hopefully bring it to him.  

Patient 3: A 30 something female, recently widowed with 4 children and diagnosed with HIV with a CD4 count in the 30's. She lives in a dirt hug, filthy inside, with dogs and cats living around her. As I approached her home we were greeted by the several animals. Entering her home I was filled with sadness. It was horrible to see someone in this state. She pulled out a plain xray film she had taken of her lungs a few days prior. She apparently was hospitalized for TB or some other opportunistic infection she was unable to convey through the broken english of the translator. As I again placed my TB mask on my face, I could not help but feel nauseated. I looked at the Xray (it actually looked pretty good), and thumbed through her various medications: stavudine and  lamivudine for HIV, septra to prevent opportunistic infections, INH/Rif/PZA (TB meds).I asked her how she was taking them and she told me appropriately. I then asked if she was eating. She told me she is unable to eat because she cannot afford food. The meds are free, but food is not, and thus she gets enough to feed her children on occasion, however, she is unable to feed herself. Looking at her she does not appear to be a woman who has taken antiretroviral medications for 1 year. She looked thin and malnourished. I talked with her about the importance of her nutritional status in order for her to combat her various illnesses: Malaria, TB and AIDS. She told me she understands, but there is only so much she can do. We spoke of her gaining enough strength in order to care for her children and possibly get a job. If she passes, she will leave 4 more orphans on this island. Unable to do much for her, we again educated her on the importance of medication adherence, nutrition, clean water, etc, however, it is difficult to do knowing she is unable to afford food and WaterGuard (the chlorination product used here to ensure clean water). As I left her home I felt helpless...a feeling all too common here. The women of the Kamasengre AIDS support group stated they would try to provide for her, however, it is difficult to care for her entire family. If only there were more I could do here...