Wednesday, November 5, 2008

Hoorah for Obama!

Hallelujah, the world, for a small amount of time made sense again!
I was woken early by Susan this morning. Her friend in San Francisco called to say that Obama had won the election and Susan immediately called me. I wasn’t entirely convinced at first as it seemed pretty early to be making an announcement, but within an hour, I was in front of a TV watching the broadcast on CNN. Kristin, Andrew, Susan and I were in high spirits as we made pancakes and watched the coverage. We saw the re-run of Obama giving his acceptance speech and we all knew that we would probably remember this moment in history for the rest of our lives. Susan was crying and I was just mesmerised. I actually find men who are smart, articulate and good public speakers to be absolutely intoxicating and despite the fact he’s a married man- I LOVE OBAMA! A few of you will be perplexed by my enthusiasm for an American President, but I really feel that we live in a global community and what happens in one country (especially one as powerful as the US) affects us all throughout the world. Here in Swaziland, where there is no hope, I desperately needed to hear the message of hope and I think Obama delivered that for me. I also know that my best friend Courtney, and her family and friends have the comfort of a promising future and that’s really important to me.

So it was with this renewed enthusiasm and hope that I entered my ward to do a delayed ward round. All that hope and enthusiasm disappeared within minutes and I was confronted with the stark reality of my existence in Swaziland. I have some really sick women on the ward at the moment. Women who just consist of skin, bones and a vacant stare that signals that their time here on earth is limited. They have no immune systems and they are covered in skin infections and tumours. They are just lying there, unable to even roll over to change positions because they are so weak. I felt overwhelming hopelessness.
This feeling was compounded by the fact that things here at Good Shepherd are deteriorating. We have no reagents to do a complete blood count. We have no India Ink to look for Cryptococcus on cerebral spinal fluid (In patients with AIDS, it is incredibly important as many patients get meningitis and it’s important to be able to tell the difference between a bacterial meningitis and a fungal meningitis called cryptococcal). We don’t have the reagents to test for syphilis (again, very common here). We are starting to run out of a powerful antibiotic called ceftriaxone which I use effectively for many of my patients. Yesterday we ran out of sputum cups so I was unable to test for tuberculosis which is in epidemic proportions here. I am so incredibly frustrated and upset that I actually feel I would be better off just getting on a plane and coming home. This is all so difficult and no hope of improvement is in sight.
Today, for the first time in my career so far, I let my hostility out on a patient and I feel incredibly guilty about it. I was seeing one of my patients who was diagnosed with HIV on admission. I had spoken to her about the diagnosis and its implications yesterday. Today she asked to be discharged and when I asked her about how she would follow up on her CD4 count, she told me (through an interpreter) that she thought I was lying by telling her she had HIV, she thought she had malaria and I had got the diagnosis wrong . First of all I was a little insulted that any patient would think I would lie to them and secondly I was just filled with enormous frustration that despite the fact that Swaziland has the highest incidence of HIV in the world, people still will not accept it as a problem here. I went up close to the woman and pointed to a patient in the bed opposite to her. The woman in the other bed has AIDS with a CD4 count of 1. She is incredibly emaciated and semi-comatose with shallow end-of-life respirations. I pointed to the patient in the other bed and said “If you do not accept you have HIV and you do not follow up on the recommended treatment, you will end up looking like her!” Perhaps my voice was raised a little because in the ensuing silence, you could have heard a pin drop. I think I shocked the nurses with my outburst. I am not proud of my performance. I was just so frustrated that I allowed by emotions to overcome my professionalism. The patient with newly diagnosed HIV was very upset with me and I know that I behaved very badly and inappropriately as far as Swazi culture is concerned. I apologised and moved on. I could not continue to argue with this patient. Her non-acceptance of the situation is reflective of most of the attitudes here. People present here at a very late stage of their illness and I am often left with hopeless situation of applying a “band aid” to give them some quality of life for their last months on earth. Because people present so late, we are often unable to effectively give anti-retroviral treatment. Many people who commence ARVs die within the first 6 months of their commencement.
So whilst the US may have gained some much needed renewed hope, I am afraid that this is not the situation here in Swaziland. My joy was short lived. Tonight I am going to Chris’s for her infamous Cincinnatti chilli, perhaps this will cheer me up.