Thursday, 2 September 2010
This day we travel to a fairly remote village in the southern Mulanje district to see one of our mobile health clinics in action. It is the Muloza clinic and today, Thursday, it is held in Mdala village, using a church as it’s base. There is one clinical officer, James (he is not a doctor, but very much like a physician’s assistant in the US), a Nurse Midwife, a Nurse Aid and the driver. When the clinic arrives, people have come from villages all around and lined up to be seen. As the others unload, the driver performs "triage" - assessing the people waiting to be seen, to pull the most critical cases to the front of the line. Any cases of cerebral malaria are seen first and immediately dispatched to the Mulanje Hospital, several kilometers away.
The clinic’s day is underway when we arrive. As has been the tradition here in Malawi, we are "sung in" by those standing outside the clinic. The crowd is primarily women, most with babies on their backs. We enter the church-cum-clinic and see people seated and waiting. Some will see the Nurse Midwife for pre-natal check and possible HIV testing. (We now know that if we can test a pregnant mother and determine her HIV status before she gives birth, certain drugs can be administered to both mother and newborn which will reduce the risk of mother-to-child transmission at birth. This is a significant step in the continuing fight against HIV AIDS.) There is a table set up that holds the supply of medications that have been given out based on the examinations. In another room, at the front of the church/clinic, is where the Clinical Officer sees the villagers.
We spend one hour in the exam room with James, the Clinical Officer, and watch him as he goes about his work. The patients are willing to let us take their picture and ask a few questions. I think our presence may have slowed James down from his usual pace. Many of the people today are tested, found positive, and treated for malaria. In one hour today, he sees 25 people. If he were to do this for 7 hours today, he would see nearly 170 people. We understand the numbers are actually larger - not all the people who come see the Clinical Officer, some see only the Nurse.
While we are in with the CO observing, we hear just outside that a clapping game has begun. Soon, there is a rousing rendition of "Head, Shoulders, Knees & Toes" being taught by several members of our troop and sung with the children who are waiting to be seen. For nearly a half an hour, there is singing and clapping and laughing floating through the open windows to the rooms where the sick are being seen and gently treated. It is a welcome intrusion.
In some respects we are lucky today. Of the 3 patients in our hour who received HIV testing, no one’s results come back positive. We are happy to share in the good news with a relieved 59 year old farmer, a young single man, and a 35 year old mother. (They do a "quick test" which consists of a finger prick for blood. If the test shows positive, they do a follow up test to confirm the results before informing the patient. The tests take approximately 5 minutes to process. Once a person gets a test, they leave the room to wait before returning for the results. This way the CO can continue to see the remaining people.) We do however witness a follow up with two other people who tested positive previously and have returned for additional counseling, instruction and some interim medications. One is a 30 year old wife and mother. Among other things, she was advised to bring in her last born child to also be tested. Also to bring in her husband to be tested. Also seen in follow up is a 25 year old father and husband. He was found to be HIV+ a month ago, has not yet been to the clinic to get started on his ARV regimen, and is now presenting with Kaposis Sarcoma and swollen lower extremities, as well as a growth in one eye. He is the father of 2, plus he takes care of his sister’s three children, as she has passed away from AIDS. He indicates that he has not yet told his wife. (The clinic staff, however, report that she has been to the clinic with the children, and it is possible she has had herself tested, but has not yet told her husband.) We have no words to give him, only a Zikomo (thank you) for allowing us be there.
No comments:
Post a Comment