HIV/AIDS, tuberculosis, and KS Part 2 – her health story

This week has been my first “normal” week since I have been here in the sense that my weekly schedule is starting to solidify. Shortly, I will post what I now do through the program. Among those activities, I will have clinical time three times a week at this point.

 

On Wednesdays, I will be seeing patients with Dr. Henry Luzze, one of the researcher co-investigators and physicians here at Mulago. He staffs the tuberculosis clinic at Mulago hospital in Wards 5 and 6, which are pictured elsewhere on my blog already. We had one woman in particular whose condition particularly struck me this past Wednesday, as do many.

 

She came in for her “check-up.” A tough woman in her 40s (but looking as in her 60s), she was taking second-line anti-retroviral therapy (medication for HIV/AIDS), presumably because of a resistant strain. She had miliary tuberculosis (more advanced form of the disease), cervical cancer (status unknown by this staff but status post two radiation therapy courses I was told), and disseminated KS (Kaposi’s sarcoma) lesions. I wrote about KS lesions in an earlier post. This lady had the distinctive KS lesions on her arms, legs, and in her mouth scattered around her oral palate. Relatively emaciated – relative, that is, to other patients seen here – she was still strong and kept going.

 

We knew a little less about her because she is enrolled in a clinical research trial through the IDI (Infectious Disease Institute: http://www.idi.ac.ug/) at Mulago, a well-funded research institute here on campus. Dr. Luzze commented on her grave condition. One Ugandan resident physician here who has rotated in the US talked about how different aggressive therapy approaches are in the US compared to here. He said in her case, “why would we continue when she is in the condition she is in?” looming on death’s doorstep. Part of his answer may have been cultural, but part of it has embedded in it in the resource constraints here, even despite decent medications available through the IDI research study. I listened but wanted to say that her life is worth it, and she keeps going; this is why she should continue therapy.

 

Physician Paul Farmer writes of tuberculosis as an imposition, a punishment in many ways. I will write more on his views and how I see them manifest after I have experienced more here. Suffice it to say, the illness-poverty link is unmistakably glaring and visible. I have studied and written about this link in the context of the USA through an opportunity as editor of an issue on the topic in Virtual Mentor: American Medical Association’s Journal of Ethics (http://virtualmentor.ama-assn.org/2006/11/toc-0611.html). And while there are similarities, there are many differences structurally between access (or restrictions) to care in the US and here. More rumination on that topic throughout the year to come…

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