November 11

The days here are rhythmic and consistent it’s like someone flicking the light switch off exactly at 6PM and flipped back on at 5AM ….needless to say our days start very early in Malawi.

Thursdays, like most days at St. Anne’s, are very busy, and today is HIV/AIDS treatment day. Every Thursday the hospital’s Clinical Officer “Lester” interviews and prescribes medication to HIV patients. This is where patients with HIV typically have one week’s supply of medication left from their last scheduled consultation and meet with Lester to describe how they are feeling and if they have developed any other symptoms that likely resulted from complications of AIDS.
I was fortunate to be able to join Lester’s HIV clinic for about one hour between 11:00 and 12:00 – which I’ll tell you about that later in my update, but for now I’d like to walk you through a typical day for Lester. Lester’s day begins around 7:30am where he does his morning routine of discussing admitted patient cases, morning rounds then return to his office were he is so often met by out patients, who through word of mouth want to meet with him, as they see him as their last hope. This morning when I joined him, he had already seen two patients and another had just walked into our meeting unannounced and distressed. Listening to Lester’s well refined bed side questions, I determined that the individual was in his late 30’s or early 40’s, married with 1 child and suffers from AIDS. AIDS however was not the reason why he desperately wanted to see Lester, it was regarding the cancer that so often accompanies AIDS. This man has been to 3 hospitals and pharmacies trying to get his prescription filled and St. Anne’s was his last option.

Lester’s calming approach settled the man and he went on to explain the medicine that he is looking for is currently reserved for approximately 40 of his clients who are in various stages of the disease and in much pain. He also indicated that he has limited supply of the drug and will run out this week. He asked if the patient was in pain to which he replied no. Lester explained how the cancer will progress and indicated that exercise (walking) was a good treatment for as long as possible. He went on to encourage the patient to return next week to see if his supply of Vankristin was restocked in the pharmacy. He also indicated that when he can begin administering the drug he would immediately registered him as one of his 140 palliative care clients.

Later I joined Lester at the HIV clinic where it seemed that he was interviewing and prescribing prescriptions to and endless stream of patients. For that hour Lester consulted with approximately 15 patients, had 3 interruptions and dealt with 1 pregnant patient who needed and immediate ultra sound - which we did without any assistance on the other side of the hospital.

The first patient was a 25 year old male with chest irritations, then a young woman in her 30’s followed by a young mother caring a child and HIV reports for both. Later, older clients came into his office, men and women between the ages of 50 and 60. One lady jokingly asked how long she had been coming for treatment. After Lester consulted her charts which are carried by the individual patients, said 2005. This made me realize that these drugs and programs are making a real difference in the lives of people, their families and communities.

That afternoon Lester, two nurses and I went to a regional hospital “Kapriri Health Centre” that was being given a Bicycle Ambulance donated by WUSC funded partially through donations from the CMF. The 4 of us were presented to the Head Chief of 7 villages, as well as the 7 village's Headman and approximately 30 village volunteers. Long speeches were given by everyone including Lester on how much the ambulance means to the villages and how many of the worries shouldered by the chief and his head village men have been taken away by this gift. Many thanks were given. The hospital and Lester asked me to make the formal presentation to the dignitaries. While not as long as the others, it certainly had its share of emotions and lively hand gestures, at least that’s what the translation looked like to me:-))