HIV Clinic

My first day I spent working with Dr. Joe Mamlin, the founder of AMPATH, who has been living & working here with his wife for over 15 years.  We went to one of the rural healthcare centers in Turbo, a small village ~45 minute drive from Eldoret. All along the road there so many people walking & carrying things to sell at market. When we drove by the market area everyone had their wares laid out on tarps on the side of the road- piles & piles of clothes, shoes & food (I remember a particularly large pile of what looked like heads of cabbage covered in dirt). We saw a young man holding up a few fish which Dr. Mamlin said were caught in the small lake I could see a short distance from the side of the road; on our way back hours later he was still there with his fish! There were plenty of crazy drivers on the road with no traffic lights, no lane markings, & no rules. Motorcycles (piki piki), bicycles (boda boda), overcrowded passenger vans (matatus), petrol tankers, cars & pedestrians all vying for space & speed on a pot-hole filled road, sometimes with a muddy sidewalk & sometimes without any at all. On our way back it was raining hard & schools had let out for lunch so children in school uniforms (different colors depending on their school- blue, red, green) were everywhere running through the mud carrying their shoes. Along the way Dr. Mamlin pointed out a “truck stop”- an area where long-distance truck drivers on the road that runs between Kenya, Uganda & South Sudan can stop for sex workers. I didn’t see any obvious signs of it except a hut with a sign saying “The Drip Hotel & Bar”— quite the fitting name!!! This practice is one of the ways in which HIV has spread not only in Africa but throughout the world.

The clinic had started as 1 room with 1 provider & since expanded to 2 buildings with clinics for maternal/child health, family planning & chronic disease, all with a medical records system. In the same building they have a social worker as well as job training & nutrition programs- very comprehensive & self-sufficient. They also have an x-ray machine, some lab capabilities & 2 pharmacies- a free one stocked by the government which is often out of even basic meds & another that is funded by the community which has very cheap meds. This ensures that people can continue to take important meds continuously. A small, free inpatient unit including a delivery room (staffed only by nurses) was made up of essentially a few bare mattresses with IV poles & delivery instruments sitting out on a table, but was currently unoccupied.

In clinic we saw all HIV positive patients, ranging from 19 to 82 years old. Some had great stories: the 82-year-old man has been on first line HAART for 10 years with a normal CD4 count & undetectable viral load. His only complaint was that he had to get up at night to pee too many times. His grandson accompanied him, translating & supporting his arm as they left with his medication refills.  Another woman had come to Dr. Mamlin when she was pregnant with untreated HIV & septic, near death. Her family wouldn’t pay for her to be hospitalized so Dr. Mamlin admitted her anyway & paid for her care until she improved.  She came in today for a regular check up & HAART refills. She has a chronic rash all over her body, which has been improving after treatment recommended by a dermatologist from UCSF who Dr. Mamlin sends pictures to for help with diagnoses. She came in today with her beautiful 4-year-old daughter, who is HIV negative!

Some stories were much worse: the 19-year-old girl had been diagnosed with HIV at 17. Her disease was resistant to first line HAART, so she is now on second line therapy with persistent pneumonia, possibly TB. She has been in & out of the hospital & therefore having difficulty finishing school. A 25-year-old woman (who looked 40) had wasted away to 80 pounds with a GI infection & pneumonia- also possibly TB. Today the lab was unable to test viral loads for us because they didn’t have the necessary tubes in which to collect the blood. This is because the supply chain had been disrupted by recent political changes in which the responsibility for payment moved from the national to county government. But we were able to do chest x-rays (no computers here- only film & light box!) & sputum testing for TB, provide antibiotics & arrange for transportation to the hospital when needed.  However, in the case of an emergency there is no ambulance & if they don't have someone with a car (none of the clinic employees seemed to have one) they would have to send them on public transportation (the aforementioned crazily-driving, overcrowded matatus).  Imagine if something goes wrong during the delivery of a patient & the nurse needs to send her & her baby to the hospital 45 minutes away??

Unfortunately I didn't take any pictures because I didn't want to look too much like the mazunga (foreigner) tourist. But here are some pictures of where I'm living- as you can see, not too shabby! The flowers are growing right outside our living room window & smell amazing! Feel free to post questions- I'm happy to answer anything I can. I will post more pictures soon! Monday I start working full time on L&D so wish me luck!