Visit to the AIDS clinic

I walked in fleeting steps through the L shaped corridor, blue walls with doors every so often on either side, it resembled any other corridor in the central hospital, but it actually was the antiretroviral therapy (ART) clinc where AIDS patients pick up their medicine and see the doctor. I turned into the longer arm of the corridor looking for room 8. Locked. So I headed for the open door of room 9 where I could see nurses in white uniform talking inside. Just outside the room sat a young man, in his twenties, perhaps only a few years older than me. He had a clean haircut and a body to die for; he did not look like an AIDS patient. He looked to meet my eyes from where he was seated and I turned away. Did not want to stare. I thought about the way he looked at me, as if to ask “Who are you and why are you not seated waiting, like the rest of us?” Really, what was I doing there? I was looking for a doctor at the clinic so I could interview her “Do you know where Dr Miriam is, because room 8 is locked”, I asked the nurses inside room 9, “Go to the other side”, a young lady told me and so I headed back to the shorter arm of the corridor. On my way, I looked around and saw that it was a normal day at the hospital, patients were waiting outside almost every door and I would have to wait. Perhaps I could sit down and talk to them, tell them about my article on chronic diseases and how these illnesses changing the normal way we deal AIDS patients and how they cope with their illness. “Pharmaceutical governance of the body through ART and medications that fight cholesterol would become difficult for AIDS patients”; I would explain, “because of the adverse interactions between the two medications.” “Take it from me, its going be much harder living with AIDS now that you have to cope with risk factors for diabetes, cardiovascular disease and cancer,” I would say. Honestly, how could I even ponder this? I do not even have HIV, I have not worked in their community, nor do I have a degree in medicine. All I had was shirt, black, with “the words fighting AIDS together” written in orange. This was from Princeton, from when I did the AIDS walk in New York City with other students in 2008. Had I started that talk, I would have come off pretentious.

So I just continued on to room 9 and 10 on the other side. There was no room 8. I figured that since patients were sitting on a bench outside room 9, the doctor is probably seeing somebody there. “Is doctor Miriam inside?” I asked a man seating in front of me, “Yes doctor is in” he replied pleasantly, “Is Dr Miriam?” I posed to make sure I was at the right door “I don’t know” he answered as I turned back to the other room 9 to ask the nurse for more specific directions. As you might expect, I was escorted back to room 9 where the doctor was and I sat down alongside the other people. People indeed, because if HIV becomes merely a virus kept at bay by the drugs in their bodies, there is no need call them AIDS patients.

I was next, and I entered to speak with Dr Miriam. I introduced myself and told her how I was writing an article on chronic diseases under the auspices of the HIV clinicians’ society. I pulled out my notebook and began with the questions I had prepared, so as not waste any time. She assured me that I was not obstructing her patient flow, which put me at ease. We spoke about Dyslipideamia, otherwise known as abnormal metabolism of fat, and about cardiovascular disease. It was a conversation I tried to guide, but then I realized that me saying less allowed her to say more. Obviously, but I just had to add to nearly everything she said. Most notably, she talked about her periodic assessment of the cause of death in ART patient booklets of deceased perons “ Once a month I go through the files to see what could have happened to kill the patient. I do this informally, by myself.” In the context of our interview about cardiovascular disease and ARV, she said “ it is not easy to see that this patient died because they started this ARV or…” and I cut in saying “because the effects of ARV, lack of exercise and diet are synergistic and bring about chronic disease” and she just affirmed it say “yes exactly”. But why did I just not let her go on? This was not a showcase of how much I know about. I probably would have learnt more had she continued that sentence, but now I will never what would have followed that “or”. On the other hand, my familiarity with the material at hand allowed us to establish a rapport quickly and she spoke to me as if I was a health practionner “ Yes, you are right, we do see dyslipidaemia, in our case lypodystrophy with patients that have been on NRTIs for 10 months or more.” I knew what lypostrophy was and so I only needed to clarify which NRTI (nucleoside reverse transcriptase inhibitor) she referred to and she told me “especially stavudine”. But this was just to break the ice between us, to open up the forum, not to show off.

At the end of the interview, I assured she would just remain a “Medical Officer at ART” clinic. I sensed she was reluctant to answer the question “Can I use your name in the article?” which prompted me to offer he confidentiality. Trust was fostered and at the very end she shared her perspective on the whole exercise “You know I really like this research you are doing, because I think it is important. I worked at a district hospital before I cam here and people are just so focused on HIV and TB only, they really miss out on the non-communicable diseases. I remember there was one patient [HIV positive] who was loosing weight and the CD4 count was high. I don’t know how many sputums were collected, but the patient did not have TB. Then someone did a blood sugar test on this patient and it was 34.”
“Is that high?” I asked to understand the patients ailment. “Really high!” she exclaimed in reply. I then tried to determine what the normal range for blood glucose what were the units of that 34, but I realized it was not important. Clearly, the patient was suffering from diabetes, because their glucose was not being used by the cells, which resulted in the wasting away of the patient, since the body breaks down fats and proteins for energy. Indeed, the wasting syndrome is typical of AIDS patients suffering from communicable disease such as TB and so the health providers at the district hospital were fixated on that possibility. I wonder to what extent this has to do with the fact that the patient ART booklet provides a list of opportunistic infections the patient may suffer from and TB, while all chronic conditions such as heart disease are relegated to the blank space next to the word “Other”. It is up to the doctor to then detail this “other” condition on the following pages in the ART care book. Absolutely, I suspect that the list of AIDS opportunistic infections that was compiled by the CDC in 1987 impinges upon the inclusion of chronic conditions in the idea of AIDS.