Day 14: HIV/AIDS Part 2, African Cloth & Bug Bites

Today was my last clinical day as part of the family medicine department. Tomorrow, I'm going to give my presentation of experiences and impressions to the department but today, I was scheduled to go back to the PEPFAR HIV/AIDS clinic to participate in their different clinics - entry clinic to start new patients on HAART (HIV meds) and bleeding clinic (to refill meds/address acute issues when patients came for regularly scheduled bleeding (= labs).

What I realized today is that the PEPFAR clinic is staffed by training physicians that have completed their house officer (= internship) and year of service to Nigeria. Family medicine residents rotate through at some point during their training. For a variety of reasons (health, having babies, working on doing residency abroad or not gaining admittance to residency in Nigeria), these training physicians had elected to work in the PEPFAR clinic. They are trained specifically to see HIV/AIDS patients within the system of the PEPFAR clinic and essentially function pretty independently without much direct/active attending supervision. Of course, an attending was available but there was no staffing of every patient with the attending.

In seeing patients with one of the training physicians, I realized that starting HAART is very formulaic that is based on their risk factors. Their likelihood of being pregnant, low blood counts (= anemia), and kidney function would lead the physicians to start a certain combination of medications. Here is the order form for the patients. Patients pick up their meds once a month and if they have high adherence, they can pick up 2 or even 3 month supplies at a time.

Among the patients that left an imprint was a young woman, probably no older than mid-20s, that recently had newly confirmed HIV. Her husband was also HIV positive. She was to be started on standard therapy but needed a chest xray completed beforehand to start. We spent a quite of bit of time discussing how one could get HIV (poorly screened blood transfusions, unprotected sexual intercourse, sharps (i.e. needles) and mother to child). When she was posed the question as to how did she think she contracted HIV, she had no response.

In Nigeria, HIV is most frequently contracted through heterosexual contact (homosexuality is illegal and not openly discussed) and there seemed to be a good number of partners that were both HIV positive and a good number of patients that endorsed casual sex with or without protection. In fact, the training physician that saw a young man who had said he didn't have sex for 2 years was surprised and asked him if he was "normal." Also, unfortunately, male condom use isn't widespread and based on gender roles, women rarely are able to successfully offer men condoms before sex.

I appreciated the time we spent discussing HIV transmission to this patient as it seems many young HIV positive women elect to become pregnant. Today, we saw 2 pregnant patients, 1 contemplating pregnancy, 1 with an infant swaddled to her back and several others that were still of childbearing age. To avoid stigmization by their community, many had traveled quite far to this specific PEPFAR clinic as many other PEPFAR clinics are scattered throughout Nigeria.

Later today, Stella and Maria, the ladies from the breast cancer research lab, took me out to Alesinloye Market to buy some fabric for clothing that we were going to have made for Eddy and I.

Once we got to the market, I realized I had been there previously and the ladies remarked how the shop owners recalled seeing me there before very recently purchasing my other fabric. I contemplated a few patterns including one that was bright turquoise but settled on this instead.



Eddy is going to get a top and pants and I hopefully can get a top and skirt and another short dress. I guess when we are invited to a Nigerian party in Chicago, this is what we will wear!

The whole day was very productive including a visit from Kemi who is a visiting medical student from George Washington University. The only blemish of the day was waking up realizing that I had 2 spots on my cheek. All morning, I obsessed about these bumps and now they are sort of red and swollen.


I know they must be bug bites of some sort (I was trying to convince myself it was acne) but I sure hope they aren't mosquito bites as I still don't want to get malaria. One good thing is that they aren't itchy or painful at all. However, my whole body feels itchy now and I sprayed insecticide all over my room. If I get any more bug bites while in my room, I guess I'll have to start using my bednet.

My presentation for tomorrow is now done. Happy that I had electricity to finish it and to blog.

Goodnight!