Monday, April 4, 2011

Day 4: HIV/AIDS in Nigeria and Food

Today, I woke up with a stomachache. My cell phone had went dead because I had no electricity for 13 continuous hours and the generator was without fuel. I had my stomach issue but I knew that they would worry about me (attending physicians would send their residents to the guesthouse to make sure I was okay and call me periodically) if I didn't show up this morning. Thus, I got dressed and walked to the hospital to tell the head of family medicine that I was feeling unwell. Of course, she expressed concern and then gently scolded me for eating out. Oops... my bad!

In all the areas of the world I've traveled with exception to Europe, I've always gotten some form of traveler's diarrhea. It's a rites of passage and after an episode or two, I'm good to go. I've been waiting for this to happen in Nigeria and of course, a very mild form happens after I ate amala and the vegetable soup. In retrospect, it probably wasn't the best idea (but I really wanted to try it) as vegetables are often the culprit in making traveler's diarrhea an issue. Not only did the head of family medicine scold me, but she had her residents discuss with me what I should and shouldn't eat!


Before I left for Nigeria, Sope told me to bring some food. I didn't really understand this because didn't Nigeria have food? I mean, I'm pretty open to eating everything (with exception to beef) - I have even grown to like Ethiopian injera! But now I understand. Nigerians prefer to eat at home with food they have prepared. Unlike other parts of the world I have traveled to, eating out is more suspect and questionable. This does make sense as I've been advised to never drink the running water, to always brush my teeth with bottled water, to do a final rinse of my plates and cutlery with bottled water and even advised to purchase a specific type of bottled water (as other types might not really be that clean). So, to be honest, I have been subsisting on Luna/Cliff bars, fruit leathers from Trader Joe's (given I'm not really suppose to eat fresh fruit), wheat bread with peanut butter and jelly and pasta with tomato sauce which is what I ate for dinner tonight. Next wk, I'll be going to an even more remote rural place to rotate and the residents who have been there tell me that they subsist on snacks, cereal and bread while they are out there! More carbs for Jane! (Don't tell my trainer!) The family medicine residents recommended a couple of places that serve Chinese food which I'm very excited to try and even recommended a place for pizza, Mr. Biggs. Don't worry, I'll pull an Eddy and take pictures of my food!


From a medical perspective, after my stomach issue resolved, I went to tour and see a pt or two at the UCH HIV/AIDS clinic called the Harvard PEPFAR (APIN-PLUS) clinic. This clinic is AMAZING. After learning about some very serious constraints evident in delivering care to most Nigerians, Nigerians with HIV/AIDS receive some of the most comprehensive and free/subsidized care available in Nigeria.

Sponsored by PEPFAR with support from the Nigerian government to continuing funding this program after 2013 when the grant expires, pts with HIV/AIDS are followed very regularly with intensive counseling, social support, access to free or subsidized studies for related health exams, free infant formula and finally, free HAART (medications that treat HIV/AIDS) and prophylaxis.
I was really impressed by this clinic as it has tremendously help reduce the transmission of HIV from mother to child, make HIV no longer a diagnosis of death, lessen the stigma of HIV in Nigeria and proactively educate all about HIV and transmission. The physician I toured with was extremely passionate and effective and plus, he had lived in Chicago for some time doing a Master's degree at Northwestern.

Here's a picture tour.

Walking into clinic area for consultations and acute care, you see all the signs clearly describing expectations. This area has a bank next to it intentionally to destigmize coming to the HIV/AIDS clinic.












The red roofs is a separate building that is open daily in the morning for clients to pick up their free HIV meds. This is a quick in and out visit but the visit to the consultation and acute area can take 2+ hrs.







These are intake rooms part of the consultation/acute care area where new clients meet with an intake officer who is either a man or woman living with HIV/AIDS as an example that you can live life with HIV/AIDS.








These are where social workers talk to clients about what's going on in their lives and help them troubleshoot. Comprehensive care!













Triage nursing area where they take vitals (they were done for the day already)











Consultation rooms and waiting area.
























Health information throughout the clinic to increase education and awareness


































A patient chart but this clinic is also entirely computerized with CD4 counts, HIV viral loads, whether or not they had co-infections with Hepatitis B and C, graphs of their CD4 counts/HIV viral loads and a chart indicating when patients picked up their meds as a sign of adherence. This is great!












Day care is like a mini-emergency room where clients with urgent issues are offered immediate care prior to transfer to the ward.












Remember when I had talked about how one needed to pay to get health care? Here is an example of what a patient would need to acquire and bring with them to get a cytoscopy (examination of inside the bladder). #16 indicates the cost.








Here is the Nigerian law that discusses the health care it affords its citizens with HIV/AIDS.

















Free infant formula that is distributed to women with HIV/AIDS that recently gave birth. From the physician I spoke to, the decision to promote to breast feeding (with risk of transmission of HIV) vs use of formula that needs water added (the water can cause diarrhea leading to infant death) is a tough one.









On my way out of the clinic.... all the packaging from free HAART














Other happenings:
* Today, while waiting for for the head of family medicine, I was approached by a Nigerian woman (presumably a patient) that asked me if I could sponsor her as a nanny to the US. It was an awkward moment for me.
* Since I look (and am) of Chinese background, many are confused if I am really American. This is pretty consistent worldwide. If there is any intense dislike of Americans in any country Eddy and I have visited, we always joke that we'll pretend to be Chinese and just speak Mandarin.
* Whenever we discuss me being American or Chinese, I invariably hear about any type of injustices that has happened to them or family member by an American (i.e. US embassy denying a visa) or Chinese (i.e. got asked to leave China and couldn't return to get their belongings).
* The women residents were amazed that I didn't cook and my husband did at home. Yes, I have an awesome husband.
* The women residents were also amazed that I didn't take my husband's last name and I wasn't Dr. (Mrs.) Chen. I think this might of offended some men.
* The doctors refer to each other by Dr. or Prof consistently. I don't think I know any of the residents' first names.
* Whenever I would be introduced to anyone, they would respond "You are welcome" which I have come to find as their way of greeting a foreigner. The first few times I was a little confused because I would say hello and wonder why they would say they were welcome.
* I'm terrible at prounouncing Yoruba. Hopefully this will get better. So far, I can say oyibo (white man), e se (thank you), e kaaa ro (good morning), wahala (which means trouble but I see lots of physicians asking their patients "madam... wahala" which I guess means, ma'm, what is troubling you?)
* There
are little lizards in the house in addition to flying ants. I'll have to try to take a picture of one.

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