Another day at Michael's Care Home...plus Tonic Lounge fun

This is what the girls look like after a long day...it's even more intense WHEN THE AC CONKS OUT (this photo was taken back at Bapu, where the AC was steadier...ahhh Bapu). But thank God for ceiling fans...it could be worse!

Ok, as Sej's and Emma's blogs will tell you, tonight we went to a pretty hip lounge for dinner and post-dinner frolicking (umm, we were still home by 8:30) and it was great fun! Emma and I got to indulge in our chicken tikka, which was God-sent after days of rice and beans. We also had chocolate ice cream, and got to listen to some hip hop music from back home (Black Eyed Peas and Fergie's solo album were on heavy rotation) which made me feel like bustin' a move, especially with the dimmed lights and the whole night-out mood. Definitely a far cry from our daytime crowd. Sej told me to just wait till we get to Mumbai...

And yup, it was another day at Michael’s Care Home...we spent the AM doing rounds with Dr. Gupta, and the afternoon learning about some of the clinical/public health issues surrounding HIV/AIDS in high-risk groups from a clinician’s perspective (as opposed to a health worker’s). All the beds were full at the home. A new patient was admitted today and the staff had to make the tough decision of who to discharge—who was well enough to be referred to a less comprehensive care center. It turned out to be a commercial sex worker; Philip (program director, see yesterday’s blog) said she would be referred to Sahara’s Women and Child Center. We’ll be visiting there on Friday, God willing.

Rounds were really interesting, and I feel like I learned a lot. We saw two patients whose side effects from their ARV cocktails were so bad that they were going to have to stop taking them altogether, and just let the disease run its natural course. We saw two patients with leprosy, and learned that leprosy is now curable with a 5-6 month course of antibiotics. One of the leprosy patients was already experiencing disfiguration in the fingertips, and one of his thumbs was bent backwards at the joint. I don’t know if it was too late for him; once disfiguration sets in, Dr. Gupta mentioned that it might not be curable. As usual, early diagnosis is crucial.

One of the newer patients in the main ward (where the sickest patients are…it’s not so much a ward in this humble care home, but more of a front room) had such a hoarse voice that you can’t hear anything when he talks. His wife died twenty days ago, of a cause unknown to the people at Sahara. He has had a hoarse voice for 4 or 5 years (!!!) and has a hemoglobin level of 3 (normal for males is 15, for females 12…HIV suppresses bone marrow). We don’t know his HIV status yet, so Auntie Jennie’s job of counseling him to get tested still needs to be done. Dr. Gupta called for a TB test because of the signs/symptoms of fever, cough, weight loss, and severely enlarged lymph nodes (which could be malignant, since they seem to be impinging on the vocal chords). Seeing that he works in a resource-poor setting, Dr. Gupta also told the head nurse, Daisy, to call WorldVision for funding for this patient. He is going to need tests and treatment, all of which cost some serious money. This is yet another facet of working in this setting, with this population. Staff must wear several hats—they’re all the hope that their clients have.

The whole issue of ARV side effects was really striking to me. The toxic effects are terrible: altered sensorium (phobias, mental effects), skin problems, neuropathy (severe pain in limbs), pancreatitis, liver problems, severe anemia…as I said, two patients we saw today were so sickened by their reaction to ARVs that they had to stop, despite knowledge that stopping them causes a patient’s viral load to soar. Even in countries that can afford to try different combinations of ARVs (ie, second-line treatments and beyond), toxic side effects are inescapable with the drugs currently authorized for HIV treatment. So even though we talk about HIV being a chronic disease that can be managed so a patient lives a somewhat normal life, it’s not so simple. Fortunately, for most people the side effects are not so toxic that they are forced to stop taking them.


More interesting stuff: we talked about sexually transmitted infections (STIs), including prevention and treatment best practices in patients with HIV; why women are more at-risk for STIs and HIV than men (semen is virus-rich, spends more time and has more surface area on a female’s sexual organs than on a male’s, women get vaginal tears during intercourse, and may have asymptomatic STIs which increase their risk); why circumcision may decrease a man’s risk (prepuce has STIs, so removing it removes a risk factor); why circumcision will remain a theoretical solution and not a practical one (so many cultures/religious beliefs); why opportunistic infections (OIs) should be treated before starting ARVs (b/c OIs are emergencies, and ARVs are not). Wow...that was a long sentence. My grammar seems to be getting worse.

We had an interesting little discussion about sex education in schools, too. It seems like it’s an international dilemma when thinking about what age is an appropriate one for starting school-based sex ed. Parents and principals in India are often against talking about sex; parents say that it’s their job to do that (yeah ok, but it’s a job you’re NOT DOING…at least not here in Delhi). It sounded a lot like the debates we have in the US. So much opposition...it appears that even the best dreamed-up public health prevention scheme will go haywire without the support of the general public. What a challenge!