Tuesday Site Visits

Today we visited an ARV clinic (here they call them ART’s). The clinic was at SMS hospital, named after a royal Rajasthani family. It was a big hospital, so it was very crowded. The emergency department was overflowing. The ART clinic was also packed. We all felt bad (all eight of us!) because the doctor tending to the HIV patients stopped clinic right in the middle of seeing her patients (she sees about 100 per day!) just to give us an overview of her work and to add to our understanding of the situation in Rajasthan.

Since last year, the doctor (whose name we didn’t get…I know, bad manners) says that the number of patients jumped from 700 to 2,100! They currently treat men, women and children and counsel them so that they follow up. Patients must come every month for their ARVs, and must get CD4 counts done every 6 months. This is provided by the government. The HIV test is not free, but it’s only 10 rupees…affordable by any standards. The doctor said that counseling is one of the best ways to ensure patients stay on track and do not drop out. They are also counseled to bring in family members, which they do. This helps ensure effective treatment.

Our second site visit today was to a community care center called Jeevan Jyoti. It’s a government-run care home that resembles Sahara Michael’s. It is much smaller, with only ten beds. It does have a DOTS program for TB, which Sahara Michael’s didn’t. And of course the people running it are not HIV/AIDS peers. But it’s doing good work. Patients can stay at the home for 15 days, getting treated for OIs and recuperating. They seem to like their stay there very much. The care center also liaises with other centers to provide more comprehensive treatment. It also dispenses condoms…we saw an FXB-devised condom dispenser there! Awesome.

It was interesting to hear from the director of the care center why it was important to create such establishments. Despite all the government’s efforts to supply free ARVs and support HIV infected and affected persons, the director told us that the care at these smaller places is better because it’s free of the stigmatization that’s rampant (and so counter-productive for public health) at government hospitals. Treatment for OIs is also free at Jeevan Jyoti, which is not the case at government institutions. Another advantage of having these smaller care centers is that it reduces the burden of HIV/AIDS patients on government hospitals.

Both site visits made me realize that it is not only in rich countries that HIV/AIDS is a chronic disease. In India, too, it is a disease that is managed over time. At the SMS Hospital ART clinic, there is a high volume of patients, but few new patients. Many just come to get their medicines which are carefully dispensed by the government in measured quantities (and patients can get only a two-month advance on their medicines). At first, I was surprised when the doctor we spoke with said that she found working in the ART clinic monotonous. But it makes sense. There are several heartbreaking stories, like the stories of people who develop resistance, or cannot continue ARTs due to toxic side effects, or the children. But for the most part, many people are in the asymptomatic phase, and just need to get their ARTs dispensed and get educated on how to deal with common ailments like diarrhea.

Now, off to finish our lecture from yesterday with Dr. Goyal!