There were approximately 60 patients at the clinic, ranging in age from babies to adults of 62 years. The patients arrived at the clinic to collect their notes, and pay a small fee (1000 Ugandan Shillings which is approx 25p). The medications are free and provided by the government but this covers some of the costs of the clinic. They then queue up to see the doctor. Today's doctor was Denis, a newly qualified, wonderful junior doctor who Flo and I both spent some time with. We worked together in the clinic and at times he asked my advice on a few things (although when it comes to HIV he was definitely the expert!).
Patients visit the clinic every 2 months, so at the appointment discuss any recent symptoms and how they are coping. We saw a range of drug side effects including rashes and peripheral neuropathy. I saw several patients with oral thrush, a range of skin conditions including eczema and shingles, aches and pains, gastro-oesophageal reflux ('heartburn'), and many patients with concurrent TB infection. Treatment for TB here uses the same drugs as in the UK and all patients with HIV are routinely screened. Interestingly, we saw a few patients with a high fever who were treated empirically for malaria (there is no facility to diagnose malaria in these peripheral clinics). I was also surprised to see that hypertension (high blood pressure) is a relatively big problem here as well as in the UK. Flo spent some time with a number of mothers who were breast-feeding to collect some data for her project.
All patients with CD4 counts <350 are started on antiretroviral therapy (ART). Most of the patients at the clinic have been coming there for years - the clinics were first established in 2004. Once the patients have seen the doctor they go to the dispensing desk. Here, the nurses dispense the medications the doctors have prescribed - this includes the ART, as well as co-trimoxazole prophylaxis which all patients receive, along with a range of antibiotics, mebendazole, ointments and anti-hypertensives depending on the particular patients. Flo and I took it in turns to record the drugs dispensed and distribute them to the relevant patients (the language barrier was an issue at times!).
After this, all patients go to see a counsellor to discuss any personal issues or concerns they have about their HIV or treatment. The stigma surrounding HIV is a massive issue here. Many patients discontinue their treatment as they don't want their partner to find the drugs and discover that they have HIV...
Whilst at the clinic, I distributed some clothes and toys that my sister Lucy had given me to take - Luce you can see here how they have been put to good use!
Another update to follow soon!
All the best,
Amy
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