Monday, June 11
My first day at the clinic has finally arrived. My housemate Nader (himself a doctor at the Baylor clinic) drove the two of us in by about 8 am to get started. The place is beautiful- brand new, well equipped, featuring a triage room, a procedures room, about seven examining rooms, X-ray, well stocked in-house pharmacy, staff kitchen, conference room, lecture hall, library, computer lab, offices, and I’m probably still leaving out a bunch. Every morning, there are about 50 or 60 patients and their parents – mainly moms – waiting in the waiting area. Some of them have literally walked about 10 km with kids in tow to get here while others have taken a 3 hour bus ride in the early morning; yet others came by some combination of those. And in line with BIPAI’s mission, all the patients are HIV+.
On any given day, some of the appointments at the Baylor clinic are prescheduled while many others are “sick visits” in response to any of the plethora of opportunistic infections that HIV+ kids are consistently plagued by. For life-threatening emergencies, we send the kids right next door to the pediatric ward at Kamuzu Central Hospital, where I will also get some chances to work starting next week. My role at the clinic, anyway, will be to shadow any of the clinic doctors during their days of office visits, eventually actually taking some histories and conducting physical exams on my own (with some supervision of course.)
Now for the HIV fact of the day:
I mentioned that all the kids we see are HIV+. In fact, in taking the social histories for any of the given cases, I realized that almost all of their mothers are as well. Here in Malawi (and probably in much of Africa) 90% of HIV+ kids under age 16 got the disease from their mothers, either during pregnancy when the virus crossing the placenta, during birth with their exposure to the mothers fluids, or during breastfeeding as the virus is present in high amounts in breast milk. This mode of getting the disease is referred to as “vertical transmission.” Without any kind of prophylaxis or precautions, an HIV+ mother will pass on the virus to a full third of her children. However, if she and the baby are given the antiretroviral drug nevirapine and the delivery mode is Caesarian section, the risk of vertical transmission drops to 2%. Considering that fact, vertical transmission is an all-too-frequent occurrence in the developing world often due to mothers not knowing their own HIV status or not having the resources to access this type of care.
My first day at the clinic has finally arrived. My housemate Nader (himself a doctor at the Baylor clinic) drove the two of us in by about 8 am to get started. The place is beautiful- brand new, well equipped, featuring a triage room, a procedures room, about seven examining rooms, X-ray, well stocked in-house pharmacy, staff kitchen, conference room, lecture hall, library, computer lab, offices, and I’m probably still leaving out a bunch. Every morning, there are about 50 or 60 patients and their parents – mainly moms – waiting in the waiting area. Some of them have literally walked about 10 km with kids in tow to get here while others have taken a 3 hour bus ride in the early morning; yet others came by some combination of those. And in line with BIPAI’s mission, all the patients are HIV+.
On any given day, some of the appointments at the Baylor clinic are prescheduled while many others are “sick visits” in response to any of the plethora of opportunistic infections that HIV+ kids are consistently plagued by. For life-threatening emergencies, we send the kids right next door to the pediatric ward at Kamuzu Central Hospital, where I will also get some chances to work starting next week. My role at the clinic, anyway, will be to shadow any of the clinic doctors during their days of office visits, eventually actually taking some histories and conducting physical exams on my own (with some supervision of course.)
Now for the HIV fact of the day:
I mentioned that all the kids we see are HIV+. In fact, in taking the social histories for any of the given cases, I realized that almost all of their mothers are as well. Here in Malawi (and probably in much of Africa) 90% of HIV+ kids under age 16 got the disease from their mothers, either during pregnancy when the virus crossing the placenta, during birth with their exposure to the mothers fluids, or during breastfeeding as the virus is present in high amounts in breast milk. This mode of getting the disease is referred to as “vertical transmission.” Without any kind of prophylaxis or precautions, an HIV+ mother will pass on the virus to a full third of her children. However, if she and the baby are given the antiretroviral drug nevirapine and the delivery mode is Caesarian section, the risk of vertical transmission drops to 2%. Considering that fact, vertical transmission is an all-too-frequent occurrence in the developing world often due to mothers not knowing their own HIV status or not having the resources to access this type of care.
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