On Thursday, we were fortunate enough to be able to tag along with the Dr. Tony and Dr. Jill (From Baylor’s Pediatric Program—they are here once a month up from Maseru to check in at the hospital and several rural clinics) for their day at the clinic in Libibing (pronounced “Dibibing”—L’s are D’s if they come before I’s and U’s—yeah, it’s really fun to try to figure that one out…).
Reid and I posted up on an unused exam table in the corner, assuming our so-far-customary positions as silent observers. This week we have basically been sponges, trying to soak up as much information about the Basotho culture and the medical issues being faced in the country as we can, so that hopefully in the not TOO distant future we might actually be able to contribute something of use. We initially planned to overlap with Dan – our predecessor here - which would have helped to avoid this lag where all of his hard-earned gains have temporarily been put on hold while Reid and I acclimate. But, you know, the best-laid plans… (Dan, if you’re reading, everyone has been asking about you! We tell them that hopefully you’ll be returning in the near future… They are also impressed when we tell them how full of metal your leg is now).
Anyway, it was a very informative day, and helpful that the nurses were translating for Tony and Jill so we could also have some idea of what was happening. They were handling primarily ART (anti-retroviral therapy) patients—both those already on treatment and potential new patients. The major frustration of the day (and this is saying a good deal for a clinic at which seemingly half the drugs that the doctors attempted to prescribe were out-of-stock), was that all the CD4 labs (the measurement used here—instead of the more advanced analysis of viral loads used in the U.S.—to partly determine the severity of the disease) that had been taken the previous week and that people had walked for hours to find the results, were unavailable because the machine at the hospital in Mokhotlong was broken. Because of this, many people who might have needed to be put on ARVs were not, and they all have to return twice more for blood tests and then results. None of the patients seemed to protest much against this failure, an attitude that struck me as a sign of how familiar these people are with frustrations and delays.
I was surprised at how many older men and women were being treated at Libibing for HIV. The stereotype is more of the promiscuous young man or woman, but many of these patients were in their 50s and 60s, and only recently diagnosed. Dr. Tony speculated that the high incidence of transactional sex taking place in these villages might mean that older men were having sex with young women, perhaps in exchange for food or favors, these men then going on to infect their wives. Horrible all around. Dr. Tony also told us of a study he read that found some evidence that being married in this region actually RAISES the risk of contracting HIV.
One sad story in particular: A 45-year-old woman with a low CD4 count was supposed to start ARVs yesterday, but when she arrived she said that she could not start treatment without the consent of her husband, who is working in
Though we didn’t specifically treat any babies at the clinic, I do think that being there was helpful to our work at TTL in its contribution to our overall understanding of the conditions in the rural villages and of HIV treatments.