the GH

I haven't yet really mentioned anything about the work that I am doing at the Government Hospital in Namakkal. I think this is because #1 I needed to first figure out what I was doing #2 I needed to just digest everything because I didn't have the system quite sorted to explain anything appropriately #3 I wanted to make sure that I was assessing the situation in a proper manner and not making judgments about the hospital or the system that weren't true.

Since my main goal here was to see HIV and infectious diseases in general, I have been spending time with the 3 medical officers for the ART center (Anti-Retroviral Treatment). It is sort of like a normal day at home, but really not at all in some ways. We meet in the morning to round on inpatients before seeing outpatients for most of the rest of the day, minus a big break for lunch. There are 2 HIV inpatient wards here.
The ART ward is simply an observation area where people are admitted for a 5 day period (monday-friday) when they are clinically ready or have low enough CD4 counts to start ART treatment. They are all sick in some way but stable in that they don't have any severe illnesses
going on. They just stay and learn from nurses and counselors how to take the medication, talk to other patients about their situation, and are monitored daily for drug reactions and also given support if the meds give them nausea, vomiting, crazy dreams etc which is very common with them when they are started. All patients here follow WHO guidelines of starting 3 drugs. They have a total of 5 drugs here, so they can do some switching if someone has a reaction, is pregnant, etc, but they don't have much options to treat resistance, since the drugs are similar classes.
The other ward is the "Special Ward," where very sick HIV patients come whether or not they have been previously treated. This is where they often stay for diagnosis of illnesses, and most patients have either tuberculosis (lungs or in any part of the body) or else meningitis, fevers, or are too sick to be able to eat for any reason.
It seems that the mortality of this ward is nearly 50% by their estimates- though the official count is much lower because many patients go home to die when they can't do anything else to help them here. Many patients here also get better- here they are often diagnosed with rip-roaring TB and are started on treatment, discharged when they can eat and drink, and then are readmitted to the ART ward to start antiretroviral therapy once they have been on TB treatment for a few weeks. Many of the patients in the Special Ward are there for Immune Reconsitution Syndrome, which is what happens when a very sick person with little immune system suddenly gets treatment for HIV and TB (or any other severe illness) at the same time and suddenly their body produces a tremendous attack against the bug since they were actually too sick to fight it before they got HIV treatment.

I'll write more about the ward another day- it's pretty spooky- it looks like a concentration camp since many patients weight 60-80lbs because they have been sick and undiagnosed for so long.

The rest of the day- outpatient ART. This means 3 doctors sitting in a small office with a huge line of patients pressed outside, waiting to see the doctor. They come with new HIV diagnoses (tested across the hall or at smaller centers around the district) and with CD4 results (the test showing the # of cells that are both part of the immune system to fight these other diseases and are ironically also attacked by the HIV itself, hence why HIV is such an aweful and sneaky disease-lower counts = more progressed HIV/AIDS and also more susceptability to things like TB and diarrhea). Doctors give quick 1st evaluations and decide whether patients should start the antiretroviral treatment.
Patients on ART also come every month for followup checks. Patients HIV+ but still well come every 6 mos to have their cell counts tested and for an exam. Patients also come whenever they have any new symptoms.

Ok. that's the short (long) version. I'll keep evolving details as they happen. Hoping to go to the sex-worker treatment clinic this week and maybe go to some field visits....

And yes, mom, I am wearing my respirator the entire time i'm in the Special Ward since it's all in one room, and whenever I see any patient with fevers, and/or a cough....