Mitchell Luu

 

0000019305-Mitchell Luu  Internal Medicine Resident, UCSF

  Suba, February 2015

Forty smiling infants sit patiently in their mothers’ arms donning blue and green caps and gowns. For these children and their mothers, it is a momentous occasion. It is finally graduation day.

I sit in the front of the stage behind the MC, bearing witness to the Second Annual HEI graduation. HEI stands for “HIV-exposed infants”. In Suba District, the FACES program had a successful year in the prevention of maternal to child transmission. Of 125 infants exposed to HIV in this district, 121 infants were found to be HIV-free. In 2014in Kenya, there were close to 13,000 new HIV infections among children—a drop from 44,000 (or 70%) in 2000. These numbers speak to the success of the program.

I am not surprised. During the month I have worked with FACES, I have been immensely impressed by its multidisciplinary model, which provides an integrated, holistic approach to HIV care. This model requires teamwork involving many staff members: the reception staff assists with checking in and arranging follow-up, clinical officers provide HIV care and treatment, pharmacists dispense medications, nutritionists supply much-needed supplemental diets, CCHAs (Community and Clinical Health Assistants) provide supportive counseling and home visits, and the logistic staff arranges transportation to the remotest regions. Together, they work as a team and every member has a role in the treatment and prevention of HIV/AIDS. The first truly integrated system to provide comprehensive HIV care that I have witnessed, happened to be here in Suba.

Even with its success, FACES still has many challenges. Laboratory tests are limited and costly, clients who travel by foot or by boat are susceptible to missing appointments and medications, and co-infection with tuberculosis and malaria result in high morbidity. Despite all this, clients keep coming back to clinic every 1 to 3 months. After a day of seeing and consulting clients in clinic, I have only seen a couple cases that had detectable viral loads or CD4 counts below 200. If there are clients who default on treatment, the FACES team will form a multidisciplinary meeting to address psychosocial challenges, find key stakeholders, and arrange follow-up.

My experience in Suba was nothing short of exception. Yes, I witnessed tragedy on the medical wards–there were cases of AIDS wasting, cryptococcal meningitis, and pneumocystis pneumonia. But, these cases are becoming less common and the wards are now mostly empty. In my short time here, I have learned a tremendous amount about tropical diseases that we do not commonly see in America. I have also developed a deeper understanding of the health care challenges that Kenyans face.

I admire the work that FACES does to transform the lives of people living with HIV and create a brighter future for all Kenyans. I hope one day to participate in the 10th or even very last HEI graduation, and congratulate a generation of Kenyans without HIV.

 

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