The two faces hardly matched. The man I was seeing now was more of a boxer ready to fight in a heavyweight match than the thin emaciated man I saw six months ago.
Don first came to the FACES clinic carried by his elder brother. He clung loosely on his brother’s shoulder, obviously using all of his remaining strength to maintain a grip. His brother Sam was doing all he could to help Don; he knew his brother was near death and too weak to seek help himself.
Don weighed 48 kilograms when he enrolled in HIV care. He was coughing, weak, extremely thin, and hardly talked. When asked his age, he mumbled something like 25 years. He was referred for sputum exam and started on tuberculosis medications. His CD4 cell count was just 18 (normal being 500-1500).
Don’s next visits would be for adherence counseling to start antiretroviral (ARV) drugs. When he heard about referral for adherence counseling he was confused and reluctant. He didn’t know why he was tested or why he needed medication; he wasn’t focusing on things well in his weakness. His brother Sam proved to be a tremendous treatment buddy, ensuring Don attended his adherence counseling sessions and that he started and abided by the ARV medication regimen.
Don was also suffering from malnutrition. His body mass index was at first a mere 16 (normal being 18-24). He was started on the nutrition supplement Food By Prescription (FBP) to increase his caloric intake.
During a follow-up visit a few months later, Don explained “The TB drugs were messing me up, but now I am getting used to them.” He then pointed at the scale and said “I’ve also gained weight!” He was up to 52 kilograms. The combination of medicines and nutrition were working!
Don’s health continued to improve and before long he had his former job back and had proposed marriage to his girlfriend. ”I didn’t see myself coming this far,’’ he said. He then pumped up his bicep and proudly said “I am not a boxer, but I used to be a makanga (mini-bus conductor) which requires strong muscles and toughness like this. Nowadays I’m a driver”. Don’s weight had shot up to 68 kilograms with a BMI of 23.53.
Six months after starting his ARV treatment, I met Don at the clinic. He wore jean shorts cut above the knee. He had a cap and an undersized T-shirt. His thigh muscles resembled those of a wrestler seen in the famous world wrestling federation (WWF). When I called his name he leapt up and ran to the vitals room, much to the amusement of the staff and the other clients. He jumped on the scale in haste. “70 kilograms!’’ he shouted in celebration. His CD4 was on the increase as well; it was up to 196!
*By CCHA Dennis Oluoch Owino & the FBP Team