Clinical STEP in HIV/AIDS & TB Co-Infection
As a medical student interested in global health, I searched for multiple opportunities to gain clinical experience in a global setting. When I found Family AIDS Care & Education Services (FACES), I quickly decided this was the experience I was looking for! FACES is actively impacting the health of people in the Nyanza province of Kenya, one of the regions most afflicted by HIV/AIDS in Kenya, and it is inspiring to witness this process. On a daily basis, I had the privilege of watching local health care workers reaching out to their HIV positive patients. FACES recognizes that HIV/AIDS is a disease that permeates the whole fabric of society and, therefore, requires a multi-faceted approach when counseling each individual patient. At each patient encounter, health care providers engage in a clinical assessment but also survey each patient’s socio-economic, psychological and personal life. Witnessing such attention to detail in caring for at-risk populations is monumental for the professional development of medical students. As I transition from a fourth year medical student to a medical resident, I believe I will benefit a great deal from my patient interactions at FACES.
In terms of clinical opportunities, I tailored my time in Kenya to my personal interests of infectious diseases and medical education. Initially, I spent some time seeing general HIV/AIDS patients but quickly moved on to the tuberculosis co-infection. My clinical management skills were constantly challenged by each new patient as many presented with advanced AIDS and with multiple other infections. Coming up with a sustainable plan for these complex patients was made more difficult given the lack of finances and resources available. From a personal perspective, I found these situations both heart-breaking and frustrating; I felt compassion for my sick patients but also unsettled and frustrated at the harsh course this preventable disease can take. From a medical perspective, these patients thoroughly challenged the medical staff and me to adapt our clinical skills to each case.
One of my most memorable patients was six months into her first pregnancy. She presented with a CD4 count of 50, a 20 pound weight loss over the course of her pregnancy, two weeks of bilateral lower quadrant pain, and her husband, also HIV positive, was experiencing disseminated chicken pox. Despite being the last patient of a long day, a health care worker and I spent over an hour with her to determine the best course of action. Although I would have consulted an Ob/Gyn and an Infectious Disease Specialist in the United States, here we were only able to provide nutritional support, HAART and close follow up. So far, her progress has been promising.
If you are interested in global health, I would highly recommend STEP. From the Kenyan people, to the medical staff, to the patients you will see on a regular basis, you will definitely find what you are looking for. However, the reality on the ground here is not always easy; sometimes there is little you can do for patients who need a lot done; other times, there is nothing you can do at all. Even though the individual prognosis is sometimes dim, there is hope. My Kenyan colleagues believe there will come a day when HIV/AIDS will be a terrible part of their remote history and I, personally, want to be a part of that story.