Suba, October – November 2014
My time in Suba was a clinical adventure unlike any other medical rotation I had experienced before. My objectives before I began were to learn all about HIV care and to understand local challenges of accessing and maintaining care. I was often introduced to patients as the mzungu daktari – white skinned doctor. After clarifying that I was a medical student from Canada, I would always attempt to speak Swahili and Luo, the local languages.
“Je unajiskia mgonjwa leo?” – Do you feel ill today?
“Je unakohowa?” – Do you have a cough?
“Je unakisi joto mwilini” – Do you have fever?
If the patient had any pain, I would switch to Luo, “kanye malit?” Laughs of surprise would often follow. Fortunately, people I worked with helped with translations and assisted during sensitive discussions when I didn’t have the ability to communicate adequately.
My time in Suba was spent in clinics very unlike my usual workplaces of academic hospitals and clinics in Canada. There was almost no access to basic labs, many medications, or the help of specialists. On top of that, many patients cannot afford a 50-shilling malaria test or 100-shilling chest x-ray, equivalent to 60 cents and $1.20 respectively. Nevertheless, the healthcare workers manage hundreds of patients living with and affected by HIV. For the difficult cases of non-adherence and treatment failure, teams are expertly organized to find the patients, assess barriers to care, and devise plans adapted to each person. For instance, there are many fishermen in Suba who live with HIV and have a hard time adhering to their treatment regimen due to their non-routine work schedule.
I also had the opportunity to be part of working group to create a specialized adolescent clinic. Youths between the ages of 10-19 years are at higher risk of stopping their medications, missing appointments, succumbing to secondary infections and dying as a result of non-adherence. I was able to convey the importance of sensitive and skilled adolescent care needed to address psychosocial factors that may contribute to poor adherence and the need to involve youths in the development of adolescent-specific services. The experience culminated in the launch of a new adolescent clinic at Mbita District Hospital with activities aimed at providing tools for youths and guardians to assist in disclosure and self-empowerment.
My time in Suba was short but enriching. I hope that I imparted as much knowledge and experience as I have gained. I look forward to the day that our paths will cross again.