HIV : THE Care and The Caregiver (cont.)

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 In between trying to raise money for my surgery and worrying about appropriate prescriptions, life was still happening to me. and life as we know is quite… ahem eventful. I was getting kicked out by my friend as I described here. I had to move to another friend’s house quite a distance from my former location. Now bear in mind that my former location was an estate (that is a gated community for my foreign readers) and that the clinic where I was slated for surgery was located in the estate. It says a lot about my state of mind then that despite all I had discovered I still wanted to go through with my treatment and delivery in that hospital; I felt I had no options.
Luckily for me at that time I was contracted as a freelancer, to carry out an extensive recce for a show so that meant some money for me- or so I thought.One of the suppliers I needed to get quotes from was an airport protocol personnel, let’s call him Peter. He came to see me at my friend’s house and when the discussion shifted to how I really needed money for my surgery so I hoped the client would pay on time, he told me of a public (maternity) hospital in Lagos where his wife had delivered 3 of their 4 children by Caesarean Section. he spoke glowingly of how the hospital had very experienced staff and how they had taken good care of his wife. he also added that I would have my CS at a fraction of the cost I was being asked to pay at my present hospital. I took in all this info with a bit of joy but with trepidation; he didnt know about my status so I felt all the benefits of going to that hospital would not be applicable to me. Nonetheless, I decided that I might try the place.
Peter had mentioned that he had a cousin that worked in the Hospital Management Board offices so if I wanted to register at the hospital he would facilitate it for me. I therefore called him but I told him that a friend wanted to register at the hospital but she was HIV positive and afraid of stigmatization. (How I hoped to get away with it is still a mystery to me but desperate times…) he gave me the contacts for his cousin at the HMB offices and I went there, and there the real issue actually begins.
Lagos state probably has the best public healthcare system in the country. For starters it is heavily subsidised/ funded and full of very well-trained personnel. However, there are a few loopholes and chinks in the system which I will discuss later but for now let me give an objective description of my visit there.
Peter’s cousin took me to the hospital, a large noisy, bustling, building next door, where he proceeded to personally ‘midwife’ my registration. (The registration is a relatively tedious process that requires approval from several offices and a number of tests.) One of the requirements for registration is that you get someone to donate blood. This I guess, is for any eventuality on the day of delivery, and there is no going around it. Usually the pregnant woman’s husband or relatives make the donation but in my peculiar case that wasnt possible so Peter’s cousin had to get a note from a very senior official of the HMB that my registration should go on and I would get the blood donation before I gave birth. As a matter of fact he had to come down to the records offices himself and speak with the man in charge. Another small delay was the problem of next of kin and maiden names. For some reason it was difficult for them to put me down as a ‘Miss’ with the same surname; but we got over that.
I forget if the registration issue took more than one day or not but when it was close to ending I was sent for a compulsory HIV test in the laboratory and for counselling at the VCT centre within the premises.This is a compulsory step for every pregnant woman registerd there and one I must commend them for.  Because everyone went for the tests and the counselling you would never know who was positive and who was not. And when the results came-the lab sent them through the VCT to the nurses- the nurses never treated you differently except to ask you privately what drugs you were on and if you were taking your drugs. It was there and then I learnt that the Nevaripine was also not the right therapy, and the nurses were dismayed because it was quite late for anything to be done about it. I was also told there that the name of the medication that an HIV positive person was on was not supposed to be secret. Unlike other drugs that the doctor would take out of the pack and place in sealed bags, HIV ARVs were exposed and the patient is informed of what she is on and why she is on it. To say I began to realise the exten of the mess my doctor had put me in , would be an understatement. However, my antenatals went on.
To attend antenatals you had to arrive really early in the morning because there was always a long queue of expectant mothers.You would request that your case file, it would be sent to the waiting room and arranged by order of arrival. The nurses would then weigh you and you would have to buy a little bottle to pee in. They would then dip a test stick (one for each person) in your little bottle to test it. After that you would wait until your name was called in to see the doctor.
Seeing the doctor is a whole other thing really, and one that can be defined as burdensome.’The doctor’  consisted of several residents and -I suspect- some interns under the supervision of a consultant. The consultant was rarely ever seen by anyone except there was a major emergency. The doctors were not so friendly and quite rushed, all they did was just check your fundal height, ask if you had any complaints and prescribe medication..but  I was lucky as I struck gold in my own doctor. He took time to talk to me. He later told me it was because he never actually spoke to educated people in the line of duty.
(to be continued)

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5 responses »

  1. Why would ANY medication be a secret, ARV or not. I have never heard of such practice and it makes no sense at all. You are supposed to know every thing that goes in your body. The doctor tells you and the pharmacist also explains it to you when you go get it. This is news to me. Btw, i got a book titled The Secret- Love, Marriage and HIV from my pathway advisor today. I told her a little bit about what i learnt from you so far. Nigeria is featured in the book (it's not fiction, but based on research). It seems like an interesting read but i won't get to it until June.

  2. Hey Madame Sting (I'm gonna shorten it to MS, if you dont mind)I love hearing from you, your posts make me aware of things I take for granted.Hiding the medication or not revealing it's name is quite à common practice in Nigeria. I have seen that happen since I was a child in different parts of the country. Usually, this occurs when you get your drugs from the same place (hospital) where you had the consultation. The doctor just writes out the prescription, you take it to the pharmacy, they pack it for you in a different pack from what it came in, or paste their own label over the bottle so unless you deliberately inquire you may never know what you are given. All you are told is the dosage.In fairness to them I think the practice came about to curb self-medication that Nigerians are so fond of. Especially as a lot of drugs are OTC here, even some that shouldn't be. I know à woman who rarely takes her child to the hospital but continually self-medicates using smaller amounts of adult medication, at her own discrétion! The flipside of that is profiteering doctors who want to make all the money possible by shrouding their processes and practices in mystery. It's the same principle my previous doctor was working with. To a large extent, I think illiteracy of the patients has made this practice thrive. I intend to talk more about the ramifications of this in my next post.I have 2 questions for you though: out of curiosity, I would like to know what factors are responsible for the rise in HIV infections in gay men. And who is à pathway advisor?

  3. MS is fine…lol. Before i answer ur question, they say MSM (men who have sex with men) because it includes bisexual men and not just gay men. Bisexual black men are one of the reasons the infection rates are high in AA women. Some of them are on the down low and don't tell these women they swing both ways but that's another story and of course there is more to it than that. MSM infection rates are higher for a number of reasons. (This is not my area expertise, btw but i will attempt to answer). There is a high prevalence of the disease in that population to begin with so there is a greater risk of being exposed esp as they get older. Most of them are not aware of their status. Young MSM are kind of complacent and think HIV is no longer a serious health threat, so they underestimate the risk and engage in risky behavior etc etcSorry for throwing "pathway advisor" out there without explaining. Pathways are a way my school came up with to help us individualize our medical education. There are 5 pathways to chose from starting first year of med school. We are exposed to all 5 in first semester then have to chose one at the end of the semester. Next step, is based on your personal interest, goals etc, you pick a advisor who is already doing work in that area, so they they will be your mentor. I've always been interested in HIV awareness and prevention, which is why i picked my pathway (Urban and community health) to begin with. My pathway advisor does a lot of research in HIV. She would be a good person to ask about MSM because that's one of her primary focus. I picked AA women because i felt i could relate better with them and might be able to use what i learn from them in Nigeria. With regards to hiding the medications, i just think Nigeria has such a long way to go. That is crazy. Your explanation makes sense cos you don't want people self-medicating. That woman who gives her child reduced dose of adult medication is…….I reserve my comment. We were taught that children are not little adults. You cannot do stuff like that because their physiology is different. If only they make these prescription meds available by prescription only, wouldn't that be a simple solution, but knowing Nigeria, they wouldn't bother carrying out such a simple but very important health reform. Because there is no reason people should not be aware of the medications they are on, absolutely no reason. It's ridiculous. I am SO sorry for my long response. Forgive me.

  4. Hi MS,first of all, stop apologising for long comments. I love them. You make me feel energized to post cos I know I am helping out somehow.I suspected the MSM included bisexual men which is why I threw the word 'gay' out there. I also suspect that bisexuality might be contributing to the problem here in Nigeria as well.About legislation to make fewer drugs OTC's I think the solution is a lot more difficult. There still isnt exactly affordable healthcare across board for the masses, so going to get a prescription everytime one is ill could be a major problem. Also, while NAFDAC has done a great job of countering fake drugs, there still are people manufacturing, and maybe even importing drugs. They will get them out into the market one way or the other. And then there's the issue of 'man-know-man'. everyone has a brother's friend's cousin in the health sector so that person can prescribe/procure/sell the required drug. so it's a hydra-headed monster, led by a lot of ignorance.I have been reading that blog. Quite a good idea to have a collaborative effort like that. Thanks.

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