LUTH Chronicles ( July 2014)

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My last appointment was in July but I was worried, wondering if the clinic would operate, as doctors in Nigeria had embarked on a national strike. Finally, I found a number of the healthcare staff who always demanded money from me and with much hesitation I called to find out. He assured me that only the clinic would be functioning. Thumbs up to LUTH for that.

As usual I was out of my house by 5.30 am and at the hospital in less than an hour, later waiting the 3 or so hours before the clinic began stirring. Sure enough, an hour and a half later we began to file in for our weight to be checked. Usually to avoid chaos people are asked to file in in groups of three, row by row. More often than not, some people, probably seeking to prove their ‘Nigerianness’, will jump the queue and go in even when their row is not anywhere near being next. Of course this irritates patients, especially the early comers. And  it really makes no sense to rush because eventually people are only attended to, by the doctors, according to the order of appointment cards ( earliest to latest) not their vitals- except for the occasional cases of unscrupulousness now and again.  A few minutes after I arrived and as I was settling in, I had noticed a young man walking in, to me he seemed well-dressed and somewhat attractive. I was a bit curious about him because of the aforesaid virtues and also because I had never seen a man fitting that description since I began to attend clinic. When the queue-jumpers made their moves however, he was one of them , and suddenly all his qualities faded before my eyes. (LOL).

A short while later, one of the healthcare attendants, a rather pleasant, soft-spoken man came to address us. (Now this man unlike most other staff is particularly loquacious but very humble towards the patients and I always wondered why. I found out from his conversation that day, that he too, is a PLWHA and realistic about his situation.) He started by scolding those of us who never attended support group meetings, saying he could not understand why the crowd he sees on clinic days thinned out considerably during support group meetings. He said apart from it being a forum to find a partner for marriage, there were things discussed at those meetings that we would not hear at the clinic until later. After a bit of hesitation- for effect- he gave an example.The consultant in charge of the clinic had attended the last support group meeting and had informed them that from October or thereabouts HIV treatment would no longer be free.  International donor agencies on which Nigeria is dependent for HIV treatment were experiencing what they referred to as ‘financial fatigue’, the rate of infection in Nigeria instead of dropping was rising so they had decided to cut off some support. The overall effect would be that drugs would be free but the accompanying tests done at regular intervals to check for proper liver, heart, kidney,etc function would have to be paid for. He assured that they were trying to make the costs as low as possible. With everyone being very silent as he spoke, the piercing wail of a caregiver, whose patient had lost their life, ostensibly due to the doctors’ strike, brought our realities painfully home.

I already anticipated the end of free HIV treatment/care in Nigeria because it had been in the news for weeks, however I do not think that that is a solution to curbing the rising rate of infection. Of course there’s no gainsaying that it is a huge shame and an indication of how badly we have mismanaged (and are mismanaging) our resources in Nigeria that we have to depend on aid for any aspect of our healthcare,and we cannot even manage that properly, but for the dependent few it is what it is. Even now that treatment is free a lot of people find it hard to come to the centres. This is because like I have said previously most of the attendees are low-income earners who have to plan their finances to travel to the very few treatment centres available. Some of them who do not have treatment centres in their states, or who may experience stigmatization in their locale, have to travel out of state for treatment. Even I can attest to how much of a struggle it has been for me to come up with the transport fare since my period of unemployment. It was for these reasons that the visit intervals were extended from 1 to 3 months. I reckon that this is the same reason for the low attendance at the support group meetings for a lot of people. For me, however, that and the fact that, unless I have to, I do not want to be at the treatment centre for any reason. I am also very distrustful of a support group run by people who for the most part treat you like you are an unwelcome, inevitable distraction. I am certain that with the introduction of these fees the centre will lose a few patients,depending on how high the fees are. In my opinion, the answer to actually reducing the rate of infection and effective treatment is to decentralise these treatment centres and increase education/awareness. I am talking mobile treatment centres in rural areas, in campuses, at bus stops. Stop making the drugs controlled substances because that only just makes it more available for the rich. Make it easier for people to ask for and receive treatment and things will change. But of course these cannot be done if there is an irresponsible government in charge.   Another nurse came to speak on free cervical cancer screening and then it was time for consultation.

My case note was given to a doctor I had not interacted with previously.  I actually made my judgement of her from afar seeing how curt and aloof she was towards other patients before me, but something she did and said made me change my opinion of her, and indicated to me that a major factor in your treatment was the disposition of the doctor you were sent to.  As I pointed out in my previous post, my CD4 count was dropping as at the last test. The doctor picked on this immediately and, observing that I was meant to carry out another test that day, booked my next visit to fall a month from that day as opposed to the usual 3 months . She explained that if my CD4 was still dropping it was necessary to catch it early and begin treatment rather than wait 3 months. I was impressed because she was obviously paying attention unlike the other doctor I had been seeing. However, I was not sure if  I was ready to begin taking drugs; at least not from this treatment centre.

If I think going for consultation is tiresome and stressful then being placed on drugs is twice that. Everyday at the clinic, the patients are divided into two groups: those who come to collect drugs and those who come for consultation. Those who come to collect drugs have to be at the clinic twice in 2 months, once to collect their drugs and the other for consultation. Some people try to make their appointments coincide, especially those who have to come from out of town, but there is always a bit of a problem as sometimes when they are in consultation, or having their blood drawn, it could be their turn to pick up drugs, and if they are unavailable they are quickly glossed over. Another factor is the side effects of the drugs. You are advised to come to the clinic immediately you notice any side effect but it is a chicken-and-egg situation because if it is not your day of appointment you will have to wait until the end of the day before you are attended to.  A number of people resort to bribing the staff to help them pick up their refills, so they can come for only their consultation appointments or whatever works. There has got to be a better way. So all these were at the back of my mind as I walked away at the end of the day.

‘Are you done?’. I turned in the direction of the question. It was a man I had observed at the laboratory where we went to draw blood. He had been pretending to misunderstand his position in the queue and had insisted on going ahead of a few people who were very displeased about it. ‘Yes’, I said. ‘Oh, you must have come very early.’ I thought he was saying this in passing until I looked over and saw that he was actually coming close to me, probably attempting to make conversation. ‘Yes’, I said as I walked hurriedly away.  Even if I decided to overlook all my reservations about the centre, and miraculously developed any interest in its matchmaking efforts – which I wont – bad behaviour and indiscipline will not be uppermost on my partner selection criteria.

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