OkaZHI: Okanagan-Zambia Health Initiative

The domino effect

This week I was able to work in the HIV clinic. In all honesty I was nervous and not so sure about working there due to having a limited knowledge base regarding HIV. After working there for a couple of days I walked away feeling thankful for the experience because I have learned a lot on such a huge issue here in Zambia which is HIV. 
I wanted to share with you one experience I had in this clinic this week. A young man aged 22 came in to the clinic with his grandfather (most children and young adults came in with their grandparents because many of their parents have already passed away from HIV/AIDS). I took his vital signs and I could tell from the findings that he was very sick. After his vital signs were taken we went into a room for the clinical officer (similar to our GPs in Canada) to assess him. This young man wasn’t able to communicate with us… We got all our information from the grandfather.
After sitting and talking with the grandfather for a while an unexpected and unfortunate story was revealed. Since two weeks ago this young man has become confused and has lost his vocabulary. He has been vomiting every day and has had non-stop hiccups. Right away I thought to myself ” why on earth did you not bring him in 2 weeks ago when these symptoms started”. Before I even had the time to ask why he was not brought in 2 weeks ago the grandfather said ” we live far away and it costs 20 kwacha (equivalent to about $4 Canadian) to get to the hospital and I didn’t have the money”. When I heard this my stomach dropped and it made me realize how oblivious I am that situations like this exist because at home if someone is sick we can find ways to receive medical attention.
The story doesn’t end there.
So this young man is now here at the clinic and able to receive some medical attention. Right away I thought I wanted to admit this patient and thought that we would,  due to how sick he was. But his grandfather did not like this idea and neither did the clinical officer. 
The grandfather did not like this idea because it was only him and his grandson living in his hut and apparently the grandson helped out around the hut. If the grandson was not home things would not get done. Another reason was that if the young man was admitted it is almost expected that family stays at the bedside to give care to their family member. The grandfather said he couldn’t do this since his hut would be left alone and he didn’t want things to be stolen. Again, my stomach just ached. At home we would not be faced with having to make a decision about staying at the hospital or staying home because we have no locks. Again, I was oblivious to situations like this. 
The reasoning why the clinical officer did not want to admit the patient was because the nurses have to care for too many patients already and without the grandfather being at the bedside at all times they couldn’t provide care to him. I could automatically feel my body heat rise. I have realized that the nurse/patient ratio here in Africa is very high, but I believe that isn’t a good excuse to not admit this sick young man. I believe that even if they couldn’t provide full proper care to this patient, setting up an IV to hydrate this patient and give proper medications to him would be way more beneficial than sending him back home. Don’t get me wrong, the nurses do have a huge workload here and I truly admire their hard work, but I just couldn’t stand turning away a patient because they were “too busy”. I just wondered how many patients have they done this to?
The young man ended up going home with his grandfather. I still have a weird feeling inside me about this situation. But it really opened my eyes up to the barriers that people are faced with in underdeveloped countries. 
One barrier after another causing a domino effect seems to be a common trend here in Africa. 
Tracy

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