Counseling patients

Counseling patients that are just finding out about their HIV status for the first time when they really have no idea what it is, how they got it, how to prevent it when they do not always speak your language is a challenge to say the least.

Today I started out with a counselor immediately after the opening at Faith Alive clinic. We saw 4 patients with very different stories. Each one of them left a footprint on my soul that will remain forever, as are many stories here in Jos.

The first was a mother with her daughter. I believe that they were Christian. She was separated from her husband and was very worried about some of her friends that she knew were HIV + and wanted both she and her daughter to be tested. She said that they were living with family but we were not sure, you are never really sure if you are getting the complete story here. The question “ where do you sleep” is the question of address. I am so glad that I am not a postal carrier here in Nigeria. 2 reasons for this, a- finding someone would be almost impossible and b- the post offices are closed. When misson workers want to get mail to the states they find it quicker to send it home with travelers.

The counselor had to ask some rather personal questions and the mother always answered for her 10 year old daughter. The mother did admit to having unprotected sex and the young lady could not make much eye contact and she looked very sad. I pray that this young child was not raped, but that would not be uncommon especially given their living situation.

Their tests were negative, they were counseled on safe sex practices and told to come back in 6 months just in case they were exposed and it was in the “window” period.

The next family was again a mother and a daughter. This family was Muslim and the older woman spoke- I want my daughter to get a test so that we can marry her off. Her husband died of HIV this year and it is getting to be a burden to care for her and her children ( ages 1 and 3 ). The young woman was thin, pale, and had no joy in her eyes. She did not make much eye contact. They were counseled and sent for a test.

This test came back positive.

The mother right away wanted the girl on arv therapy so that she could “get her married”

It is a big step here in the Muslim community for them to have even come in for testing.

A few years ago it would not have been uncommon for the young girl to have been “ married off” prior to getting testing. She could have infected a whole group of wives and they would have blamed her, not her first husband. They were counseled and encouraged to bring her babies to the clinic later in the week to be tested. I fear for these little ones, they have done nothing wrong but to have been born into a family were HIV has reared its ugliness. They will be the ones to suffer the most even if they are negative.

There were several women who said that they were students and had had unprotected sex most of these today were negative.

The woman that could not believe even the 2nd test because she had no risk factors except to be married to a man that traveled a lot and was only home one day a week. She is Christian.

Her test again was positive and she would not believe the result and was sent back to the doctor for counseling. This woman had a 4 year old at home and is pregnant with their 2nd child.

The last woman could not speak English. She was brought in by a nurse from one of the northern states were testing is not available. She is the mother of 8 children. 4 are married, 3 are in school, and her youngest a 13 yr old is still at home with her. She appears malnourished and depressed. Her husband died of aids this year and she is very afraid that she has the virus. She is a Muslim by faith and said when her test came back positive that it was the will of Allah. She is not a young woman and without babies to care for she will not be high on the list to receive ARV therapy from either the Pepfar or MCC program.

There are waiting lists for these medications. Compliance with drug therapy here is very good ( greater than 90%). We believe that the reason could be that this is their only chance for survival. Without ARV therapy they would surely die in just a few years at best. Once drug therapy is started, it must not be stopped. If there are time gaps, weeks or months resistance can develop much like resistance to antibiotics that is becoming so prevalent in the United States. 2nd round therapy is very limited and not readily available.

I fear that if we do not petition our senators and congressman to extend Pepfar ( and to make it easier to access); that in just a few years we will be losing all of the progress that has been made with HIV therapy here in Nigeria and in all of Africa. It is a slippery slope. The United States is having trouble taking care of people in the United States. Our healthcare system is in need of a huge overhaul. Nigeria’s healthcare system needs help from ground 0.

Nigeria has the potential to be one of the richest countries in the world yet it’s people live very poorly in comparison to their North American brothers and sisters. The African countries need to start accepting some of the responsibility for treating their own people.

It is next to impossible to import needed items and just as impossible to export items that we know would have a good market in the United States and Canada.

HOW CAN THIS BE?

WHY?

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