Week number 2 officially in the books. Jeff and I have now seen, and collected data on, a total of 243 patients. Not bad for only 5 days in the clinic. Today we tied up loose ends, finished up abstracting some data, and rounded on some patients in the mens wards. Also, Jeff gave a lecture on quinolone, Bactrim and Flagyl. Tonight we are having dinner with the Director of the hospita at his home to say goodbye to Jeff.
This weekend I am traveling to Cape Maclear to do some scuba diving and to grab some beach time.
For next week, continuing to work in the ART clinic and collecting data. I am also scheduled to give my first teaching session on Antiretroviral therapy to the hospital staff next week.
A view of the outside of the ART Clinic. The patients wait extremely patiently on the bench to left, in line, waiting to be seen first by the triage nurse, then by the clinician and finally the patient goes to the dispensary to grab their Medicine. The triage nurse room, clinicians room, and the dispensary are all right next to each other less than 10 feet apart.
Inside the ART dispensary with the Director of the ART clinic and an ART nurse, both amazing, and I am very thankful for all of their warm welcome, support and help. When the ART clinic is open, the patients come up to the caged window, pictured in the background, to pick up their medicine. On the shelves on the right are NVP+AZT+3TC (top right, greenish boxes, hard to see). Below that, is the workhorse, and first line regimen here in Malawi as determined by the Government, NVP+d4T+3TC, named T30. We go through about 135 bottles of 60 a day. Patients take this regimen one pill in the morning and one pill in the evening, all three drugs combined in 1 pill. One of the many problems with this regimin we have seen so far is the d4T induced neuropathy. A lot of patients we encounter have this problem (about 25 out of the 200 or so patients we have seen so far). We manage it here with Elavil 25mg daily which, back when i learned about this drug at Maryland, I was taught it does'nt work for peripheral neuropathy, o well. If the patient faisl Elavil there supposed to try mortin, and then finally if they fail motrin, they are eligible for an AZT (AZT doesnt have the problem of neuropathy, but it comes with its own unique set of baggage) based regimin. Here in our clinic we havent been giving out Motrin, or any other Nsaid for that matter, we just switch straight to AZT, checking their hemoglobin first, as AZT can cause anemia at the dose used here. If their Hg is >8 we will switch.
Another angle of the outside of the clinic. The pharmacy window is on the left side. Next to it to the right, are two evaluation rooms for the clinicians, and the third door down is the intake room where the triage nurses takes their weight, temperature, pill count (however no one brings their bottles about 1/10) etc. The patients wait extremely patiently here. There have been some days where patients have waited over 5-6 hours to go through whole process. Patient satisfaction survey anyone?
A view outside of the guesthouse at dusk. It is here where we commonly toss the B after work. The sunsets and skies are beautiful here. We have a nice porch with table and chairs to enjoy it.
Are you eating well?
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