World AIDS Day: 'I have never seen anyone as sick survive without an intensive care unit'
Eamon Faller is a Galwiegan doctor who has spent nearly six months working in Homa Bay, Kenya. He writes for World AIDS Day
With a wave from the back of a motorbike, Florence put a wide and enduring smile on my face.
Her journey with us bordered on the absurd – three months, three weeks and two days on antiretrovirals, anti-TBs, antibiotics, blood transfusions, Intravenous (IV) fluids, diuretics, clinical nutrition, physiotherapy and more antibiotics – she had been bed-bound for almost 3 months.
I distinctly remember the Thursday, Friday, Saturday, Sunday and Monday when I left the hospital thinking that there was a high chance that she wouldn’t see the morning. Yet there she was, smiling, waving and, most importantly, departing after a successful restoration therapy.
Florence was 22 and had been diagnosed with HIV three years earlier in an Médecins Sans Frontières/Doctors Without Borders facility.
She had been doing well for a long time. Her diligent adherence to treatment, so important with HIV, was largely based on two factors: good counselling from the outset provided by MSF staff, and a dispensary within a walking distance of her home – supported by the ‘Decentralisation of Care’ programme.
Unfortunately, as occasionally happens with HIV in the tropics, she developed TB and got very sick very fast.
She came to our inpatient unit emaciated and dilapidated. We feared for the worst. I have never seen anyone as sick survive without an intensive care unit.
What’s more, a generalised public sector nurses’ strike had just kicked off meaning the hospital’s inpatient unit was reduced to a skeleton MSF-supported staff. But thanks to the project, we had the people, the appropriate lab tests and drugs, to at least give her a chance.
And with that chance she began to improve slowly.
And then she improved more quickly. And then she gained weight. And, putting an even wider smile on my face than previously mentioned, began to walk again. It was very shortly after this that I saw her happily escaping.
What’s more I would be optimistic about her future. I’d anticipate a pretty normal life for her going forward. She had been married recently before falling sick and will be able to have a healthy family if she so chooses.
She will have a couple of visits to a TB clinic in our hospital after which she will go back to her local dispensary and continue her life with very little interference from her illness.
With 24% infection prevalence in Homa Bay, HIV has devastated this region.
But the situation has been improving and will continue to. What once seemed insurmountable now very definitely seems controllable. Stigma around the disease is decreasing with time, and there’s a definite realisation that HIV is something you can lead a full and healthy life with.
In a month, my 6-month mission will end and it’s been an amazing experience.
As well as doing my best to contribute here, I’ve learnt an awful lot and I fully intend to come back on another mission.
I look forward to the next challenge, and whatever the context, as a doctor, it’s easy to find motivation when there’s a story like Florence’s fresh in your mind.
Eamon Faller is a Galwiegan doctor who has spent nearly six months working with Médecins Sans Frontières/Doctors Without Borders (MSF) in Homa Bay, Kenya. MSF is an independent international medical humanitarian organisation that delivers emergency aid in over 70 countries worldwide