Frieda

HIV/AIDS is common here due to a number of reasons, one of which is the break-down of the family unit. Many families live apart because the husband may find work in a city several hours away, and consequently adultery is more common. It’s a shame to be associated with the diagnosis so many people are in denial of their diagnosis as well. I admitted a 5 year old 15kg female about a week ago who presented with fevers, abdominal pain, tachypnea (rapid breathing), and tachycardia (rapid heart rate). Her HIV test came back positive. We started her on prophylactic dose of Bactrim for PCP, but otherwise waited for CCC to see the patient. CCC is a department of the hospital that manages informing the patient and family of the diagnosis, investigates the social situation, and arranges medications and further follow up and management. They kept deferring to discuss with the patient because the woman with her was claiming to be her aunt and not her mother. Finally they found out that the woman was in fact the patient’s mother, and she was 7 months pregnant. They tested mom and she was HIV positive too. She had another small child at home as well. We suspect that the mom was already aware of the child’s diagnosis and that she’d been trying to hide the child and not seek medical attention because then everyone would know her AIDS status as well. We treated her for dysentery and pneumonia but she continued to have high fevers to 104 at night. So we treated for Malaria even though the test had been negative. She was very thin though she had a large abdomen so we treated her for worms. The fevers began to come down and she improved clinically, but she continued to be tachypneic and hypoxic. An abdominal xray had been performed on admission and Ces (one of the surgeons) had seen it and said bilateral lung fields looked whited out, but we could never find the film. The child’s lungs sounded clear on auscultation but due to the tachypnea and hypoxia I kept trying to reorder an Xray. But the staff and the family continued to refuse because they didn’t want to pay for the second film. Finally they accepted because they were told the hospital would cover the cost since they’d lost the first film. The films were a classic example of miliary TB. So we started her on TB medications. This story hasn’t ended yet….