Why I Do This
It´s kind of been a whirlwind of thoughts and feelings since I gotten to the first project that I’ve been assigned to fly into. I´ve had to change my perspective on my goals and objectives here in this project and my time overall with MSF. I was assigned to improve the HIV/TB program in each of the projects I visit, but along with that, I have also been making myself helpful by working in the pediatric wards, which has been taking up the majority of my day. The town is called Kalolele, there are no major roads to get here, and it is only accessible via helicopter or airplane. There are no vehicles in sight, only motorbikes. There is a road supposedly that one can use through motorbikes that would take one back to the capital, but it is rarely used and expensive. Kalole is a very young place, I’ve read in a project briefing that the median age here is about 19 years old. The majority of hospital admissions are children, which is why I am always in the pediatric wards in the usual morning. I feel like I’ve assimilated well in their medical team here and I look forward to helping and rounding with the local doctors. I´ve seen some difficult tropical medicine cases, such as cerebral malaria and many vaccine-preventable cases such as tetanus and measles. I have gotten a handful of new TB related cases every week, pulmonary and extrapulmonary TB. The majority of extrapulmonary TB I have seen are TB lymphadenopathy cases and one probable peritoneal TB case. As for HIV, I am seeing a new diagnosis at least every two to three days. They have usually been in children, a few very young children below the age of two, usually presenting for fevers and having a positive malaria test, but due to their malnourish state, get tested for HIV. It made me more alert to re-present the guidelines for MSF to prevent mother to child transmission of HIV, which I will be presenting with one of the local nurses next week Tuesday. The local HIV nurse in charge of their program is great; she is hungry for knowledge, capable and tries to be as organized as she can in this kind of setting. Mind you though, there is no Wifi in the hospital and all of her records are hand-written which can be very tedious work. We´ve also made it a habit almost every weekday to meet at 4 PM to discuss an HIV/TB topic and talk about it so that she learns something new. There is one case that I´ve been thinking about and is a constant reminder for me why I should and will always make the time to work in these settings in the future. There was a 15-year-old boy presenting about 10 days ago for a large swollen abdomen. Family says that his belly has been gradually getting bigger for the past 1 year, parents have tried traditional local medicine with no relief. They come from a town about 2 hours away using motorbike. On presentation the boy is in moderate distress, emaciated and appears about 10 years older than his stated age. Due to the high prevalence of tuberculosis in this setting, our first instinct as a team was to discuss the probability of TB-related peritoneal/abdominal disease. My first project in South Sudan had quite a number of these cases as the people living in that region drink unpasteurized milk, so Mycobacterium Bovis infection was quite common, and the presentation was very similar. Cases that I have seen responded well to anti-tuberculosis medication, so we started him on them right away.
For all patients presenting with TB symptoms, we also run a panel of other tests, which includes the rapid antigen/antibody test for HIV and the antibody tests for both Hepatitis C and hepatitis B. To our surprise, the hepatitis C antibody test was positive. The viral hepatitis diseases are very difficult to treat at this level in the Congo. MSF, despite all the good that it aims to do for the people it wants to help, does usually have a narrow scope of aid. Treatment for Hepatitis B could be started, but Hepatitis C is a completely different story. Due to the lack of (financial) interest by pharmaceutical companies to make Hepatitis C treatment more accessible to all people, this child will likely die from liver failure secondary to hepatitis C. Now, I have no way of confirming whether this patient does have active disease or not; the hepatitis C test that I have been given to use does not confirm active disease, it just says whether the person has been exposed to Hepatitis C or not. In fact, there is a chunk of patients that will clear the virus on their own. But, if he does have active disease and the cause of his abdominal swelling (or ascites) is hepatitis C due to the liver starting to fail, he will eventually die from the disease. This family has no means to go to the capital and seek treatment. The best we could do for this child is continue the course of TB medication, as long as can he tolerate it, treat his symptoms related to Hepatitis C with diuretics and paracenteses (abdominal puncture to let out fluid). He will be sent home this upcoming Monday with follow up at the local Ministry of Health clinic by his home. Him and his family were thankful for our help and services, but we emphasized as a team that his symptoms may continue to come back and that it may not be curable at this level. It´s very difficult to communicate this kind of news considering that this is my first French speaking project and that this family only speaks Swahili so all communication had to be dealt with a translator. Despite this saddening news, he was excited to go home and asked when he can go back to school. It´s these kinds of cases and people that I have met in my life that leave a kind of thorn hanging on my side. It makes me uncomfortable thinking that we live in a world so capable to accepting this kind of injustice. Having a growing son and a family now, I want the best. I want my son to grow up, go to a nice school, become educated and live a life of relative comfort, but, its theses kinds of cases and situations that leaves a sense of discomfort thinking about that. It´s not like I shouldn´t want that for him either, its just that, this is the kind of world that we live in. It´s all a roll of the dice. It´s the luck of the draw. It´s an unfortunate truth. I want my son to somehow realize this as well. I want him to see that what he has, others do not have and that this life is only worth living if we can find a way to try to right these wrongs. I shouldn´t have to accept that this 15-year-old boy will die here in the Democratic Republic of Congo, but if he were to be in my family, if he were my son, he would live and reach his potential in the United States. But… this is why I do this. This is why I am here. I choose to see this.
