Conundrum

Friday, March 30, 2012 

AFTERNOON

We sit for lunch and bless the food only to have Dr. Karen explain some very bad news to us. She told us that the reason she and Dr. Tom had been absent from the hospital all morning was because they had been praying over some issues that had recently arisen with the leaders of the Wesleyan Church in SL. She proceeds to tell us that she and Dr. Tom have a serious decision to make and they may not be able to return to work in Kamakwie next year. The day went from bad to worse. We were all very upset about the news. It was very discouraging for both myself and Phillip, especially after being here and seeing all the good work that has come from their sacrifice and labors.

We all decided that after lunch it was best if we stayed away from the hospital for a while until clinic.

The remainder of lunch went by in the usual fashion, but everything seemed to pass in slow motion with so much uncertainty in the air now. It was hard to see the children who come after school, but I forced a smile as we played on the porch.

 

The rest of us went to clinic while Ali stayed in the OB ward with the women. We saw four cases of assault- one a small boy who’d been beaten by his mother with a board. For the second time that day, my heart broke. I reached my arm around his bruised back and gently hugged him. I don’t think that I let go of him until his escort from the Health Poverty Action (HPA) domestic abuse agency took him away again. I don’t know the exact process yet, but we have several HPA cases each week so I’m interested to find out more. Dr. Tom even introduced me to one of the guys that works there, so Jenny and I hope to go one day next week to talk to them.

After clinic, Dr. Tom informed Steph and I that the labs were back (after three days of waiting) for a patient of ours in the women’s ward. She was very thin and complained of a new cough that had been present for a couple of months. We found out after her first few days of admission that she was HIV+. Her labs now showed she was positive for Tuberculosis. Dr. Tom asked that we get her started on treatment and moved to a private room for isolation purposes as soon as possible, so we left to go talk to her nurse.

She informed us that there is only one nurse for the whole hospital that takes care of all the tuberculosis medications. We leave to go track him down, but only learn that he is in Freetown for a meeting all week and will not be back until Monday. Someone told us to go find another tech in the lab, but when we got there we were notified that the entire staff is in an emergency meeting that was called in the chapel to discuss the Asher’s leaving.

We got to the chapel just as they are adjourning the meeting. We found the lab technician, but he sent us to find the outpatient nurse. Once we found him, he told us that the Tuberculosis nurse is in Freetown to get more medications and that all our isolation rooms are full. He told us that we would have to discharge the lady since we wouldn’t have treatment for her until Monday. He seemed quite perturbed and when I questioned him further he explained that he felt she’d wasted a lot of our time by not telling us she was HIV + when she was admitted. I learned that the HIV counselor told him that the lady had received treatment in Freetown prior to her admission here. 

I had to stop for a moment and ponder what would motivate a person to do such things. I wondered if she knew how many people she’d exposed to her respiratory illness because of our lack of insight. It frustrated me to think about how much more quickly we could have had a diagnosis if we’d only known to go in that direction from the beginning. We wasted critical time chasing many other diagnoses without knowing that important piece of information…

According to the nurse, this is a common occurrence. HIV patients are often ostracized completely due to a lack of understanding and education on how the disease is transferred.  He says the patients often times have a hard time finding people to take care of them, even among their own family members. This patient, in particular, had specifically requested we not tell her mother who’d been diligently caring for her progressively weakening young daughter, unknowingly exposing herself to both diseases in the process.

After much discussion we leave. It was a conundrum for me. I was angry that she’d deceived us for so long, but I didn’t want to send her home to die, however I knew there was nothing I could do to help her here and she’d only continue to endanger the rest of the patients by staying. I reluctantly write the discharge orders and give the ward nurse the instructions.