Weeks'-End-Update and a Word about Food

It already feels like ages since that last uplifting entry and yet the weeks have flown by lightning fast, I can’t believe it’s already Friday again. But it’s all been rushing forward towards big things.
Next week is big, for both of my projects.

Monday is ART-OPD integration at clinic number 3, in a neighborhood called Chazanga. It's hard to believe it all happened so quickly. When I first got here in July, they had spent 9 months preparing to integrate the first clinic, Ng’ombe. Chazanga we planned from start to finish in less than 3 months. Something that makes this clinic unique is that they don’t yet have an ART program. ART will be starting next week as well. So not only are they initiating ART, but it is beginning as a fully integrated clinic, with ART just part of the outpatient department. It will be nice because we don't have to rework any of the established systems in the clinic, but it will be more challenging for the staff I think because they will just be learning how to work in an ART clinic. It's nice for the patients, because until now, they haven't had ART in their neighborhood clinic, and they've had to travel to other health centers to get their ARVs. Now it'll be close to home, and I think we're going to have a lot more people testing for HIV, since we've made (opt out) testing a standard part of any clinic visit.


My peer educator program evaluation moved along nicely as well. The interviews are complete. Let me tell you, it was a royal pain in the butt coordinating availability of my staff, who were conducting the interviews, with availability of the clinic staff to be interviewed, with availability of transport to get them there. But somehow (with a few extra visits to the clinics, why did we have to choose the furthest away clinics for our program) we managed to interview everyone we intended to.
Next week we're hosting officials from the local Ministry of Health, doing a site visit with them so they can see what the peer educators are doing, and then presenting them with the data we've collected. Overall there's been a very positive response to the program, from staff and from patients. And the concern that the people who volunteer at TB corner would be resentful of our peers getting paid to work at TB corner was somewhat founded, but doesn't seem to be too harmful overall. Everyone here is always looking for "motivation," incentives, snacks, transport allowances. I think the only thing holding us back from expanding this peer program will be available funding. I think our CDC funding is much tighter this year. Looks like if the MoH says yes, we will be able to continue the current peers at least for the coming year, but expanding it to other clinics looks uncertain. I’ll know on Wednesday if I can call this project a success.

Wednesdays have become my clinic days, and it's been really awesome. I've been going long enough now that I'm even getting to see some patients who return for follow ups. Yesterday I saw the little 8 year old girl who I first saw a month ago for her initial history and physical. If you look back to my January entries, you can read all about what a bad condition she was in at the time.
Right after I saw her in January, she was initiated on anti TB therapy and given various antibiotics and antifungals for her opportunistic infections. She definitely looked better yesterday than the last time I saw her! For kids we do CD4%age instead of absolute CD4 count. Her %age was, get this, 0.4%! Anything under 25% is considered getting low. Her CD4 count was essentially nothing. We initiated her on ARVs yesterday, it was really interesting for me to see how we go about doing that, choosing which drugs and which doses, based on her co-infections and other medications. Concurrent ARVS and TB treatment can be tricky. Of course just this morning I read an article about IRIS, immune reconstitution inflammatory syndrome, a serious condition patients can get after initiating ARVs while already on TB treatment. Now I keep thinking of her and hope I don’t see her in a few weeks time with that too. It's hard to see kids like that, but I really enjoy the overall experience too, the medicine, the interaction, the support, the learning.
I have to say though, working in an HIV clinic makes is not helping me remember my non-infectious disease stuff. I saw another patient a few weeks back, a friend of someone at the clinic who just needed to be seen for malaria like symptoms, HIV negative. Long story short, I totally wanted to work her up for SLE (lupus) after talking to her for a long time. But sadly, a simple ANA is hard to get and very expensive too. And it wouldn't have been worth it for her, she's not doing all that badly. And then who would manage it? Maybe for me it would just have been the thrill of making that kind of diagnosis, in a place where usually people never know they have those types of conditions.
It’s going to be another busy weekend as usual. 8 mile run. The return of Stitch n’ Bitch Lusaka, first one for 2009. Birthday party for one of our friends, with Thai lady catering. Sadly, the boat shipment did not come in, and there will be no Pad Thai due to the lack of noodles.
Curious what food items are available and not available, and when. I shouldn’t complain. Before I got here, I expected no availability whatsoever. I pictured myself eating onions, tomatoes, eggplant and carrots all year. But once I’ve been given the opportunity to buy an item here, it makes me sad when I can’t.

Cilantro
Red chili paste
Couscous
Balsamic vinegar
Granola
Chickpeas
Celery
Canned diced tomatoes
Tahini
Sweet corn

Usually when they’re out of a particular item, they’re really out of it. Like a totally empty shelf, you reach all the way up to see if maybe one is left all the way at the back and come back with a dirty hand, and no more in for weeks. I don’t think I’ve ever made a grocery trip without not being able to find at least two of the items on my list, items that are usually there. We like to come home saying, “Gosh, there’s a run on lentils and popcorn this week!” This week I really wanted parsnips, and they actually almost always have them. But they tried to be sneaky, they put Chinese turnips on the shelf instead, long and white and root looking yes, but not really the same thing at all. Celery is just luck of the draw. Zambians don’t really do celery. But they know mzungus like it. Sometimes they only have little milk cartons instead of big ones, or small trays of eggs instead of large ones, or only instant coffee, or no instant coffee. Good thing there hasn’t been a run on toilet paper yet.