Two Kinds of Clinics

On a pretty ordinary side street in Cali, a few blocks off of Calle Quinto, just behind the bullfighting stadium, there’s an HIV clinic. Unless you know it’s there, you probably wouldn’t even notice it. The only signage is a logo over the front door, two hands entwined in a show of support. Inside, it’s quiet and peaceful, with a spacious waiting room and a beautiful garden in the back. Doctors and nurses shuttle patients calmly between the waiting room and the few exam rooms.  Secretaries wearing identical clothes on each day of the week (Tuesday is khaki pants and white, flowered blouse day) efficiently register patients and collect medical records from the back. Most patients are greeted as longtime friends, which they are. Their thick medical records can attest to years of antiretrovirals, blood tests, and a few hospital stays here and there.  This definitely felt a lot more like Yale’s Nathan Smith clinic than any of the overcrowded, privacy free, bare bones clinics I saw in Zambia. Colombia’s HIV prevalence is the same as the US, about 0.6%, and many of the same people are affected: men who have sex with men, transgendered, economically disadvantaged women and IV drug users. Over the past two days, I’ve been fortunate enough to meet some of these people and hear their stories.

First there was Señora R., a short, quiet, middle-aged whose husband either died or disappeared many years ago, and she discovered her HIV positive status earlier this year when she landed in the hospital with neurological symptoms and was found to have toxoplasmosis. She made it through okay, and now here she was, ready to be initiated on treatment. She had a strange, peeling, bumpy and itchy rash on her face, arms and legs which had been present for months.  She had chronic diarrhea. She looked tired and drained, but fairly well put together. I watched the doctor explain to her that her CD4 count of 19 was very low, and that her viral load of 300,000 was very high. They went through each and every box of medication, five in total, and how to take it. Señora R just smiled slightly and nodded her head.  I think she understood, at least some of it. Going from 0 medications to 5, taken at different times of the day, is not easy. 

Then there was J, a 35 year old transgendered female, and she looked so good that if I saw her on the street and didn’t know her past, I wouldn’t suspect a thing. She wore bright, multi-colored sneakers, tight, low rise, skinny jeans accenting her every curve, a fluorescent colored sleeveless vest top, unzipped slightly at the top just enough to reveal her ample breasts, bleached blond hair pulled back in a ponytail and a subtle hint of makeup. She spoke comfortably with her doctor. She’d been feeling good but eating a lot recently, and her weight was slightly up. Always takes her medications, she’s been on the same regimen since 2009. No concerns, no other questions. On her way. See you in a few months. 

Today I met  Señora L, who surprisingly, I had met before. In this city of 2 million people, what are the chances that a visiting student from Yale on an infectious disease rotation will see a patient at the hospital as a consult, and then see her again at a random, independent HIV clinic. But there she was, and she recognized me first. Even when I saw her in the hospital, she had a positive energy and pride about her. Today, despite her very slight stature, and the mystery surrounding her new recto-vaginal fistula, her lymphadenopathy and why her viral load is no longer undetectable, she continued to smile and speak positively with the medical staff. Her biopsies have already been done, there’s nothing to do but wait for the results, and she’s okay with that. Talk about continuity of care.

There’s a fabulous attending at the clinic. Although he is not technically ID boarded, he has been treating HIV patients for years, and their clinic is involved in occasional clinical trials. He has spent countless hours with us, presenting interesting clinical cases, talking through lunch hours and late into the evenings.  I saw pictures of a patient with disseminated histoplasmosis of his skin. I saw a case presenation of a patient co-infected with both mycobacterium tuberculosis and mycobacterium avium. Never have I seen anything like this before.  He could go on talking for hours, and he does. I think he does it because he loves it, and he wants to pass it all on. Although they don’t have the newest ARVs available here, they have many regimens that work well, and some of their patients have been coming to see them for over 20 years.  In Cali, HIV care is alive and well.

As Cali seems to be full of private clinics, I was able to visit another clinic today as well. This one, however, is a bit different. The doctors who run this clinic, “La Clinica de Alergias, Stem Cells Center” are a married couple that I met at the rabbi’s house. If we were in the US, they’d be living in Berkeley. They are wonderful and friendly and kind and like to talk about their healthy diets as well as their healthy souls. They invited me to stop by their clinic today. At 6 pm, just as it was getting dark, I found myself walking through glass doors into a peaceful courtyard, trickling little fountains, greenery, large pieces of artwork, luxurious couches, almost like walking into a hotel lobby or a private home. The mezzuzahs on the doorposts and Star of Davids on the metal railing of the gate let me know I was in the right place. They greeted me with open arms. “Remember that patient I was telling you about on Shabbat, the one with Crohn’s disease and the colostomy and rectal prolapse who was so sick before? She was just here. She’s doing much better now! It’s regenerative therapy!” I was hoping that my visit to the Stem Cells Center would leave me with a little more information about what exactly is their stem cell therapy, where they get the stem cell from, how they process them.  On their website I watched a video of one of their patients, an old woman with osteoarthritis who at first is walking very slowly and talking about her pain. The post-video shows her walking along more steadily, and answering that it doesn’t hurt a bit. Another success of the regenerative therapy, which they’ve been doing for 25 years.

I didn’t actually learn any of this though. Instead, I sat with the wife for a bit, talking about our families and backgrounds (her family is from Germany, they came after the war), and my impressions of Colombia (something every Colombian I ever meet asks me) and then about the Jews in Colombia and what their situation is like. Then she very generously offered to have their restaurant, Elements, cook me a fabulous fish dinner, although she and her husband could not join me, they had to work. So as I sat solo on the dimmed terrace of the Stem Cells Center’s Elements Restaurant, dining on delicious fish, fresh salad, and a glass of white wine, the evening Cali breeze blowing pleasantly, I reflected on the amazing hospitality I’ve experienced here in Colombia, on the many invitations I already have if I ever come back, and on what their stem cell treatments are exactly.  From looking at their beautiful and successful clinic, it seem that although some of this country is suffering, and the public healthcare system seems in danger of falling apart, somebody is able to afford to come to a clinic like this.

For me, Colombia continues to be a country of contrasts and extremes. I wonder if the stem cells could help the HIV patients?

Highlights from last weekend, on Lago Calima, a lake created by a dam about 2 hours north of Cali, world renowned for kite surfing and wind surfing.

A view of Lago Calima, and the kite surfers

 Kayaking with Jaime

Hummingbirds taking a snack at "Dieciocho", literally, it is Kilometer 18, on the road outside of Cali, where the weather is much cooler up on the mountain, and people stop at restaurants. My stop involved hot chocolate with cheese dipped into it (sounds awful but is yummy).