First day at the clinic and Perspectives #1

Today I finally got to work at our clinic (Clinica Saude de Medicina Sao Lucas).  It was a busy day since apparently Wednesdays are the mornings when HIV patients come in for their CD4 counts.  I should have gotten a picture of the clinic as I arrived as there were people sitting everywhere - and then it got so busy I didn't have time to grab any pictures. (sorry! :() We saw at least 20 patients, which is impressive only because the last 10 or so took twice as long because I was allowed to stutter through Portuguese with them.  I have no doubt the my translator and medical student Jabulani would have seen many more patients in that period of time.

Here are my initial impressions:

Facilities: First of all, I came in with low expectations, so perhaps to some of you it doesn't mean much, but I was super impressed with the facility having air conditioning.  (Seriously! Not expecting that!) It was also newer in construction and contained many amenities more culturally American (Welch Allen opthalmoscopes, thermometers), hand sanitizer dispensers, and even a few computers.  So all that's superficial, but worth noting in that it makes life on the medical caregiving side easier. 

Patients: During this first day, I saw fewer patients with HIV than I had anticipated - this could be due to just the random collection of patients we were given in that only 15% or so were positive.  The seropositivity is 40% in the city, and with underreporting I really thought every other patient would be positive.  However, one patient with STD symptoms we had to tell had a new positive HIV test - and his hopeless expression and quiet reception of the news grieved me in knowing how utterly and completely the diagnosis would shape his life.  I would hope it was a false positive test result but that's not likely.

Almost all the patients with fever and other cold symptoms were screened for malaria.  The most seriously ill patient was a 1y9m baby below the 5th percentile by a full kilogram with bumps throughout the occipital cranium and face with a nasty cough most likely TB.

Perspectives #1  In waiting for a ride after work, I sat stumbling through portuguese with a staff-woman from the clinic.  In just asking her a few questions it reminded me again of how ravaged this whole country has been by famine, disease, violence, malnutrition, and willful ignorance by most of us.  She told me that she was a single woman in her 40's who only had one son that died when he was 24.  She had 6 siblings, but only 3 were still living.  In hearing about her son, she said she was glad she 24 years with him, that that's more than some people get.

Can you imagine?!  Take half your family and one of your closest loved ones and imagine life without them.  All my siblings, my parents, aunts, uncles, and cousins (minus one) are living.  I've known all my grandparents and one great-grand.  Life would be so different without them, it gives perspective to the suffering that not just the poor but most people have gone through here.