| Nov 12, 2009
“She has a cough,” Joey, my translator, said. He had just asked a sparrow of a woman why she had come to our medical clinic. It was late in the afternoon and he was tired. Translating all day in three or four different languages must be exhausting. He never complained but sometimes his patient summaries were a little too brief.
I needed to know more. “How long,” I asked. “Fever?” “Shortness of Breath?” All the usual questions to find out more about her cough. She had been coughing for four months, often had a fever in the evening, was short of breath when she tried to work in the fields.
I looked at her. Her cheek bones glistened on her black skin, arches above the hollow of her cheeks. Hunched forward in her chair she really did look like a little bird. A hungry little bird.
“Have you lost any weight,” I asked through Joey.
Not lifting her eyes from the floor she nodded her reply.
It wasn’t difficult to guess at the likely diagnosis in this despondent woman. A cough lasting four months with weight loss points to tuberculosis. I remembered seeing a poster on the wall at the Nakivale hospital a couple of days after I’d arrived in Uganda. “TB? Think HIV.” Its crisp message had stuck with me.
“Joey, ask her whether she would be willing to have a test for HIV.”
She made the brief low hum that the Congolese often use to indicate agreement. I pulled a requisition pad towards me, circled ‘HIV serology’, and sent her to our little laboratory for the test.
Twenty minutes later our lab technician handed me a piece of paper. She was HIV positive. Her cough was possibly the first sign of the onset of AIDS.
We know HIV in Uganda is widespread (5,155 cases per 100,000 compared to 268 in Canada) but when confronted with one of the victims the statistics become very personal. I spoke to her about the medications that will suppress the virus in her body. She has to take the medication every day for the rest of her life. If she stops, the virus will immediately begin reproducing itself and destroy her immune system.
In Canada the current medications for HIV (called anti-retrovirals or ARVs) can suppress the virus so that it is undetectable. People with HIV can live normal lives and potentially have a normal lifespan. Unfortunately the virus cannot be eradicated, it lurks in brain tissue or in the cells of the gut. As soon as the ARV is stopped the virus steps out of its hiding places and begins to create copies of itself, billions of copies that slowly destroy the cells of our immune system.
In Uganda ARVs are now available to people with HIV. The medications dispensed here are not as effective as those in Canada but they do work and can prolong life. That afternoon we sent her to be tested for tuberculosis and arranged a referral to the HIV counseling service at the little Nakivale Hospital.
I think about my little sparrow often. Was her cough improving? I wonder whether she was able to get a supply of ARVs and I truly hope she has been able to gain a little weight.