Medical Update

Things at the hospital were pretty much business as usual this week—a lot of abscesses needing drainage, a lot of broken bones, one kid with bubble gum stuck down his ear, and a lot of pregnant mothers. I did get to spend some time in the ARV (anti-retroviral: the drugs that fight HIV) clinic, which was a fascinating experience. With any medication that a patient has to take on their own over a very long period of time, you’re going to have issues of people missing dosages or neglecting to take their meds or other adherence problems like that; with ARVs, these are especially serious because failing to take the drugs for any significant period of time often means that the virus becomes resistant to them and the drugs are then worthless. It actually turns out that in terms of all conditions requiring long-term medication (like diabetes, hypertension, TB, or HIV), patients who are on ARVs are actually the most adherent to their drug regimen, and TB patients who are also on ARVs usually do a better job of adhering to their TB medication than patients who aren’t on ARVs. The reason is that any ARV patient is required to undergo counseling before they are put on the drugs, and there is an intensive process including a home visit and designation of a “treatment buddy” who will be responsible for making sure the patient takes the drugs at the right times and comes in for all their appointments—with other conditions, they basically just send you out the door with a prescription and don’t check on you for another six months. There are still a ton of adherence issues, especially with alcohol abuse being such a huge problem around here, and any time a patient stops taking their pills they have to be switched to a new regimen because the virus will quickly become resistant to their previous one (a lot of times, patients see their condition improving when they start taking the drugs and they feel so much better that they assume they’ve been cured, so they stop taking their medication, which is tragic because it means that they have to be taken off a regime that was working and put on a new one which may or may not work as well—if they fail both first and second line ARVs, their only option is to stay on the second line drugs and hope that a spot opens up in a clinical trial for some experimental drug).

In other news, Dr. Perold has moved on from referring to me as “colleague” to “my sexy American friend”—this is traditionally one of the ways South Africans indicate that you have been accepted into their tribe or culture, and I consider it a tremendous honor.