After one week in Uganda, I have realized that life here is a constant battle for most residents—a battle against limited funds, resources, support, and often the unfortunate hand dealt them. My own troubles that once felt important now seem trivial in comparison. One patient in particular ingrained this message into my mind.
On Tuesday, we settled to work in the HIV clinic at Nakaseke District Hospital. Expressionless patients seated in rows turned to look at our foreign faces as we entered the building. HIV prevalence in the district is higher than the Ugandan national average, with over 7% of individuals infected with the virus. It thus seemed apparent that this afternoon would be overwhelming—not only due to the number of patients in the waiting area, but also based on my understanding of the social, financial, and emotional repercussions of the illness.
However, as the clinic began, patient after patient seemed both happy to see new faces and in relatively good health despite their disease and their consequent daily doses of ART and prophylactic treatment. Young women entered the room emulating fountains of feminine youth, filling me with hope for their long futures ahead. The only real complaint we had received was of back pain from several elderly patients, which was not surprising given their age and lifelong work as farmers.
Yet, as the end of the clinic approached, a young boy entered with big eyes and swollen lips. He placed his blue book containing his treatment record on the table and sat silently, almost nervously, in the chair closest to me. Dr. Herson asked that I interview the patient and record the HPI (history of present illness) with the help of one of the translators. By glancing over notes of nurses who had previously interviewed him, I learned that his blue book was relatively new. He had been found to have HIV only a few months ago. Someone had recommended that he be referred to both a teen support group and to social workers because he had been struggling with the diagnosis. His most recent CD4 count was below 200, a dangerously low number.
I quickly introduced myself. He responded by looking into my eyes, just briefly. Papules had taken over the skin all over his body, and a crusty, blistering lesion sat above his top lip. Although he did not mention any current pain, I turned to Dr. Herson and asked her to take a look. She talked through a differential diagnosis for his lip lesion—perhaps it was herpes, or maybe streptococcus. She tried to get more information from him, such as how long he had had the lesion and whether his skin itched, but his responses were brief and inaudible, accompanied by a slight nod. After renewing his ART and prophylaxis prescriptions, we settled on Acyclovir for the current lesion. He quietly stood up and left, head slightly downward and glassy eyes focused on the ground below.
On Saturday, we traveled to a small village in the hills to help out at the ACCESS (African Community Center for Social Sustainability) Family Planning Mobilization and Education Day. After a few hours of meeting members of the community and witnessing the excellent rapport established by James and Eric, two of ACCESS’s leaders, we boarded the bus to descend from this hillside village and return to Nakaseke. As I walked to the bus, I saw the boy from the clinic standing shyly behind it. I waved to him and he smiled back with big, tired eyes as he stood alone in the bustling village center. I kept trying to catch a glimpse of him from the window, waving again. We looked at one another as the bus pulled away, and he turned his body, which had aged years over the course of a few months, back toward his village while I watched and hoped for a miracle.