Primary Care and Travel Medicine in Washington, DC since 2004
Day 2 – Severe HIV – St. Elisabeth’s Hospital
February 21, 2011
We began our day with rounds at St. Elisabeth’s hospital. Approximately 30% of the hospital is HIV positive. We learn that close to one million orphans are living with HIV. Many do not tell their families of their disease or seek testing as there is still a stigma associated with this diagnosis. For this and other reasons many patients are not seen in the clinic or the hospital until they are considered Stage 3 or 4 in their disease, this is extremely advanced. Many of the patients including the children carry blue cards that list their current CD4 count (a type of white blood cell count that is related to the patient’s immune system) and the medications they have been given. We see tuberculosis, cryptococcal meningitis, severe malaria and dysentery. The hospital is funded mostly by grants, much of the treatment is covered, but some patients must pay for their medications and many cannot afford treatment. Patients or their families often times bring in their own bed sheets and food as this service is not provided. Follow-up is difficult for the doctors and keeping the patients on the needed medications. The wards are crowded sometimes more than 10 patients per room. There is no isolation room, tuberculosis (an infection spread by respiratory droplets through the air) patients are placed by the windows. There are no masks, sinks or standard infection control measures in place.
The doctors are doing the best they can with few resources. We saw Falciparum malaria in the laboratory and observed the quick slide testing for malaria and HIV.