Mark 1/14/2015: HIV Clinic; Joy and Grief in the Maternity Ward

Another fascinating day at Ilula hospital today.  As the only psychologist in our group, I have been looking for ways to plug in. The mental health needs of these patients seem to be immense from my perspective as US trained MH clinician, yet everyone seems to get by despite great hardships.  Today, I helped out with the HIV clinic; we saw over 50 outpatients in about 5 hours.  I have not had much exposure to HIV, but after less than one week in this hospital, I have a much better understanding of the disease and treatment options, thanks to the pharmacy staff and MN students that have been so helpful in explaining the complexities of HIV drugs available in TZ.  The mental health status of these patients is across the board, from withdrawn and sad to upbeat and smiling and grateful to have the drugs. Attached is photo of Grace and Astrid with one of our happy patients. 

Grace, a new friend and Astrid

 The patient that stands out for me is a 45 y. o. male who presented with a stocking cap drawn over his right eye. He removed his cap and told his story that he lost his right eye about 4 months ago due to an abscess. There was disfigurement around his eye-socket and discoloration of his skin above around the eye-socket and right forehead, not a pretty sight.  He saw that I was wearing glasses and inquired if he could get some glasses to help his vision with his remaining eye.  Anita, the TZ medical officer prescribing the HIV meds, did not know what might be available to him.  My impulse was to give him my glasses, thinking this patient is struggling with vision and obvious body image issues. I don't need these glasses, and this was the least I could do to help him. But I knew that would not be best... a feeling of helplessness and frustration came upon me. Anita was kind and supportive to him, and he seemed appreciative when he left. I hope he can get those glasses somehow.

Here I come!

Right after seeing this patient I was pulled to OR to observe a C-section, my first ever.  C-section seem to be more common here than in US.  Ilula hospital is fortunate to have an updated OR and it is a busy place.  A healthy baby boy was crying within a minute of coming out.  Brought back to me fond memories when my first son was born 27 years ago.

Ten minutes old

Tomorrow,  I will do rounds on the maternity ward.  Dr. Saga has asked that I provide counseling to a 35 year old woman who is 28 weeks pregnant. She is identified as a "precious baby" patient. This is her 11th pregnancy.  All prior 10 pregnancies have not been successful. Today, an ultrasound revealed that there was no fetal heartbeat.  Jessica did great presentation during case discussion this afternoon as to reason for her failed pregnancies.  We have lots of questions as we don't know her medical history clearly - no EMR here.  We will share with her the news of the ultrasound and do what we can to help her work through these major grief and loss issues. Sure wish I could speak better Swahili.  

Mark