KIHEFO promotes local initiated solutions to fight disease, ignorance and poverty in southwestern Uganda
The following story was written by Anna-Kristen Siy, a Canadian family medicine resident, who is currently volunteering in Kabale with KIHEFO, as part of an international rotation in Western Uganda.
The drive from Kabale to Muhanga winds through the forested foothills I’ve come to call home, the KIHEFO ambulance raising rusty clouds in our wake. I take in the glory of the landscape. The steeply terraced hills- bearing the most tenacious of the dry-season crops- and deep valleys, they are a beautiful and stark reminder of the terrain our patients cover on foot to make it to their monthly HIV follow-ups.
Tony, our driver, stops a few dozen kilometers from the village. Annette, the HIV counselor, passes a black plastic bag out the window to a thin man. “His antiretrovirals [for his HIV],” Tony explains, “He lives far from Muhanga but heard we’d be coming today.”
We lurch to a halt atop a hill beside a primary school and a church. The crumbling church is our destination. We realign pews, wipe off a few benches, and unload our boxes of medications and charts. I will deal with general medical complaints. Annette walks me through the medications I have at my disposal today. Multivitamins. Acetominophen. Antimalarials. A few antibiotics. She places them on the bench beside me. Barnabas, a social work intern, will help translate and dispense. Annette will deal with the HIV-related complaints and complications.
The midday light filters through the cracks in the walls as the benches crowd with patients. We funnel them through with remarkable efficiency, although not without the occasional hiccough. Working in resource-limited settings, I’ve come to understand, in principle, the importance of syndromic diagnosis and treatment. Nevertheless, I am humbled when I ask, via Barnabas, a patient if she can make it to Kabale for confirmation of her likely malaria. “She has no money,” he says, not even bothering to ask her my silly question.
Right. I dispense and explain the dosing of the antimalarial tablets.
All of our patients today are women. This is unusual among KIHEFO’s partner cooperatives, Barnabas explains, but partially reflects the continuing stigma among men who are HIV positive. Moreover, many of these women are widows. Of those who are married, some men will send their wives for medication. Indeed, we prescribe deworming treatments and refill some antiepileptics for family members who could not make it in.
Not everything is treatable. A woman presents with end-stage osteoarthritis, bone creaking against bone as I examine her knee. She has chronic swelling from the irritation, filling the hollow at the back of her knee, making it hard to walk. The idea of joint replacement surgery is ludicrous, and I know better to even talk about it. So we explain the diagnosis and offer her pain control. Another patient has had a worsening dry cough, primarily at night. Raised eyebrows confirm my suspicions when I ask about asthma. She is out of medications though, and was hoping we might have some. No, not today. Perhaps her symptoms will improve when the rainy season dampens the dust. Our antibiotic supplies don’t cover well for respiratory or urinary tract infections, so some patients leave with prescriptions that I hope they will eventually be able to fill.
Not everything is treatable, but the room is full of gratitude. As the stream of patients wane and we pack our supplies back into the ambulance, a dozen women jump into the back with us to hitch a ride toward their homes. I’m amazed at how far we ferry some of them as we weave back through the hills, the ambulance filling with laughter and song.
A community of sorts has formed around these clinics, I realize. For all the inconvenience, these women find these clinics valuable enough to show up every month without fail. Perhaps these outreaches offer not only care for their physical health, but also the support of having each other along for the ride.
(Anna-Kristen Siy is a rural family medicine resident training in northern Alberta, Canada. She is enjoying her international rotation in western Uganda, working with Mbarara Regional Referral Hospital and with KIHEFO. She loves thunderstorms, tea, and meaningful attempts to improve the lives of others).
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