Three years ago, I spent the summer working in Eldoret, Kenya with the Academic Model Providing Access to Healthcare (AMPATH) program at Moi Teaching and Referral Hospital. The program, founded by the visionary Dr. Joseph Mamlin, specializes in HIV/AIDS treatment and prevention and boasts a catchment area of over 160,000 HIV-positive adults and children. The program not only works at the hospital itself, but also utilizes its network of rural clinics to reach individuals in the surrounding area who otherwise may not have had access to treatment.
Every Wednesday, I worked with AMPATH’s rural clinics to gather data on patients who missed their HIV checkups. I joined Kenyan community health workers (CHWs), driving for hours on bumpy and sometimes treacherous dirt roads in order to reach the most inaccessible. Our destination was almost always a small mud-built hut in what seemed like the middle of nowhere.
Upon arriving, my colleagues introduced themselves and explained the purpose of our visit. As the majority of the patients spoke their ethnic dialect rather than Swahili or English, I was usually limited to a smile and a wave. Thankfully, the CHWs graciously translated in real time so as to include me in the conversations.
“We noticed you missed your HIV appointment checkup. Was there a problem? How can we help?”
The answers to these questions were incredibly heartbreaking and eye-opening. Explanations ranged from not having enough money to cover travel expenses, to not having enough money to pay for medication and food, to patients’ deaths – and everything in-between.
Three home visits stand out in my memory as particularly powerful.
ONE: When we arrived at the home of a male patient, we discovered that he had been unable to make his appointment because he had died the week prior. Unfortunately, this was not an unusual answer. However, his wife’s story was just as heart wrenching. The couple had engaged in a polygamous relationship with another sister wife and, after his passing, the sister wife fled, taking the family’s entire life savings with her. With no bank account or savings, his first wife was left with nothing but the near empty hut. A young HIV-positive mother herself, she shared her story while breastfeeding her young newborn. Being so far from the hospital or clinic, I could not help but wonder if she had the knowledge or the medication to prevent mother-to-child (MTC) transmission. After we said our goodbyes – or, in my case, my smile and wave – I asked my colleagues if she was taking anti-retrovirals (ARVs) to decrease the risk of MTC. They just sadly shook their heads and got back into the car.
TWO: As we pulled up to the hut of another HIV-positive mother, her young son gladly welcomed us into their home. His mother looked on the brink of death. At approximately 5’5” (167 cm), she could not have weighed more than 90 pounds (40 kilograms). She was so emaciated that it took visible effort for her to stand to greet us – even with her son’s help. When asked why she had missed her appointment, she answered that the ARVs made her extremely hungry and she was unable to afford more food. Therefore, when faced with the choice between a lifetime of constant and excruciating hunger versus an imminent death without hunger, she had chosen the latter.
THREE: We approached another female patient’s hut but were unable to find the patient. After nearly an hour of searching and asking neighbors if they knew of her whereabouts, we finally spotted her in the distance. However, there was one problem. She refused to speak with us. Every time we approached her, she ran away. I later learned that this was a common reaction to the CHWs’ attempts to speak with patients. Why? Because our car had AMPATH’s logo on it – a logo that villagers commonly associated with HIV/AIDS. My colleagues explained that if she approached the car, others might see her and (correctly) assume that she was HIV-positive. In that area, the stigma associated with HIV can result in great social consequences. In other words, she considered the threat of her neighbors and friends knowing her status more dangerous than the disease itself.
To conclude on a more positive note, my AMPATH colleagues must be lauded for their incredible work. Not only do they perform Wednesday checkups, but they also allow for easier access to ARVs and educate communities about HIV prevention, symptoms, and treatment. Without their (often under-appreciated) efforts, the number of HIV-infected patients would undoubtedly increase along with the disease’s social and economic consequences.
After working alongside these everyday heroes, my admiration for their determination, their impact, and their heart has grown exponentially. If there is one thing I learned from my summer in Kenya, it is that community health workers are a vital link between doctors and the populations they serve.
Girls’ Globe blogger Lauren Himiak will be attending the 20th International AIDS Conference in Melbourne, Australia from July 20-25th. Follow her on Twitter @Lauren_Himiak and join the conversation using #AIDS2014.