Last week, I visited a hospital in Maroua where many HIV-positive people receive health care. Relatively speaking, this hospital is a good one. It is private, so patients pay for their services, but the on-site lab and pharmacy provides better and faster services. By spending a full day at the hospital, I learned more about what every PLWHA (stands for Person (or People) Living With HIV or AIDS) must experience in order to stay healthy.

Here, PLWHA are treated side-by-side with other patients. By fully integrating their care into general hospital services, people living with HIV/AIDS are not singled out by having to go to a separate clinic, see a separate doctor, or go at a special time. This integration maintains the dignity of PLWHA.

I arrived when the clinic opened at eight in the morning. The outdoor waiting area was already filled with sick men, women, children and elders. Several dozen people were waiting patiently. The doctor warmly welcomed me and ushered me into the clinic.

He sat behind a desk stacked with dozens of carnets médicals, small notebooks documenting patients’ chronology of consultations, vaccines and prescriptions.

Throughout the world, debates ensue as to how medical records should be managed. Here are a few pros and cons of patient-possession of medical records in a Cameroonian context:

PROS

• If a patient can keep this notebook, she can then present it to any doctor or nurse and access an entire medical history. This is particularly helpful when a patient has limited health literacy.
• A patient may feel more empowered to take responsibility about his/her own health.

CONS

• Patients forced to hide carnet from family members if records are on their person. This system risks making private medical information, such as an HIV status, less confidential.
• Because sparse hospital administrations do not always keep records, requires the patient to be responsible.
• Carnets médicals may be easily destroyed due to patients’ living conditions (eaten by termites, soaked by heavy rains, lost in a fire) If lost, there’s no back-up.

Mothers, brothers and other caretakers accompanying their ill were kined up on a wooden bench, clenching pastel-colored carnet médicals in their fists.

The first patient in the doctor’s office that morning was an 18 month old baby boy brought in by his nervous parents. He had been crying inconsolably for three days. His constant crying inspired the other waiting families to insist that he be seen ahead of them. I honestly have never seen anything like it in my life, and I have seen far too many sick babies. I thought that he was going to die in that office during that visit. The baby’s head kept drooping backwards, his eyes rolled back and his entire body trembled. The doctor saw the tell-tale signs of meningitis and made the diagnosis on the spot, writing a prescription and sending the family straight to the pharmacy. There was no discussion with the parents about what the disease was, its prognosis, what the treatment entailed, or if other members of the family should be tested or vaccinated (which, I found out from my Prevention of Communicable Diseases book that, yes, they all should have been). Nor was there any plan for a follow-up.

Ensuring patient adherence to preventative regimes or medical treatments requires effective communication to encourage changes in behavior. Overcoming language and cultural barriers and limited health literacy only compound the problems with 6-minute consultations. Given the complexities of HIV/AIDS and its courses of treatment, patients need to spend more time with health care professionals who can guide them. In the States, I once met an HIV specialist who said that part of the appeal of his work was that he was allowed an hour with each patient.

Surely this type of scenario is serious for the community at large. I feel like with a disease like HIV, an overtaxed health care system like this can only make a dangerous disease even more dangerous. After seeing the baby boy with meningitis, the reasons for the peer educators’ lack of basic knowledge about HIV did not seem surprising at all. If their own doctor does not have the time to educate them a little bit, who will? In the same sense, just like the family of the little boy, they were never told what the disease was, its prognosis, what the treatment entailed, or if anyone around them should be tested, too. I remember from my training as an HIV counselor in the United States, that there is usually immediate, positive behavior change following an HIV-positive test result—after just the standard post-test counseling, not an extensive behavior-change intervention or counseling. Simply hearing the result and having questions answered will affect behavior because new knowledge gained is then introduced into the decision making process.

For this reason, EFA works to make up for lost time. HIV-positive people join the youth groups and, along with the groups’ leadership, we strive to put them on a level playing field. How can you help prevent future HIV transmission if you do not know just how HIV can be passed from person to another, partner to partner, or mother to child? How can you keep your CD4 counts low if you don’t understand how to navigate the complex healthcare system to access ARV treatment? How can you prevent opportunistic infections from overtaking your body if you do not understand that you immune system is compromised? If you don’t know what an immune system is? And what about for those who do not ever know their HIV status?

While prevention programs or behavior-change programs that focus solely on providing information to motivate personal change are not nearly adequate for fighting this disease, it is an excellent place to start.

-Caitlyn Bradburn, Peace Corps Volunteer

Tags: diagnosis, doctors, knowledge, Maroua, News from Cameroon, peace corps, treatment