HIV and mangoes

In March while sitting at Travellers Corner a local café there was an accident between a boda and a taxi. I heard a terrible bang and then saw a man catapulted down the road. He was badly injured with major head and facial injuries. There was blood all over him. As people gathered round him and manhandled him on to the back of a pick up I grabbed his head to support him, in the process getting blood all over my hands. The patient died a few hours later. There is no intensive care out side of Kampala and he had very severe injuries. He was one of six people who have died on the main street of Masindi since it has been resurfaced. A few days later I began to realise what a stupid thing I had done. In any country it is not advisable to handle blood but in Uganda the chance of a boda driver having HIV is fairly high. Logically I knew the chance of me catching HIV from this blood was low but during the next few days it became a worry and I realised that to be sure and in fairness to Maggie I would need to take a test after the three months window period.
HIV testing in Uganda is readily available and this week I arranged a test. I did not put my self through routine counselling because I am fully aware of all the issues. I by passed the system and asked Soloman the laboratory technician to do the test. I was confident that the test would be negative. I knew my risk was low but it was still a slight worry as I waited 15 minutes for the test result. How different it must be for most people, many of them know they have significant risk. They may already know that their partner is positive, they may already be suffering from ill health. Many people take the test expecting their result to be positive. I have to admire the way most Ugandans accept their testing and results. It is more difficult to understand why many people continue to put them selves at risk in spite of having the knowledge about risk factors.
It must be particularly difficult to have your child tested. One of the nurses at the clinic has been struggling with this problem. She is HIV positive and has been taking ARVs for three years. She has always been afraid to have her child tested although she suspected he was positive. He has had a number of infections and recently had a particularly bad chest infection. She was persuaded to let us test him and he is positive with a very low CD4 count. This means that the virus has already seriously affected his immune system. He needs to start ARVs him self but she is still reluctant to start him on treatment. She feels guilty because she caused his infection and she is finding it very difficult to discuss it with him. How do you tell a nine year old boy that he has HIV and that he will need to take medication for the rest of his life? How do you answer your son when he asks why he has the infection?
It is a year since we came to Masindi on holiday. Once again it is the mango season and Masindi is full of talking trees. In every mango tree you walk past there are young boys hidden from view searching for the juicy fruit. Each one you pass shouts “muzungo how are you” and if they are cheeky enough they add “give me some money”. The standard answer is to say “I am fine” and I always ask them for money which usually provokes a fit of giggles from the middle of the tree. This time of year the incidence of fractures goes up as the boys regularly fall out of the trees.
Another harvest this week has been the flying ants. The weather has been rainy and this has provoked swarms of flying ants. They discard their wings after mating and are eagerly collected by every one. They are fried and served as a delicacy. It is said that in the schools you can tell when ants are about as the health of the children improves with better nutrition. We have not eaten ants yet but I did have some grass hoppers which were very good.
This week’s challenge at the hospital is lack of drugs. The drugs were supposed to be delivered from the national medical stores 2 weeks ago but have still not arrived. We have run out of many essential drugs and have no x-ray films. The community clinics are in an even worse situation as their drugs are 4 weeks late. Yesterday I was told that one of the delivery trucks had been involved in an accident and thieves had stolen the drugs. We wait to see what arrives in Masindi but it may be we have to wait another 2 months for the next drug supply.
We had a good trip to Fort Portal and it was great to see a different part of the country and meet up with fellow volunteers. Fort Portal is much prettier than Masindi with beautiful hills and crater lakes. We climbed one hill called “the top of the world” from where you can see for miles and view 3 crater lakes. On the walk through the forest we encountered lots of beautiful birds and at 3 types of monkey. The monkeys took no notice of us and seemed happy to be photographed eating, grooming and leaping from tree to tree.
Fort Portal hospital is a regional referral hospital of 350 beds. It was sad to see that it suffered from the same problems as Masindi. There was a shortage of doctors and drugs. There were few places to wash your hands although as it was a newer hospital it was easier to keep clean. The x-ray unit has been closed for refurbishment but this means that they will not be able to do any x-rays for several months.
It was interesting to look around the psychiatric unit as this is the first I have seen in Uganda. There is no psychiatrist but two psychiatric clinical officers run the service. They were obviously trying hard to provide a service but hampered by lack of medication. They knew what they should be prescribing but were limited to what was available. Basically they had some chlorpromazine, some amitriptyline and diazepam injections.
Masindi has been cooler the last week.This means we have no excuse for being lazy.It is Heroes Day today and a national holiday but Maggie and I are both at work although the pace is slow. Hopefully today we can sort out a budget for the community project.