On Wednesday, Isaac and I headed up to Gulu (in NW Uganda) to meet up with Anita and Simon from CHAI to help with data collection at the Gulu Hospital. Anita is heading up a project studying patient loss before patients enter antiretroviral therapy (ART) when they are in the “care” phase where they are visiting the hospital regularly and being treated for any opportunistic infections. When HIV-positive patients are “lost” or stop coming to the hospital, there is a good chance they will not start ART until they are already extremely weak or have a very high viral load. If they reach that point, it can weaken them physically to the point that even if they are initiated on therapy, they may not live as long as they could have or worse, treatment could be started too late to save them. (Please forgive my very un-technical and imprecise medical explanations….)
The project we are working on is collecting data from patient records up to the point that they initiate ART. We’re trying to find possible reasons people stop coming and drop-off points in order to make recommendations for how this phase of care could be improved. Patient records aren’t always pretty, and they definitely aren’t in electronic form, so it can be very tedious work.
Going through the files, you come upon notes like “also infected in household – co-wife and husband” or “visited patient at home – adherence is good, but family has abandoned patient and locked him in a room where one person is taking care of him” or “28 year old referred from Gulu prison.” Some (most?) of the files just make you sad – the 7 year old boy who was infected at birth and has stopped coming to treatment or the 20 year old woman who comes diligently every month but is constantly fighting opportunistic infections.
When we entered the HIV wing of the hospital (pictures below give the nighttime view) it was filled with patients who would then wait 2 hours or more to see a nurse or doctor. Nurses we spoke to complained about how under-staffed, under-paid, and under-supplied they were. It’s hard to really get a full picture of the treatment patients get without actually sitting in the room with them, but it’s pretty obvious from the records and from spending time in the hospital that wait times are too long, insufficient time is spent per patient on counseling and examination, and medicine stock-outs happen all too frequently.
The project we are working on is collecting data from patient records up to the point that they initiate ART. We’re trying to find possible reasons people stop coming and drop-off points in order to make recommendations for how this phase of care could be improved. Patient records aren’t always pretty, and they definitely aren’t in electronic form, so it can be very tedious work.
Going through the files, you come upon notes like “also infected in household – co-wife and husband” or “visited patient at home – adherence is good, but family has abandoned patient and locked him in a room where one person is taking care of him” or “28 year old referred from Gulu prison.” Some (most?) of the files just make you sad – the 7 year old boy who was infected at birth and has stopped coming to treatment or the 20 year old woman who comes diligently every month but is constantly fighting opportunistic infections.
When we entered the HIV wing of the hospital (pictures below give the nighttime view) it was filled with patients who would then wait 2 hours or more to see a nurse or doctor. Nurses we spoke to complained about how under-staffed, under-paid, and under-supplied they were. It’s hard to really get a full picture of the treatment patients get without actually sitting in the room with them, but it’s pretty obvious from the records and from spending time in the hospital that wait times are too long, insufficient time is spent per patient on counseling and examination, and medicine stock-outs happen all too frequently.
No comments:
Post a Comment