Mozambique

I'm about to wrap up a week and a half in Mozambique, and I have to say, I have never been more excited to go back to Kampala.  It's been a good adventure and definitely a good learning experience, but figuring out a new place (two new places, I was in Maputo and Beira, a port town in the middle of the country) by one's self in an unfamiliar language is a little tricky!  On the upside, Mozambique has an amazing coastline and spectacular seafood, so my senses have been kept happy.  Internet here is spectacularly bad, but I'll post photos as soon as I can.

I am in Mozambique to work on a research project.  In 2010, CHAI co-published an article in the Lancet about the impact that point-of-care testing could have on reducing patient loss.  The findings showed that allowing patients to get a CD4 test (which determines whether they can begin antiretroviral therapy basically by measuring the strength of their immune system) the same day as they test positive resulted in fewer patients getting lost before beginning ART.  

Now, we're trying to figure out if that impact is sustained by following the same two groups for 2 years from their enrollment in care.  To do that, I go through patient files and track whether the patients are attending, whether they initiate ART, and when they are getting CD4 tests.  The work can be a bit tedious (thankfully I don't have to do much of this type of work), but it was really interesting to see how health centers in Mozambique are different and similar to those in Uganda, and patient files themselves can be fascinating. 

Flipping through files, certain ones stand out and make you want to cry-- the 12 year old who can't seem to shake tuberculosis, the mother of 5 who died at 32 after being in care for 2 years, the 6 year old who died just two months after enrolling into care.  Some are unexpectedly entertaining - the woman who managed to put on 50 pounds going from 90 kilos to 110 kilos in the 2 years after she was diagnosed (it usually goes in the opposite direction!), or the man who shows up every 6 months or so just to get a CD4 test and make sure that he is actually miraculously staying as healthy as he feels.