NEWS FROM MALAWI
The people were friendly and happy, and very hard working. Many had to carry water great distances to their families for cooking and cleaning. Since water was at a premium, they didn’t get to bathe as often as we do here. It was hot and humid with nearly daily rain showers for an hour.
The rainy season was 4 weeks late so they are off schedule growing their corn (the main crop). This means the money from their mature crop will come 4 weeks late and they will have hardships. Climate change is messing with their money and lives. The western world has set up corn as the staple there to sell so that is what they grow and eat, rather than more nutritious crops. They make a paste of the ground corn called Nsima and it may taste like library paste to us, but they love it. They grew up with it.
With the rain and heat came critters. I had many in the house I was staying in. Usually about 20 mosquitoes in my room, a small scorpion, tiny and some very large ants, and then some larger termites that are ant-shaped. Also millipedes and a frog visited, along with a stray cat. The mosquitoes liked to hang out on my bed net. The only bite I got was from a couple of mosquitoes flying around inside my bed net. So I made sure to kill any of them trapped in my net before getting inside. I was on pills to prevent malaria, but a visiting surgeon caught malaria even though he was on 2 different prevention pills!
There were a number of patients who died because they linked to care too late for their HIV. Their immune system wasn’t strong enough to assist the antibiotics. Some had pneumonia, others had meningitis. There was a 17 year old mother who was diagnosed with HIV during pregnancy, but avoided care after the baby’s birth. The baby, not treated for 11 months, died under our care.
A 17 year old girl was suffering from a rare anemia problem but was improving. I treated her new stomach pain with omeprazole and 20 minutes later she died. They don’t have the equipment or medications to resuscitate patients. Later we found out she had malaria and sickle trait, but her sudden death was a mystery.
During the rainy season, starting after I left, Malaria will fill the 45 bed pediatrics department, and more will be on the floor in the rooms and halls.
There were no X-rays for those who can’t get to the X-ray department. There were only 4 antibiotics available in the hospital, and that dropped to 3. There were no EKG machines, not enough blood pressure cuffs, or suction machines. Oxygen could only be given in low concentrations since they don’t have many tanks.
Three patients were suffering from fluid on the lungs or body from either liver or heart failure. We ran out of intravenous medicine to make them urinate a lot, so we had to use very high doses of oral medication which wasn’t as effective.
To transfer a patient to another hospital would take about 2 hours over very bumpy roads and critically ill patients might die during the trip.
This experience makes me very thankful that many more now have some kind of insurance coverage here in the US.
HIV PATIENTS HAVE HEARING LOSS
As we age, we tend to lose some high frequency hearing, but HIV patients have more of this and also lose more in the lower frequency ranges too compared to HIV negative people. It is not clear if this is due to the virus or the medications. Those with CD4s below 300 are at greater risk.
LOWER DOSE OF PREZISTA® WORKED WELL TO MAINTAIN VIRAL LOAD SUPPRESSION
Prezista® comes in 800mg and 600mg tablets. The 800mg is the typical dose for starting and maintaining viral suppression. The 600mg is typically given twice a day to those who have protease inhibitor family experience/exposure; this higher dose is given to make sure it works against resistance. It is always given with Norvir® to boost the levels. A new study showed that after the virus was suppressed, the lower dose was good at maintaining suppression.
SAVING MONEY AND LIVES
The new healthcare law funds research into better quality healthcare and cost savings. One of their efforts is to prevent falls and injuries. This effort has saved many lives and much money. They are working on other projects that emphasize quality results in healthcare rather than making money for the providers.
Keep those questions coming. Be Safe!
Daniel Pearce, D.O., FACOI, AAHIVS
Clinical Associate Professor of Medicine, Loma Linda University School of Medicine
Adjunct Professor of Internal Medicine and HIV, Touro University California College of Osteopathic Medicine and Midwestern University Arizona College of OsteopathicMedicine
Researcher, Veterans Administration Hospital, Loma Linda
HIV Specialist, Riverside County Public Health Department
Hepatitis C Specialist and Researcher, Southern California Liver Centers, Riverside