Morning Rounds 3-- The Retro Clinic

On the walk home from clinic today, a pickup truck passed me with a BABOON sitting in the flatbed. Just hangin out. Wow. Working in Africa is awesome sometimes!

On a more clinical note, today was the weekly Retro Clinic at the Korle-Bu Children’s Health Block. While I’d like to say that Wednesdays are the day everyone whips out their bellbottoms and tye-dyed tshirts, unfortunately Retro in this case refers to HIV (a “retrovirus”).

For those of you who are interested (which I assume you are if you’re reading this blog), the following passage from my Handbook on Pediatric AIDS in Africa is very informative:

“At least 90% of the 2.1 million HIV+ children (<15 yrs. old) worldwide live in sub-Saharan Africa. The high infection rate of children in Africa results directly from (1) the high HIV infection rate in women of childbearing age and (2) the efficiency of Maternal to Child Transmission (MCT). It’s currently estimated that in developing countries 1,600 children are infected daily by their HIV+ mothers.”

Accordingly, the Retro Clinic at Korle-Bu works closely with the Prevention-of-Mother-To-Child-Transmission (PMCT) counselors at the Maternity Ward. They recommend HIV screening of all pregnant women, which the counselor told me has been very successful at screening almost all the patients. Now the task is to recruit more pregnant patients to Korle-Bu!

Once an HIV+ pregnant patient is identified, she is (1) counseled on the pros/cons of Cesarean Sections, breastfeeding, and safe sexual practices, (2) offered antiretroviral medications in the perinatal window to prevent transmission to her child, and (3) recommended for followup at the Adult Retro Clinic. The counselor told me that this has been a very effective program with mothers who are fully compliant. Unfortunately, some pregnant patients forgo these treatment options because they are afraid of the social stigma associated with C-sections and nonbreastfeeding, or they are simply in denial. I saw one woman in counseling who was diagnosed with HIV several years ago, pregnant with her second child, and had never been treated at all. That was a difficult session to witness....

The Retro Clinic at the Children's Block is (sadly) a hoppin place. Almost 50 patients are seen every week in the span of roughly 4 hours. I'm sure I won't have trouble recruiting my study patients here, and as expected, there is lots to learn about medicine in resource-limited settings from an afternoon at the clinic:

Some things that have disturbed me at the Retro Clinic:

-There are 3 exam rooms, to which the doors are never closed. So everyone in the waiting room can see the patients’ interviews and exams.

-Two doctors see two patients at a time, in the same room.

-The nurse overseeing PMTCT (Prevention of Mother-To-Child Transmission) counseling advises her HIV+ patients to avoid breastfeeding if possible. My pediatric mentor, on the other hand, advises all patients to breastfeed, because malnutrition is a formidable foe here in Ghana. These mixed messages must cause confusion. Pair this confusion with the strong cultural pressure to breastfeed, and most HIV+ mothers here are breastfeeding. Like the ones I saw in clinic today….

Some things that impress me at the Retro Clinic:

-The same nurse works the front desk every week. I think this consistency is great, because the nurse must have a level of proficiency in her work, and she may even get to know the patients. Familiar faces can be very comforting.

-The charts include a standard WHO progress booklet, in which the WHO staging system, clinical details, and a full history are included. This helps to coordinate care between the labs, physicians, and nurses. It will also hopefully help me in data collection!

Obviously some of these problems cross cultural barriers, and others are dealt with both in the US and in developing countries. Nonetheless, they are difficult each time I learn about them or encounter them firsthand.....