Treating cholera is now routine- The nurses are well tuned in, the protocols are effective. The doctors handle the strange ones- fever or blood or too much pain, relapses and complicating illnesses. Things are way down the road… pretty gratifying after just 6-7 months. We manage about 1-2 admisssions an hour- it’s hard to find places to put them, and there’s big pressure to discharge them, but the assessment and early intensive care is no longer a puzzle. If they get to us, nobody dies.
Back at Bon Fin, I was so impressed with medicin sans fronteirs’ ability to calculate precisely how much tarp, how many mops we’d need, how to arrange the entries and exits. And they got it right, the latest email reports suggest the disease up there is manageable.
So that’s how you work a plague these days- great excitement, then settling into a routine.
It begs the question- how should we manage that other great plague, HIV?
Haiti’s HIV/AIDS rate is 4%, they say- a lot, but it’s no Chad, or Zambia with rates of 40%. Low enough there’s still loads of social stigma and shame, plenty of denial.
There is a government authority, GHESKIO, that manages AIDS patients near St Damien’s, but people don’t seem to like it- govt medicine is pretty impersonal (get ready!), and they line them up to get their meds in the SIDA (AIDS) line- people hate being singled out like that.
St Damien’s is mostly a children’s hospital, so they got certified to treat AIDS in children, then young mothers. They are ambitious, so they are building an adult hospital right this minute- it has a GI lab, among other wonders.
They brought Dr Maria Gambirazu, ( Name alert, Fabio and Giuseppe- God, I wish I was an Italian!) an AIDS scientist from Univ Milan. She knows many things about AIDS, but never treated cholera, so today we worked the cholera wards together, and as always, we had about 10 AIDS patients I’d been taking care of en passant.
My approach was to dose them with antibiotics early, try to clear the cholera, then ship them to JESCO, and wish them well. There was a little of Alex’s sayonarra fror Osama, as I’d learned it at Baltimore City Hospital- AMFYOYO, which begins predictably, and ends “you’re on you’re own.”
Maria is a whole new factor. She’s very skilled at looking at, and characterizing the severity of AIDS, assessing the complications and prescribing treatment for AIDS…
and then what?
Kim and Farmer arm-twisted big Pharma into cheap medicine prices for 3rd world multi-drug resistant malaria, saying 1) we’ll create the drugs in violation of your patents in Zambia, come and get us if you can, and 2) the disease will come home to you soon enough if you don’t let us treat it in Africa, Siberia, Peru and Haiti.
So they gave them up cheap, the outbreak was contained, and now they’ve done the same for AIDS. It costs $1500/ year to treat an AIDS patient with the necessary antiretrovirals, antifungals and antibiotics- at least 15 times that in the US or Italy. The only uniformity is that the price is pretty unreachable in all locations- who knows why?
How much is a Haitian worth?
Rick Freschette, the stevedore/doctor/priest with a carpenter’s belt, thinks they’re worth at least $1500, and he’s leaning on Maria to make it so…
In the US, AIDS is out of the realm of regular doctors- sequestered into dedicated units where everybody is familiar with the disease, the drugs, and the patients. It’s routine, like cholera. Nobody dies- sound familiar?
Now I suppose I’m going to have to learn all those nasty drugs after all. The side effect profile alone is worse than Kreyol.
But to make routine the reclamation of these emaciated souls, to render the high drama of care in extremis into some bland procedural process, to make it so MSF might say “well you’ve got 100 AIDS patients, you’ll need 10 pounds of Bactrim, 5,000 doses of ARV’s, 5 isolation beds,” etc…
A person could mistake that for progress.