CTC (HIV) Mobile Clinic

Thursday, February 7, 2019

Once a month the Ilula Hospital team conducts mobile HIV clinic rounds. The primary purpose is to provide medication for and check the welfare of those HIV positive patients who live too far away to attend the weekly HIV clinic at Ilula. Mostly these are poor people who live more than an hour away from the town and who cannot afford transportation to get to the Ilula HIV clinic. Mobile HIV clinic goes to two sites, each in mountainous villages south of Ilula. The setting is beautiful, with mountains and rolling hills and lush green forests as far as the eye can see.

The team all piled into an Ilula hospital ambulance for the ride to the villages. There were 11 of us in back and 3 in front. The rooftop carrier was piled high with boxes of antiretroviral drugs for distribution. HIV drugs are provided by the Tanzanian government and are free to all who need them. We travelled along dirt roads, bumpy and rutted from rain, up and down steep hills, around sharp turns, across bridges. The ride was something akin to a roller coaster. When we arrived at the first village half of the staff poured out of the ambulance to set up the clinic, while the rest continued on to the second village.

At the first village there were many people already waiting for us. More people were walking to the clinic along the road. There were no vehicles to be seen, everyone arrived on foot. Women were dressed in there most colorful African clothes with babies cleverly tied to their backs with a piece of fabric. Men were there too, but were far outnumbered by the women. The morning began with a speech by the local medical  officer followed by a speech by one of the Ilula nurses. Then we set up a weight station, a prescription station, and a drug distribution station inside the community center building.

There was a long line of people waiting to be helped. The people were serious, there was not a lot of chatter or laughter, quite unlike other gatherings of Tanzanians where people are talking a mile a minute and laughing and joking and enjoying one another’s company. The queue was very orderly except one old man who was protesting loudly and tried to budge. The others just ignored him. There were no angry words or  pushing.  Probably the villagers know this crotchety old man and know just how to deal with him. As each person entered the building, they were weighed at the nursing station and the weight was entered into the paper chart (No electronic medical record here!). Each proceeded to the prescription station where the chart was reviewed for signs of weight loss and a brief series of questions about how they are doing. If there were no new problems or symptoms the patient proceeded to the pharmacy station where they were given a 2 month supply of antiretroviral therapy. Almost everyone takes the same 3 drug regimen combined into one daily pill. Only those who have failed to respond go on to second line therapy. 

We saw 104 patients, 101 of whom were doing well, no weight loss, no symptoms of opportunistic infection, going about there daily business like the rest of the people in their villages. Three people had an acute respiratory illness, one of whom needed further evaluation. There seemed to be so many people with this condition. The line of waiting patients seemed endless. It was hard to remember that although 5% of the people in Tanzania are HIV positive,  the vast majority, 95% , are negative. 

When we finished with the clinic, we all piled back into the ambulance for the ride back to Ilula. On our way we stopped to do home visits for 3 patients who were too ill to attend clinic. These were people, who, for a variety of reasons, were non compliant with taking their antiretroviral drugs. Each of these patients was very ill, lying in a dark mud hut, on a mat on the dirt floor. The suffering of these people was almost palpable.

We new comers came away with some very deep impressions. 1. Medication compliance is absolutely critical. People living with HIV can have long and productive lives if they take their medication. They are much less contagious if compliant, which is so important in reducing the burden of this illness on Tanzanian society. 2. Those people who are non compliant or non responders, endure terrible, really unspeakable, suffering. The mobile HIV team does a great job in ensuring that the most HIV positive  people are taking their meds as prescribed, and are working and productive members of their community. 

Deb Mangham MD