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Dr Meena Okera – South Australian Doctor in Homa Bay, Kenya
Dr Meena Okera, a doctor from South Australia, is on her first mission with MSF and working on the HIV/AIDS and TB programme in Homa Bay, Kenya. Here, Meena describes the human side of a doctor’s work in a high prevalence setting. It happens every day. On a multiple basis. I watch as the two faint lines appear slowly on the reagent paper. Confirmation. The test is positive. Ninety percent of the time the test only serves as proof – the telltale signs of oral thrush, fever, loss of weight, malaise - are enough to suggest the patient is HIV positive. Still, there are surprises – a grandmother who presents with TB and incidentally agrees to have a test, an infant whose mother’s status is unknown and suddenly, mother and child are presented with HIV positivity. It’s so common here. Numbingly. I have come to dread those two little lines – a fingerprick, a drop of blood, a pipette of reagent and ten minutes later….boom, life changes for a human being, forever. Normality takes on a different meaning. The fragility of life assumes its lingering stance in the background. Here in Homa Bay, the HIV prevalence is one of the highest in Kenya – approximately 35%, compared to the national average of 6%. Complex social patterns are partly responsible for the vast difference but the politics and challenges of health care and public health also play their part. However, I’m neither a sociologist nor a politician. But I can see that it’s no wonder that MSF has been here for over ten years. The HIV epidemic, surely, is slowing but its aftermath continues to escalate. The consequences of such a chronic illness, on such a huge scale, requiring life-long therapy and observation, are immeasurable. Furthermore, the effect on families, on communities, on their sustainability, on their ability to develop and grow – is devastating. MSF provides a crucial role in the HIV/TB program at the district hospital in Homa Bay, providing comprehensive integrated care to patients in collaboration with the Ministry of Health. As the ‘TB doctor’, my daily routine is primarily based at the chest clinic and on the TB ward but no clinician here can escape the ever-present entity of HIV. 90% of newly diagnosed TB patients are HIV positive and in this high TB-prevalence setting, an HIV positive individual has a lifetime risk of contracting TB of 50%. The two diseases have certainly become partners in crime. Despite being faced with the situation on a daily basis, how hard I still find it to look across into a patient’s eyes, to tell them that they have TB and will need treatment every day for six months. And then, after seeing those two little lines, having to first pause and take a deep breath before looking up at my fellow human being and explain what it is to be HIV positive and how they will need to embark on a lifetime of taking anti-retroviral drugs and attending clinic appointments. Things are bleak yes, but pole pole (slowly in Kiswahili) things are changing. Antiretroviral drugs and health care services are here but now the challenges lie in ensuring that they are accessible to all and that somehow, in the midst of all the problems, ensuring that the quality of care and the principles of medical ethics, are not compromised. Each HIV positive individual has the potential to lead a healthy, normal, fulfilling life and together we should all be working to achieve this. My praise and admiration goes wholeheartedly to the people who will continue to devote their time and effort towards helping their neighbours and improving the standard of care. Things have come a long way already but never forget - there is still so much work to be done and so many who remain in need.
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