Day Eighteen: HIV Clinic

With M away in Bangkok this week, I've been spending the past couple of days hanging around in the clinic with Dr. S, the HIV doctor. Almost singlehandedly, he oversees the care of the 800+ children who have been diagnosed with HIV at AHC. Since pediatric HIV doctors are so scarce in Cambodia, his patients come from all over the country just to see him. They come from as far as the Thai border, which, due to limited access to transportation,  usually takes about a day for travel to follow-up appointments.

Just thinking about Dr. S's job makes me tired. Because of his specialized training, he has no choice but to hold an outpatient HIV clinic every single day in addition to other duties in the inpatient ward. Despite all this, he still manages to provide excellent patient care, even having a reputation for being particularly strict with patient follow-up. Having lost many members of his own family to HIV, Dr. S has a burning passion to make sure that no other children under his watch will fall victim to the disease under his watch. His patients all call him their "father." Honestly, it's not hard to see why.

And it is truly incredible to watch. There is such a high rate of compliance in the HIV clinic at AHC that it really puts anything I've ever seen to shame. Dr. S only gives out 2 months of Anti-Retroviral (ARV) therapy to patients to ensure that they return for follow-up. And even if families come from hundreds of kilometers away, he will frequently admit patients to observe their HIV therapy and make sure that their families have places to stay. Since they are all generally placed on triple-combination ARV medications, the patients' caregivers are all given proper education for a week before they are allowed to administer medications on their own. In addition, there are staff members (usualy nurses) who organize homecare visits out to the rural villages to check up on HIV patients and their families. There is also a substantial food support program that is provided in conjunction with the medication, which is particularly helpful for the many families in the region who are virtually poor subsistence farmers.

It is amazing the range of patients that walk in to Dr. S's HIV clinic. There are HIV-infected children who have been treated with ARV therapy for years and are asymptomatic. Others are not so lucky, such as one 8-year old child who walked in with advanced stage HIV and TB, coughing violently and looking very much like a walking skeleton. I watched as Dr. S talked and examined all of them, seeing around 11 patients in the morning and 7 more in the afternoon.

In two days, I get to participate in the homecare visits with 3 HIV patients in the villages. Am looking forward to seeing how this all works outside the hospital...