So, I am back after a "mini"-hiatus (thanks to all the "BOOKS" that have been keeping me really busy). So I read recently in the papers about a Kolhapur village "taking back" an HIV+ widow and her child (see link below). One of the causes I was actively involved in, and want to be involved with in future is PLWHA (People Living With HIV/AIDS), especially widows and children. So, here I share a detailed account of my "tryst with HIV/AIDS"....the HOW and WHY, for my association with HIV/AIDS in general.
This case is from my final year, in MBBS, when we were posted in the Department of Paediatrics, and were actively involved in Case-Discussions. This one case I distinctly remember, because I was lauded for my efforts (at case-presentation) by my Professor......and more importantly because the boy's face is etched in my mind till today.
I'm presenting it to you the way I presented it back then.....I guess it'll also give you an idea on how we present cases! It might seem BORING to some, so a WARNING at the outset.....read only if you really are keen on knowin' what happened..... details are (medically) authentic because I have retained the case-discussion notes till today! So, here goes:
(OBVIOUSLY, no personal details revealed----- patient-doc privilege, you see)
The INFORMANT in this case is my patient's GRANDFATHER.
Master V, 9 years old, residing at K village, K district, studying in the 2nd standard and 2nd issue of a third-degree consanguineous marriage presented to our hospital with:
Chief Complaints of: Cough since 8 years; fever since 1 month
The patient was apparently alright 8 yrs back. Symptoms of COUGH began at the age of 13 months.....intermittent in nature, with a crescendo-decrescendo pattern (gradually increasing and decreasing although not having completely regressed). Cough is associated with whitish expectoration about 2 teaspoonfuls in quantity. The intensity of cough increases at night. There are no relieving factors.
Since the last month, the patient has been complaining of fever which is, again, intermittent in nature. The fever is not relieved by medication and it is increased at night. Fever is not associated with chills or rigors.
There are associated complaints as follows:
1. Breathlessness (on and off), which he experiences on walking a little distance.
2. Relatives have noticed that the patient has stopped talking since the past one month, although he can hear and understand what is being said.
3. The patient has developed weakness in both his lower limbs since the last episode of fever. He walks with difficulty and with pain in both lower limbs.
4. The weight of the patient has also decreased due to loss of appetite.
5. There is a history of ear discharge since the past 4-5 months, which has stopped at present.
6. There is a history, of a vomiting episode yesterday. Vomiting was non-projectile, bilious in nature and vomitus contained only food particles.
7. There is a history of passage of loose stools (on and off) since the past one month.
There is, however, no history of:
convulsions, rash over the body, dysuria or frequent hematuria, contact with an open case of TB (Koch's disease), haemoptysis, haematemesis or e/o worms in the stools.
Other RELEVANT PAST HISTORY:
The patient is a known case of HIV infection diagnosed at the age of 13 months, and currently not on any form of ART (Anti-Retroviral Treatment). Patient has had recurrent Lower Respiratory Tract Infections and bilateral ear discharge, since then.
Both his parents have died of "UNKNOWN" causes, as per the Informant.
There is no significant history regarding any hospital admission or surgery in the past.
Family History:
The patient is a second issue of third-degree consanguineous marriage. His father died in 1999 and mother in late 2000. Patient's elder brother has no similar complaints and is non-reactive (i.e. doesn't have the HIV infection).
Birth History:
Full-term normal vaginal delivery, at HOME. Patient cried immediately after birth. Perinatal period was uneventful. There is no history of NICU (Neonatal Intensive Care Unit) admission or any major illness in the neonatal period.
Socio-Economic History:
The informant (grandfather) is the guardian of the child (both his parents are dead, as reported previously). Grandfather is literate (but has studied only till Class III). The patient lives in a pucca house; no history of over-crowding. Sanitary facilities available at home. Tap water is available from a common tap catering to around 10-12 houses in his village.
Dietary History:
The patient consumes 1150 kcal and 30.8 gms of proteins a day, during 4 meals in a day.
The expected intake is 1950 kcal and 40 gms of proteins a day.
Thus, there is a dietary deficit of 800 kcal and 9.2 gms of proteins, per day.
Anthropometric findings:
Height: 102 cms Expected: 122 cms -----Under the 3rd percentile.
Weight: 12 kgs Expected: 28.1 kgs -----Under the 3rd percentile.
The patient is severely malnourished with evidence of wasting as well as stunting.
NOW, normally I would present the examination findings, general and then system-wise examination (i.e the Cardio-Vascular System, Respiratory System, Central Nervous System and the Per/Abdomen findings)..... but that would be Greek/Latin for a majority of my blog readers.....so I'm sparing you the torture.
By now, you may guessed the "WHY" part..... the kind of "trauma" this child faced for no fault of his !
His *&%$%@#@$$@$%$$@ father went and @#$#%$% a CSW (Commercial Sex Worker) without a condom (or "protection" as its popularly known)..... then transmitted the infection to his wife who then transmitted it to this kid. Yeah, I'm playing the blame-game here and why shouldn't I ???
But after a year, I passed my MBBS examinations and was then posted as an intern, to the TB & Chest Medicine Dept. of my teaching hospital ..... and REALITY struck me in a "LIGHTENING" sort of way..... every third (or so) patient who walked into our OPD was HIV +ve and came in for DOTS treatment (Directly Observed Treatment- Short course chemotherapy)...... because Tuberculosis was (and still is) the most common opportunistic infection in our country in PLWHA..... and our government provides FREE TB treatment to our patients at government hospitals.
And now, thanks to HAART (Highly Active Anti-Retroviral Therapy)..... the life-span of PLWHA has increased..... but still, knowing that you have HIV/AIDS and yet facing the onslaught (of recurrent infections and thence ill-health), just like my innocent patient, V, did.... defines TRUE COURAGE for me. Kudos to these brave hearts.
"V" must not have lived long (no follow-up, a common patient issue), because he wasn't on HAART and his grandfather wasn't very genuinely interested in taking care of him..... coz he ( V ) was just an additional financial, emotional and SOCIAL burden on him..... (stressing on the SOCIAL-stigmata part here)..... and that is the "harsh" REALITY !!!
So that's "HOW", I got involved in a cause that is dear to me..... no details on how I actually am involved with the cause, because I don't wanna be a brag-n-tell @$$.
That's my "tryst with HIV/AIDS"..... and this article is dedicated to my aforementioned patient, "V"..... wherever you may be, my dear..... GOD BLESS YOU !
Here's hoping the HIV vaccine becomes a REALITY soon.....
LINK: http://epaper.hindustantimes.com/Publications/HT/HM/2010/08/14/INDEX.SHTML
{Read Page 8 of the e-paper}
