Managing HIV in Malawi

Shown above from left, with different client, the health workers who participated in Zainabu’s care: Fanny Chirwa, TB nurse; Mike Master, community health worker; Levison Longwe, clinical officer

Four years ago Zainabu hovered near death on the wards of Partners in Hope. Her body was cold, thin and shutting down. For someone with such a low blood pressure, her heart should have been racing. Instead, it barely ticked along.

We acted quickly. Intravenous fluids flowed through a vein in her arm. I hurried to the tuberculosis clinic and grabbed three of the big red combination pills used to treat the disease now rampaging through her system. Zainabu was able to swallow them, after which we gave a dose of steroids, fearing that the infection had damaged her adrenal glands, an important factory for stress hormones.

By the next morning, her body had returned to normal. Well, not to normal, but to a more normal response to infection: fever, fast pulse. She was fighting.

Zainabu survived the immediate danger. The chronic recovery proved more problematic. A commercial sex worker, Zainabu had a strained relationship with her family, who were not pleased with her behavior. Still, her mother took her back home. Our community team made many visits, encouraging Zainabu to swallow her medicines faithfully.

The uplifting ending would be that she lived happily ever after. Instead, Zainabu struggled to take the antiretrovirals consistently. But she remained relatively healthy and out of the hospital ward.

While visiting Partners in Hope last month, I learned from Mike, the lead community health worker, that Zainabu was sick again, now unable to walk without support.

Her speech slurred, her gait shuffled, her hands shook (see video: she answers correctly but inarticulately.) A test confirmed suspicions: Zainabu had syphilis in the brain. The HIV medications were failing. She would need a course of intravenous antibiotics in the hospital and a new regimen to control the virus. Again, her family came through. This time her sister helped to pay the hospital bill.

With antibiotics Zainabu improved. Her coordination and speech will likely never be normal. Syphilis of the brain has a nasty habit of relapsing after initial therapy. The trend was not a good one. How many severe infections can one survive in Malawi? As Yogi Berra famously remarked, “It’s déjà vu all over again.”

The truth is that managing HIV infection is just that, managing. There is no cure. There is no “solution.” It’s a hard, slow plod alongside the patient, marked by both easy and hard stretches. It’s what makes institutions like Partners in Hope so vital. The team will be there, even the next time Zainabu falls ill.

Reported May 2015 by AMHF Executive Director: Jon Fielder, MD

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