The problem with Livingstone

September 3, 2009

This morning I spent the morning doing home-based care in Nakatindi. Nakatindi is among the poorest communities in Livingstone. Instead of the brick houses that are typical in other areas, almost all the homes are built of sticks and clay. Michael, one of the volunteer caregivers, met us at Nakatindi School and we set off into the community. We saw around ten patients, most of who were doing well. Their major complaint was simply a lack of food. As I mentioned earlier, 1 in every 3 people in Livingstone is HIV positive. Once their CD4+ count drops below 300 they are put on anti-retroviral treatment (ARTs). ARTs are supposed to be taken with food. Unfortunately when food is not available and the drugs are taken the patient becomes nauseous. When vomiting occurs, the drugs cannot do their job.

I started asking Michael about his family as we walked back to the school to be picked up. He said that he has six children. The oldest boy completed secondary school but because he cannot find a job, he still lives at home. His oldest daughter completed the 9th grade but is unable to attend school anymore because Michael can’t afford the school fees ($165 a year). His wife sells fish products at the local market and he spends his time volunteering to help his community. Jobs are scarce here especially for those that do not have a good education. The money his wife brings in is spent on food for the next day’s meals. The children eat first and if there is enough left the parents will eat too.

It is hard to comprehend sometimes how little they have. They buy their food with 2500 kwatcha. This is equal to about $0.50. Some healthcare is free. HIV treatment, medication and testing are free as well as Malaria and TB treatments. Children under 5 are seen for free as are people over the age of 65. Any other treatment incurs a clinic fee of 5000 Kw. They also need to have a book to write their medical history, vitals and appointment notes. This costs them 1000 Kw. Transportation to the clinics can also be very difficult. Those that cannot walk must save up money to pay for a taxi. To top it all off, the clinics may refuse to treat the elderly or those that are severely ill.

All of this leads to a lack of quality medical treatment of those that need it the most. Clinics run out of ARTs and TB meds regularly. The waiting rooms are full of people waiting to see the doctor, if there even is a doctor at the clinic. A lot of clinics are staffed with only a few nurses with insufficient training.

I had a discussion today with one of my fellow volunteers. Lately male circumcision has been promoted as a way of preventing the spread of HIV. It sounds like an absurd thing to be promoting when it may cause a decrease in the use of condoms, but it turns out that it can decrease the transmission of HIV by up to 50%. The problem seems to be more in how the clinics are promoting it. It should not be presented as a cure but rather as another preventative measure that should be used in conjunction with other preventative measures like condoms. The other volunteer said that no one should promote male circumcision because the people here are not smart enough to understand the difference between a cure and something that decreases the risk of transmission. I was in favor of telling people the truth and letting them apply the knowledge. Just because these people aren’t educated doesn’t mean they are stupid. And despite everything that they have to deal with here, they are quite a happy bunch of people.