A Clinic in the Hills

Uganda’s nickname as “The Pearl of Africa” undoubtedly comes from its lush and hilly Southwest. Along its western border, the Rwenzori Mountains separate the Baamba and Bakonjo people and their cattle herding from the majority Banyarwanda of the Democratic Republic of Congo. Further to the south, the Virungas Mountains and their crystalline lakes are shared by Rwanda, DRC and Uganda.

I met my friend Alexi during a weekend trip to Jinja. Also from the coastal North County of San Diego, we talked about our shared friends, life at home, and the trials and triumphs of our work in Uganda. As a public health Peace Corps volunteer, Alexi had been assigned to work in a government health clinic in a small, remote village called Kazo in Southwest, Uganda. 

Home to the Banyankole people, Kazo is a beautiful and peaceful land, but one battling the vicious plague of HIV/AIDS.

I arrived at the health center having very little experience interacting with HIV/AIDS patients. On my first day there, Alexi showed me around the different wards and then introduced me to the clinic staff who welcomed me into the lab and walked me through the process of HIV testing, result delivery, and counseling.

One by one, patients came in and sat down to have their fingers pricked by a small needle. A drop of blood was placed upon a reactive strip of paper and within minutes, results would appear. 

In the span of an hour, I watched as six patients extended their hands and winced as the needle went into their finger. Of the six who came through on this Tuesday morning, half would find out they were infected with HIV.  Perhaps the most tragic of cases was a young girl barely 17 years old. As the clinicians read the positive results, they talked amongst themselves about the unfortunate case: with all of the outreach efforts to educate the community about the risks of unprotected sex, how did this girl become a victim so young?

As each patient returned to the lab for results, they were counseled. Two young men under the age of 21, both negative, were reminded of the risk of sex and warned that a negative test did not necessarily mean they did not have the virus in their bloodstream. Those who had positive results were sent to a trained counselor who explained their options for treatment and offered advice on how to continue living as fully as possible with the virus. 

During my second day at the clinic, I was taken to a room where tubes of HIV-positive blood were entered into a CD4+ analysis machine. The machine was in its first week of use at the clinic, a celebrated recent addition provided by the Ugandan Ministry of Health. I watched as the machine counted the CD4+ levels within each sample, essentially determining how able the body’s white blood cells are to respond to viruses and diseases. While a healthy person has a CD4+ count ranging from 800-1300, the lowest CD4 count of the day belonged to a 21 year old girl whose blood cell count was only 23, well below the threshold of 200 that makes one highly susceptible to opportunistic infections. Below 50 CD4+ cells per micro-liter of blood, the immune system becomes too weak to fight off normally harmless illnesses that can rapidly cause weight loss, blindness and death.

I was amazed by how the clinicians casually handled each result which affected me deeply. Minutes after recording a patient’s personal information and extracting their blood, they would be forced to play the role of God, informing a patient about their status and estimating how long they had to live.

After some time, one clinician suggested I receive an HIV test. At first, I refused, sure I was HIV-negative. But as I sat there in the lab and watched patient after patient enter, I started to think: in the past few months, I had cut my hand open with a knife in a kitchen shared with an HIV-positive woman; I had been pricked by a used, but supposedly sterilized needle when I was sick with malaria. I sat beside the lab worker and my heart raced as he prepared the needle. While I knew my chances of infection were much lower than those who had knowingly engaged in risky behaviors, I suddenly understood the uncertainty and anxiety present in a world where roughly 13% of the population has the deadly virus.

My results appeared quickly, and luckily were negative, but the experience of receiving the test in such a setting shook me to the core.

For the past 30 years, AIDS has ravaged Africa, debilitating families and prematurely ending lives. I realized early in my visit to the Kazo Clinic that the life of a medical health provider in Africa is incredibly noble, but ill-suited to my compassionate nature. For Alexi, an aspiring MSF doctor (Doctors Without Borders), dealing with such cases had become the norm. Over the past two years, he had witnessed countless patients come in with weakened, skeletal bodies, suffering from infections like pneumonia and tuberculosis, who came to the Kazo Clinic to die.