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I'm in Uganda for a month, taking care of patients on the female ward at Kisoro Hospital. Recently I was called away from clinic for an urgent admission. I arrived to find a thin woman in her 50s, dressed in swaths of colorful fabric.
She was carrying one of the little black plastic bags that people use to bring vegetables home from market. Before I could ask her anything she coughed, hard and wet. Then she spit a mouthful of bright red blood into the bag. She had a fever of 101F and had a big right side infiltrate. I didn't need a laboratory to tell me this woman had TB.
This woman is a cardiac patient in the chronic care clinic. There are several pages of notes documenting her heart condition, which is known as endomycocardial fibrosis. She's been seen by the legendary Jerry Paccione, who politely rebutted the previous resident's opinion of hypertension with a "not likely" scribbled in the margin.
We talked for a while, and eventually I thought I had a pretty complete history. I started to finish up, and sent my mind back across the most likely diagnosis. Why did this woman get TB?
"Have you ever been tested for HIV?" I asked her.
The way her eyes went left and right, scanning for nosy ears, immediately told me the answer. I stepped forward so she could whisper, and motioned my translator to do the same. The words she muttered were barely audible.
"She has HIV," my translator said.
I looked down at the five pages of "Chronic Care Management" notes I was holding. They went back as far as 2006, and she'd never mentioned the fact that she had HIV.
"Do you have a doctor taking care of your HIV?" I asked. She said she went to the HIV clinic in this hospital for her care.
So she wasn't telling her heart doctor that she had HIV. And she wasn't telling her HIV doctor that she had a heart condition. The two sets of doctors were a hundred yards away from each other, and for three years this duplicity had been maintained.
It makes me angry. I can't help it. You don't want to talk about HIV? You don't want to bring it into the open? Fine. But other societies have been down this road before. I was just a kid when the HIV epidemic started in the U.S., but even I remember that Silence = Death.
(I'm keeping a blog of my experiences in Uganda at www.whougandabelieve.blogspot.com)
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