Reflections for October

Abstract

Presents a case study of Loveness Mwinga (not her real name) steps out of my sparsely furnished clinic at Chikankata Hospital and into the bright Zambian sunshine. She is tired, having walked for 4 hours to make it to her follow-up appointment with the Epilepsy Care Team and collect her 3-months’ supply of phenobarbital. Without warning, her convulsions would begin with falling backwards and then violent whole body spasms. As part of her antenatal care, Loveness attended the Maternal and Child Health program’s clinic. Triomune is substantially more expensive at $198 per person per year, but the second-line antiretroviral agents that could be used with an enzyme-inducing agent are almost $500/year and are simply not available at most of the HIV clinics in the region. I have only one medication to offer Loveness for her epilepsy. Muka Buumi has only Triomune to treat Loveness and protect her unborn child from the ravages of HIV/AIDS. As Loveness slips into Muka Buumi Clinic, I worry about the impact of my decision on her HIV care and I ruminate on the future hypothetical patients who may find themselves with a form of HIV that will not respond to available treatments. (PsycINFO Database Record (c) 2012 APA, all rights reserved)