My defined position in the clinic

Several weeks ago, I discovered what my main responsibility is going to be this year...working with our 20 HIV positive children. Somebody from the clinic brings these children monthly to their appointments in the infectious disease program in the public hospital in the capital city. Over the past year or so, the doctors there have refused to write in our charts from the Ranch, therefore, leaving this responsibility up to our clinic staff. None of the girls in the clinic are actual nurses, but are the equivalent to nurse assistants at home, as far as their schooling goes. They have had on-the-job training, which gives them the ability to do IVs, injections, and such. However, due to their lack of actual nursing education, this has caused many problems when they are left with the responsibility of attending consults, asking appropriate questions, and writing notes from the hospital appointments. This leaves us with problems of information and medication doses getting written down incorrectly, which leads to obvious problems in their treatments. So, between Nora (the clinic coordinator), our doctor from the Ranch, the international medical director of NPH, 2 volunteer doctors here from Germany, and myself, we have decided it is best for continuity of care for these kids, if just one nurse from the clinic is responsible for going with the kids to their monthly appointments (before it would rotate through everybody in the clinic, a different nurse going every week, leaving nobody that really knew each child's case). So, over the past several weeks, I have taken on that responsibility, and have been going with them to their appointments, organizing their charts, and developing a system in which it is easier to control their treatments. One of the German volunteer doctors, has had experience working with HIV positive patients in Africa, so we will be working closely together on this project. I'm happy to have been given this opportunity, to work more with these children, and learn more of the aspects of health care for this population, as it is an area I have considered going into at home, someday.

However, as you can imagine, this isn't a task that is so easy. Other than the frustrations of having to deal with the disorganized medical system of the country, lack of reliable lab tests, and the lack of well-educated doctors we deal with occasionally (I just found out the doctors that work in the infectious disease department aren't even trained in infectious disease...there are only something like 5 of them in the entire country), it's emotionally draining as well, seeing these kids that I have grown to love, and having to accept the fact that there is health care available in this world that they don't have access to, and having to accept the fact that some of them will die before they have been able to live a full life. We have a few kids that are progressing faster than others...one of them even that the doctors are talking about just treating now with palliative care. He has developed resistance to all anti-retrovirals, and his immune system is down. He's only 12...sweet, cute kid. Keep him, and all of our other children in your prayers. This week we are going to work on developing a type of "support group" (i use that only for a lack of a better term) for our HIV kids. One of the German doctors and myself will be in charge of organizing it. I think it will be difficult in the beginning, but hopefully it will get better with time. Several of our kids, especially the older ones, have had bouts of depression and aggression, so we're hoping this group gives them an outlet.