There is little that a nurse hasn’t seen. In a hospital, the unexpected can happen around any turn, and many of the things I’ve encountered left a lasting impression. Still, it is what I have seen as a volunteer that remains the most vivid.
I have been a nurse practitioner since 1994, and I currently work at the Montefiore Medical Center for Positive Living/Infectious Diseases Clinic in the Bronx, New York. My duties include managing the care of HIV patients, and I recently started a diabetes clinic within our HIV clinic to help people dealing with this co-morbidity.
My work has instilled an interest in me for educating people about HIV and developing curriculums for nurses and nurse practitioners in developing countries, particularly regarding HIV care and co-morbidities. For the last five years, I’ve spent my summers traveling to work with patients infected with HIV/AIDS and provide both treatment and management education to health care providers. My travels have taken me around the world, from Nigeria, Israel, Lesotho, and India to the Dominican Republic and Kenya.
Leaving the greatest city on earth to spend a summer with the sick may not sound like a season well spent to many, but I knew the need for nurses was great. When a group of colleagues returned from a recent trip to Africa, they mentioned that they never saw any African American volunteers. I was amazed and saddened, and I decided I needed to make a difference.
In March 2005, I took my first volunteer trip to Ife, Nigeria. I traveled with two nurse practitioner colleagues. Our mission was to conduct an HIV management seminar for nurses, community workers, and physicians. We also visited a hospital and participated in support groups, speaking to HIV-positive patients. All were highly knowledgeable of HIV prevention methods, but I noticed that stigma was still a big problem for infected Nigerians.
This trip was quite the eye opener. I had to learn very quickly about the class system in Nigeria, where people do not mingle and cohort with those “lower” than themselves. This had an impact on the treatment of HIV-positive patients. Health care workers did not work long hours. Patients admitted to the hospital slept on bare mattresses, because there were no bed sheets. Those who needed to be dialyzed were not allowed to use the one dialysis machine in the building, which was reserved for all other patients—we were told there was no “dirty machine.”
Few patients were offered antiretroviral drugs because there was only a limited supply, provided by a clinic in New York City. I worked with many patients and met several who did not survive much longer after we left the country. I came home appreciative of my life and determined to continue to give back.
During the summer of 2009, I spent three weeks in the village of Dagoretti in the Lenana slums area of Nairobi, Kenya. I went there not knowing anything about my living facility, but I decided I would make do with whatever the circumstances. When I arrived in Kenya I could not help but think about how I was going to leave shortly, but the people there had no other way out.
I ended up living with a woman named Margaret, a pastor born and raised in Lenana. She was very proud of her heritage, but I confess, I had a hard time understanding why. Most people living in the slums rented from her parents but had no means of paying. She lived on the ground floor of an apartment building that would be considered well-off by slum standards. We had electricity, indoor plumbing with a hot water shower, a maid, and plenty of food to eat. The first night of my visit was quiet, but filled with anxiety over what the following day would hold.
I woke up at 8:00 a.m. the next morning and chatted with Pastor Margaret until 10:00 a.m., when Elosie arrived. She was to be my escort to the patients I would be seeing that day, and she had walked three miles to meet me. During our 90-minute walk back to her clinic, Elosie explained what I would be doing. She worked in a very small office with one other person, Josephine, and their job was to provide care to homebound HIV patients and their families.
Elosie and Josephine had no medical training or experience. They both were in charge of a testing and counseling center, yet had run out of testing supplies over six months before. When people stopped by for testing, they had to be turned away. We visited two HIV-positive patients. Both lived in one-room homes with deplorable facilities. We were finished before 2:00 p.m., the end of their workday. I walked back home, knowing I needed something else to do for the rest of the afternoon.
Pastor Margaret then took me to meet Kilowsi, an HIV infected patient who was in charge of the testing and counseling center within the slums. Again, there were no supplies, so he could only provide counseling. If someone needed testing, Kilowsi would personally escort him or her to another clinic about three miles from the village. He knew everyone with HIV in the community and had developed a personal relationship with each. I continued helping Kilowsi after my work was finished with Elosie for the remainder of my stay, doing simple health assessments and blood pressure screenings in the community.
The next day, Pastor Margaret told me there was a very ill HIV-positive woman nearby named Carol who was possibly dying of malaria. I had limited knowledge of treating malaria, so I went feeling nervous. I packed my medical bag and was escorted to Carol’s home, where I found her lying in bed in a very dark and damp one room house made of metal and concrete. On the floor were two small bowls of rice her neighbors had dropped off three days before, but she could not eat.
Carol’s daughter had come home from boarding school because of her condition, and her 12-year-old son, who had a developmental delay, was there too. The boy had a history of seizures and no access to medication. It was clear he was having frequent attacks because his seizure induced falling had caused a lot of bumps and bruises over his eyes and around his head. The family was especially concerned for him, as it was thought that the only one who could manage him during his seizure attacks was his mother. A minister was also in the room, giving Carol her last rights, and some neighbors had gathered as well.
Carol did look ill, but I immediately knew she was not dying. I found no high fever, a sign of malaria. She was also fully awake, alert, and oriented. Carol said her back was bothering her the most. We flipped her onto her side and found the problem—ulcerated herpes lesions on her buttocks. I went back to my room at Pastor Margaret’s and collected Valtrex, multivitamins, and some Motrin. I started Carol on as much medication as I could spare.
By the next day, Carol was already feeling better and had eaten the then four-day-old rice. I brought her cornmeal and some vegetables because she had no money to buy food. On day three, Carol was sitting in the chair awaiting my arrival, and by day five she was fully recovered from the lesions. I often wonder what would have happened to her if I had not intervened; I know the mind has a powerful affect on health.
Inspired by my experience with Carol, I began making home visits within my immediate surroundings. If I saw 20 patients in a day, over half had high blood pressure. A standard clinical visit in Kenya did not entail a blood pressure check, as it required an extra fee people could rarely afford. I worried about these findings because people could not afford health care or medications. I counseled the patients I saw regarding diet and restricting their sodium intake, and they were open to my suggestions.
One of the more heartbreaking cases I encountered was another patient from Lenana, who was both HIV-positive and diagnosed with cervical cancer. She came seeking help, and I learned that she had five children, her husband died of AIDS, and she was on the brink of eviction. Her biopsy revealed high-grade carcinoma, and she needed $300 to be admitted to the hospital, though that did not include surgery or medicine. She worried about her children and who would care for them if she died. She said she waited for death every day, because there was no other way out of her suffering. This situation affected me more deeply because I knew how different her life would be if she lived somewhere else.
It seemed that every day there were new health issues. The community was plagued by asthma, caused or exacerbated by the garbage and animal feces surrounding the slums, a condition I didn’t come equipped to treat. I saw an HIV-positive patient with an infected great toe that had gone untreated for years, who felt hospital visits were a waste of time and money. I visited a maternity ward that did not resemble a hospital at all, where I was shocked at the haphazard treatment of newborns and babies waited their turn for a single nebulizer. And I ventured to a Maasai tribal village, where there is absolutely no form of modern health care.
It is estimated that 2.2 million people are infected with HIV/ AIDS in Kenya—almost 7% of the population—with 800 new infections happening every day. Hundreds of thousands of Kenyans have already died from the virus, and hundreds more die daily. BBC News recently reported that in some of the poorest parts of Nairobi, the capital of Kenya, every fifth house is run entirely by children orphaned by AIDS.
More than 50% of hospital beds in Nairobi are occupied by people suffering from AIDS-related complications, causing an immense strain on the already limited medical facilities. As is commonly seen across Africa, women are at much higher risk of becoming infected with the virus. Four percent of men and nearly 8% of women have HIV/AIDS.
Fueling the epidemic is a lack of access to medication. The estimate of antiretroviral medication use has increased dramatically in recent years among adults to over 70%. However, only 25% of infected children receive treatment, due to a combination of factors, including neglect, lack of resources, and social stigma and family shame. As I have witnessed through my travels, antiretroviral medications are often left unused and even expire, due to a shortage of trained medical personnel and a lack of understanding among providers. Though efforts to get more patients on medication have been increasing, logistical and manpower issues and rampant corruption prevent significant change.
When the country experienced political upheaval in December 2007, more than 1,200 people were killed and some 350,000 displaced into temporary camps. Part of my journey included a visit to an Internally Displaced Persons camp in the Rift Valley for the opening of a new clinic. There were no medicines or equipment to run the clinic, but the people were happy because it was a start. I took vitamins and other medical supplies with me, and the doctors and nurses there seemed appreciative. The children living in the camp ran around covered in dirt, carrying their younger siblings on their backs. There was no water, very little food, and a lack of medical care available to the residents. More importantly, there were no immediate plans for improving the situation.
Admittedly, my frustration mounted daily. Volunteering overseas is not without its hardships, and it is difficult to see patients suffering from a lack of supplies that are always prevalent where I work. There is so much that needs to be done, but I have learned from my visits that caring goes a long way in providing comfort to those that have nothing. Volunteering brings me the joy of knowing that while I may not be able to provide much, a blood pressure check or just a hug makes a big difference. The people I’ve treated are always very grateful for whatever health care knowledge I share with them. It is an unbelievably rewarding and fulfilling experience, and nurses are able to make such a difference in the lives of other health care providers and patients infected with HIV, all over the world.
Latest posts by Nathan Cullen (see all)
- Asian American Health Insurance Disparities Vary by Subgroup - April 16, 2013
- Improve Your Hospital’s Cultural Competence without Reinventing the Wheel - April 16, 2013
- Worth 1,000 Words - April 16, 2013