Land of the euphemisms

It smells of cat food again. The “hospital cat” has had kittens, and now both the female ward and the male ward smell weird. I’m doing rounds in the Male Ward with the recently graduated Dr. Shwa’ib and soon learn that the charts are riddled with euphemisms and vague descriptions. A suicide attempt with eating glass is described as “patient had an attack of shock”, patients that can not leave the hospital because they can not yet pay the admission fee “are waiting for their families” but the most common euphemism is that a “patient is suffering from ICD.”

ICD means immune compromising disease, in other words, the patient is HIV positive. More than 15% of the lake side population of Tanzania is infected with HIV, but you will not find it mentioned anywhere at the hospital. Doctors give you meaningful looks when they tell you that a patient “is NON” and “has IDS” (immune deficiency syndrome). A NON patient is a non-compliant patient that knows he/she is HIV positive but is not on, or refusing, anti viral therapy. It’s hard to see that the stigma of HIV is still so widely attached to patients that not even doctors dare to have open conversations about the disease.

Keeping the >15% infection rate in mind made today’s events extra scary. Dr. James was removing a lipoma (benign fat tumour) on an old ladies hand, when during the suturing of the wound his needle slipped and pricked him in the finger. He immediately cleaned his hands and rinsed the prick side, and then he performed a HIV rapid test on himself and the lady. While he was waiting for the results, I was asked to suture the rest of the wound. I’m not exaggerating when I say that my biceps was shaking because of the enormous pressure I had to exert on the needle to get it through her tough skin. No wonder the needle slipped and stabbed Dr. James.

Test results came back when I was finished with my one little stitch: the woman did not have HIV, ICD, IDS or whatever euphemism they wanted to use. Dr. James invited us for a nice evening out tonight, to celebrate.

In maternity ward I saw first hand one of the reasons why somebody would not want to use anti viral therapy for HIV. In one of the beds lay a 25-year-old woman, from top to bottom covered in blisters and peeling painful skin. Her mouth and genitalia are swollen to triple their size. Before today I had not even heard of Steven-Johnson Syndrome, but to see that this terrible reaction was related to anti-HIV medication, made me realise that these are very powerful drugs indeed.