Monday, January 19, 2009

Medical and Moral Dilemmas

Two youngsters in our pediatric unit spiked fevers of 40.1C (104+F) within one hour yesterday, shortly after they had received blood transfusions for anemia. Since they've responded to IV quinine, the probable cause was malaria-infected blood -- a classic question of the cure being worse than the disease. In this case, as Dr. Hardison explained, "We could screen for malaria in the donated blood, but we'd probably eliminate half of our supply" -- which is obviously at a premium. Instead, we will be prepared to treat with quinine before transfusing anyone. Adults experience malaria as a flu-type misery; young children experience it as a life-threatening illness.

Two mamas on Ward II, both of whom tested HIV-positive, were admitted this week with serious opportunistic infections. After they agreed to be tested and were then informed of their status, both separately refused counseling and registration at a Comprehensive Care Clinic -- ours or anyone else's. Although they could qualify for and receive free anti-retroviral drugs and medical care, Diana and Ritah cannot cope with the social stigma of their diagnosis. This is a recurring problem. Women in rural Kenya are afraid to be seen going to a CCC because their husbands may discover their status and dismiss them -- and quite possibly their children.

We cannot force them to get treatment, of course. We can only encourage them to go with their husbands to get (re-) tested together. In almost every situation, the husband has infected his wife/wives, but the female is the first to get sick. If a wife is diagnosed as HIV-positive, however, the husband will often refuse to be tested and will conveniently blame and abandon her. He will continue to infect other women while his wife and his children may die. PEPFAR funding and HIV/AIDS education have made great inroads in Africa, but social stigma is the same the world over.

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