For pictures
http://web.mac.com/dr.annie.degroot/iWeb/Site/Bamako%20June%2015.html
But start with the words – the simple words of a doctor speaking to a patient, a very thin woman in a yellow headscarf, who is 28 years old and who waited for over two hours to have her turn in his office today. A small child sits quietly in her lap. The doctor asks her some questions. She speaks softly, coughing as she is answering. A medical student looks at her lab results. She has 20 T cells. He asks her if she had ever been given medication before, and she says yes, but it was a long time ago, and the medicine had run out. The doctor pauses, considering what to do. Her life is in danger, but she has no money to pay for emergency treatment, and the hospital is far away.
This story would be the same as one told today in Providence or in New York City. It is a story that is told over and over again, and but for the blue tattoo around the woman’s mouth, and the tattered chairs, the scarred desk, the broken screen and the view into the dusty courtyard beyond, the sweltering heat and the slow ticking of the fan blades, overhead, we might as well be in any clinic, anywhere in the world. But this scene is taking place in Sikoro, not Providence, and I am sitting behind the doctor, watching the scene unfold.
I am here with Sophie Walsh and a medical student (Binny Choksi) who are both outside, talking to the TB care nurse. We are here to contemplate a mission that we have accomplished. We are here to celebrate the completion of a clinic that it two stories high, covered in fresh paint, and filled with gently used but clean and functional equipment. That clinic is just on the other side of the wall from the clinic that I was sitting in, awaiting the ceremonial ribbon cutting, the opening of the doors, the celebration of the work of so many people over many months that has culminated in this dream come true. We are opening a clinic for HIV care in a place that might as well be at the end of the earth – this is Bamako, not Timbuktu, but as far from first world health care as you can go, and still be on this Earth.
This is a place where children look after children, while other children work near by. This is a place where goats, dogs and small boys pick through the garbage in the streets, making sure that there is nothing thrown away that is still good enough to eat. This is a place where one in three to four children dies before the age of five, where (in our small clinic) one hundred babies are born every month, where mothers die in labor without so much as uttering a sound. This is a place where, too, a small tree of hope can take root, where green leaves can shine on slender branches, and where hope and dreams can eventually bear fruit.
Our tree is a clinic named after hope – hope for health. We built it to ease access to care for the hundreds of HIV seropositive patients who are living in this village of 35,000 people. We planted the clinic here at an arm’s reach for the patients, like the one we saw today, because we know she will not wish to travel far for her care. We planned the clinic here for our patients because they prefer to see doctors they know will care for them. Those are the doctors who will pause for a moment when confronted with a young woman they know well, and think about her HIV infection in the context of her while life. What would it mean for her if the doctor made the decision to send her to the hospital far away on the top of the hill? Would she go there? How would she pay for her care? Who would take care of her small child? And what of the family members who would have to travel there to feed her and pay for her care? What of the burden of her care on the family? This is the context of HIV care in West Africa. These are the barriers to health.
Our new clinic has an infirmary where she will be able to get care. Our new clinic has a new laboratory, where we will be able to see if she has tuberculosis, and a conference room where we will be able to plan her return to her home (only a few streets away), where we’ll map out her directly observed TB treatment therapy visits, and her follow up care.
The need is great, and the cost is small. For less than $35,000, we have created a space where patients can receive the care they need right near their home. Right now, less than one in eight patients who need HIV care in Sikoro are receiving it. And less than one in five patients with active TB is getting treatment. We have plans in place to bring those patients to our new clinic, reducing the spread of HIV and TB and improving the chances that each citizen of Sikoro will have a chance for a productive, healthy life.
We have done much to be proud of besides building the clinic. We are improving care, opening eyes to the possibilities of care at the margins, we are using simple tools that are low cost to teach about HIV and to encourage people to seek care. Our ‘hand of hope” peer education program has increased the number of HIV and STD tests at our clinic by four fold. The number of patients in care has increased from less than 20 a year ago to 120 today.
We planted a mango tree in the courtyard of the clinic when we first moved here. That tree is still there – now taller than I am, but it has yet to bear fruit. I plan to be there when it does. Our clinic – our Hope Center Clinic, is opening on Saturday. This is the first mango to ripen. The tree is small but full of promise. We can see the future. We have set down roots. There is so much that remains to be done. Because we are here a young woman, 28 years old, who has a small child to take care of, will be here tomorrow, and the next day, and the next. She will get better. This much we have done. It is no small thing to do, in a clinic that sits at the farthest corner of this Earth.