At the moment, 6 shipping containers – literally millions of condoms – are sitting at the airport here in Lilongwe. They were donated by the Global Fund, as always around here, but they have not yet been distributed. They are just accruing airport charges that no one wants to pay. In fact, 1 of our two clinics was out all last week. Yes: no condoms in a clinic for HIV+ patients! The condoms are waiting for someone or some organization to come distribute them now that the Central Medical Stores (CMS) is temporarily shut down for a top-to-bottom reorganization and rebuilding process (read: corruption reduction). The decision to revamp CMS is great; the abyss left in its wake is terrible for the health system.
Compounding, or complementing, the dearth of condoms is a severe, nation-wide shortage of HIV test kits. See problem source, above. I guess if you can’t prevent infection, why test for it anyway? In an effort to help others laugh (uncomfortably) and not cry, I’ll tell a quick anecdote. Last week, a bigwig from the World Health Organization (WHO) came to visit the antenatal care center next door, Bwaila Maternity – the largest labor and delivery center in the country. We went with them to show the linkage to HIV care. The Bwaila team was showing the WHO delegation how they do HIV testing: a group education session, lining the women up conveyer-belt style for the HIV finger-prick test, and then individual post test counseling for results. The WHO folks were very impressed until they noticed that the women were holding cardboard strips rather than HIV tests. When asked why, the Bwaila team responded, “we wanted to show you what we do when we have test kits, but these days we have none.” So, they just line the women up for their tests, and then just put them back in line. Arghhhhh.
One last thing: there is also a severe shortage of 2nd line HIV treatment drugs in the country – the drugs used to treat people who had severe side effects to the 1st line drugs or who did not get better on those simpler treatments. Same ordering and distribution problems above. This leaves the sickest patients temporarily without drugs or temporarily (we hope very temporarily) back on the 1st line drugs they failed previously. Because our clinic was one of the first clinics to have drugs back in 2002, we have a disproportionate number of patients on these later-stage medications. Our nurses and clinicians have to ask patients to come back next week (and the next) to get drugs. This week, a former head of the defunct logistics team (above) had the gall to make a personal plea to the director of my clinic to beg for 2nd line drugs for a family member. Of course, there are no extra meds just sitting around and no personal favors. That’s karma for that guy, plain and simple.
To balance the news from the trenches, Jon and I have a big group of friends headed over tonight for a potluck. Do you know what turns a stressful week into a great weekend? MARGARITAS! Ole!
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