I am now seeing patients in the outpatient clinic of the Fevers Unit at Korle Bu on my own. My partner doctor makes it a point to tell the patients that I may look Ghanaian but I’m obroni (white person or foreigner). They ask for those with good English skills to sit at my consultation desk. They speak to me in Twi or Twinglish and I reply in simple English. Some patients are shy speaking English but we manage. Others wonder aloud what kind of Ghanaian doesn’t speak any local language. I once had an Nzema-speaking woman and I’ll admit that it pained me that I could not respond to her in Nzema, my parent’s tongue. She had come in with someone to translate from Nzema to Twi and the translators English was marginal.
I am nosy with new diagnosis patients asking what led them to get tested for HIV in the first place. I am surprised that a good number had positive tests before but were too shocked or in disbelief to do anything about it. They were presenting now because they were sick or pregnant. This is the power of stigma.
Patient Refuses to Test His Children
I made a patient cry. He was a young man who had come to the clinic for about 2 years and was doing well on HIV treatment. He reported that he had been divorced from his wife before finding out he had HIV, that she was nowhere to be found, and that he did not know her status. It is a sibling that came with him for his disclosure and his ongoing adherence counselling. He has two young children under the age of 5 who are cared for by another sibling. All I asked of him was to bring his children in to be tested because they were young. He didn’t want to test his children for HIV out of fear that the sibling taking care of them might find out and stop taking care of them if they were retroviral positive. He cried I tell you. I even had him talk with another doctor in Twi to make sure he understood my request and I his defiance. Wow! Wow! Wow!
Husband Refuses to Get Tested
I had another patient who tested positive during her current pregnancy and was presenting for treatment. Her husband refused to get tested because he had been tested many years ago and was negative. Yet, he accompanied her to her visits and counselling. Wow!
Woman Neglects to Tell Ob-Gyn Her Status
Another pregnant woman tested retroviral positive late in her pregnancy. Before she could be started on antiretroviral therapy, she had an emergent c-section for pre-eclampsia during her 8th month of pregnancy. She neglected to tell the OB-Gyn that she had HIV. Lack of communication between hospital departments meant they had no records so she and her baby did not receive any ART medications. Here she is now, and I had to determine the utility of starting ART prophylaxis in a 2 week old baby to decrease the chance of HIV transmission. Wow!
Disclosure Counselling
I have sat in at disclosure counselling sessions which are conducted by social workers. They do an excellent job. The sessions are so emotional though. Even when a session is held in Ga or Hausa, languages I do not understand, I can feel the anger, the sadness, and the disbelief.
Over-all, I am learning that HIV stigma is real!
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