Well, after a nice weekend, tonight I am prepping for a couple more days of work at HIC, and then Wednesday it's off to Les Anglais with the CHI/HFM team. As I prepare for the mobile clinic in Les Anglais in a few days, I still lie awake some nights wondering how to effectively care for HIV + patients, while keeping their status to the rest of the community a secret. It's important obviously for an HIV infected individual to get access to care at either HIC or Port Salut hospitals, because without care the outcomes don't look so good. But, I still really struggle with the stigma issue. If people in a community know you're HIV+ they might not buy from you at market anymore. Many of the female patients who test positive are so afraid of the stigma attached to the diagnosis that they don't even tell their husbands, for fear that their husbands would leave them. Others up and move without telling their community health workers, who encourage patients - no matter what their medical condition is - to return to the hospital/ clinics regularly for check ups and makes sure they're taking their medicines. They are so afraid of returning to the hospital and people finding out about their positive status that they feel the only option is to move without leaving a trace of where they might have gone.
Tomorrow or Tuesday I am going to be trained by the nurse educators at HIC on what to say to patients once they receive a positive diagnosis at clinic in Les Anglais. Hopefully, this will help me to at least know how to council patients before we arrange for their transportation and continued care at Port Salut hospital. But this training still doesn't solve my stigma concern. My main project this upcoming week will be to test patients and then have an educational session with the HIV+ patients before arranging for their transportation to Port Salut. Since I will mainly be doing only HIV diagnosis/ care, how do I keep myself from being known as the "blan HIV doctor." I am fearful that once this happens, no patient is going to want to talk to me again in Les Anglais. And fearful of what will happen to the patients that I speak with if that were to happen. I don't want to be responsible for socially ostracizing patients, but I also want to get them the care they need.
And then there is the issue of transportation. The team and I need to figure out a way to transport the patients to Port Salut without locals figuring out what's unique about the patients in our tap taps. Why they're the few that are chosen to go to Port Salut... Perhaps I could just send the names of the patients onto the infectious disease doctor and social worker at Port Salut, and help the patients get a ride on a regular tap tap that goes back and forth between Les Anglais and Port Salut? I can give them instructions on what they're supposed to do and hope they go get the care they need. After all, the team and I cannot force people to seek treatment, and the problem of people with positive tests not coming back for necessary care is an issue that Haitian staff, like Dr. Cleonas, are working so hard to fix at HIC. So many people are engaging in collaborative efforts to deal with this complicated situation, and yet the problem remains...
So tonight, as I get excited for my data collection project to start tomorrow and for the team arriving on Wednesday, I am filled with some nervousness for the week to come. If anyone has any good advice for this complicated situation, I welcome any and all support. Praying everything turns out okay and that my name by the end of the week is not the "blan HIV doctor"...
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