Oh...and I have AIDS

I have been doing health related research in Uganda since 2006, but every day I go out into the field I learn something new. In Gulu District, I have been traveling to rural villages to talk to community members about their access, obstacles, and solutions to healthcare. I have also been traveling to various medical facilities to talk to patients about their healthcare experiences and to observe patient/provider interactions.

Recently I was observing such an interaction. The patient was an older woman who was complaining of stomach pain, chest pain and general weakness. She, like nearly every other patient that day, was prescribed amoxicillin and acetaminophen after a consultation with a nurse that lasted less than 4 minutes. She wasn’t prescribed these drugs because they were the best ones to take for her ailment - her ailment wasn’t even tested or diagnosed – she was prescribed these drugs because these were the only drugs available due to rampant drug, supply, and staff shortages.

Perhaps hypertension was the cause of her chest pain – but there are no anti-hypertensives available. Perhaps it is indigestion – but antacids are not there. Perhaps the pain is due to tuberculosis – but the lab tech is too busy to run TB tests that day. Maybe it was malaria – but even if antimalarials are available, women are often told they are too old to be taking medication and they should save these drugs for children.

As the woman was leaving I stopped her to ask if she was satisfied with the services she received that day. She said she guessed so, but she didn’t think the medicine was going to work because it was the same thing she was prescribed last time and saw no improvement. I then asked her if there was anything else she would have liked to ask or tell the doctor. She then launched into detail: “I’ve had a persistent cough that has lasted for over a year. Sometimes I cough up blood. I think I have TB, but I can’t go to the hospital because it is too far, too expensive, and I have young children and my husband won’t care for them if I’m not there. Oh…and I have AIDS.”

I asked her why she did not mention this to the nurse and she said, “She didn’t ask.” Then she gathered her things and left for her long walk home. My translator explained that women in Northern Uganda are often raised to be quiet and submissive, which greatly discourages them from asserting themselves – even at the doctor’s office. I asked my translator, “Since when is AIDS an afterthought?! How is that something she forgot to mention?!” He gave me sympathetic smile, but said nothing more. When HIV/AIDS seems as common as the cold but still carries a heavy social stigma, anti-retrovirals are not in regular supply, and no one cares to ask anyway, I suppose it’s just not worth a mention.