John's Story

John* is 30 years old and has recently successfully completed treatment for TB. He knows that he is HIV positive, his first wife died of AIDS. He is keen to commence ARV treatment. He came to TSH for assistance. We pick him up from the side of the road as arranged and take him to hospital where he is commenced on Anti-retroviral treatment. His new wife does not know of his status, only his mother.

A few days later, the Community Health Officer tries to visit John. He is not at home, he has been feeling ill and has gone to church for prayers. The next day we visit again. On arrival, we find John lying semi-conscious on the floor of a back bedroom. He complains of having a headache last night and today has not moved. He is unable to speak and is weak down one side of his body. His teeth are clenched together in his mouth and he moans quietly. If disturbed he stares but doesn’t appear to see. His neck is stiff. A family friend who works in another clinic has set up an intravenous drip.

In the UK we would dial 999 and call for an ambulance. There is no ambulance and he is too large and unconscious to attempt to move him by car. We know that even if moved to the main hospital in Freetown, he may not receive the treatment needed to save his life. The journey would involve sitting in heavy traffic for perhaps hours in stiflingly hot conditions. His family are all too aware that they do not have the money to pay expensive hospital bills.

We fear that John has meningitis, a complication of his HIV infection. We help the family understand what may be happening to John and the possible options. It is clear that they would like him to stay at home with them; they are afraid to move him.

We reassure them that we will do our best to make him comfortable. We provid a Home-based Care Kit and attend to his personal hygiene needs, changing his clothes and bed sheet and laying him on incontinent sheets. We cool his body with tepid sponging and encourage his family to talk to him and keep him cool with a fan.

It is impossible to give him any medication by mouth and so we administer an injection of Tramadol, the strongest pain killer that we have available in Sierra Leone. (However since October 2010 oral morphine is now available to Patients of TSH). We leave him and his family and promise to return the following day. His family seem relieved to have some support and tell us that he is now in God’s hands.

*Patient's name has been changed.

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