Outpatient Medicine

Practicing medicine on the inpatient wards is quite frustrating; working in the outpatient FACES clinic, on the other hand, is pleasurable and extremely rewarding. FACES is an organization created in 2005 by several collaborating universities in order to provide comprehensive and quality HIV care in Kenya. They are currently located in Kisumu, Migori and the Suba district, where I am currently stationed. The first Suba district clinic opened in May 2006; since that time, the organization has grown and de-centralized in order to reach as many locals as possible. They have done an amazing job in the process. As of this morning's report, Sindo (the largest clinic in the district) was providing health care to over 2000 HIV+ patients; at least 700 of them are on ARV or triple cocktail therapy for their illness. And this is only one of 13 centers! Enclosed is a picture of Mbita, one of these centers.

This means that on average, clinicians see 25-40 patients in one day! (If only I were that efficient in my own primary care clinic!!) Many of the patients come from quite far, walking several miles in order to make their appointments and get refills on their life-saving medications. I've met so many who initially presented with essentially non-functioning immune systems, emaciated and too weak to work. Many of these people now have CD4 counts above 250, are able to work, provide for their families and contribute to their community. One gentleman in particular comes to mind, who I saw last week in the little clinic of Kitare. He was diagnosed with HIV and TB at the same time 6 months ago, when he weighed 42kg, had a CD4 count of 4. He was carried to the clinic by his brother at that time. Now, he weighs a hefty 50kg and looks great -- he was the energetic lead singer in an impromptu Swahilli folk song concert that took place in the waiting room. It's always a pleasure to see such patients in my little exam room, pictured here, taking care of their monthly and often not-entirely-benign medical issues but seeing a positive trend in their overall health. :)

The transformation of Suba district HIV care has occurred with minimal resources. There is only basic infrastructure here and an ability to perform few, but essential lab tests. Before the clinic's permanent dwellings were built, most health care was provided in a massive tent! This tent is still quite useful today, providing some extra clinical rooms and a larger waiting room where patients get daily education seminars. The education provided here is phenomenal and necessary to provide comprehensive care. We have excellent community health workers and outreach teams who teach every patient about HIV, sexually transmitted diseases, TB, medication side effects, worrisome signs and symptoms, etc... They are truly the backbone of this clinic, in my opinion. A similar system could certainly be implemented in resource-poor settings in developed countries. I can definitely think of ways in which the vulnerable population of San Francisco could benefit from similar education services....