Some nuts and bolts...

OK, so theres been a request from my dad for some more info about "people, patients, and your work." i.e., less about puppies and fun weekend trips. Which is fair, and I've been thinking about what to write...its just hard to explain. So I'll start with a few bullet points:

• Where I am - Lilongwe, pop. approximately 300,000. The capital of Malawi.
• Currency - 140 Malawian Kwacha (MK) = $1 USD. Things are really priced about the same, or a bit more expensive. Some things are really a lot more expensive - 8$ for a box of cereal?
• The UNC Guesthouse - is really pretty nice. Hot water, power, and internet...about 75% of the time.
  

My work is coming along slowly - I just finished going through a preliminary copy of the tracing database and sent along a draft of a new tracing form I created to my bosses. I also went on several tracing visits with a couple of the community health workers - this is when they go out and try to track down patients who have been missing study visits, or patients who aren't doing well on their meds and need to have their ART regimens changed. What I didn't realize is that I wouldn't even be allowed out of the car - the stigma around HIV is so bad here, that even the health workers have to dress in indigenous clothes and leave the vehicle far from the patient's home, to avoid neighbors' targeting that person as having HIV. But even just sitting in the vehicle I attracted a lot of attention - practically every kid in the village would show up and start cavorting around the truck and posing for pictures. I'll upload some of those, they're cute kids.

Its so difficult to understand how in a country where as many as 30% of the population may be HIV positive, stigma is still such an issue. There are all kinds of issues, I'm finding, that keep people - particularly women - from getting care. I'm finding it disturbingly common in the database records that women are lost to study or refuse further participation because their husbands beat them or threaten to beat or divorce them if they participate in studies. Partly thats just a poor understanding of what the study drugs and procedures involve, and sometimes the community health workers can talk to the husbands and explain things. But mostly its just a real control issue. The gender-power inequality here is frustrating, its easy to see how it contributes hugely to the AIDS crisis.

Anyway...so what else? The people who work at the Tidziwe Center (research study HQ, and clinical care center) are almost all Malawians, they're very nice but also very busy and I've had a bit of a time figuring my way around and whos who. There are Americans coming and going from UNC all the time so I guess its really no one's job to give me a grand tour. There's also not a lot of space for temporary researchers and students, so I do a lot of my work at home at the guest house.

And I've been spending a lot of time this week at home...but not because I've been working, I've been sick this week. I'll spare you the gory details, suffice it to say that it necessitated first-hand experience of the health care system from the patient's perspective, and now I'm feeling much better. Thanks a lot, Shigella.

Think I'll sign off for now! dinner time.