Clinical work

It's been a busy week, so I'll concentrate on one of the clinical things that I've seen here this week.

I've got myself a once weekly slot in the rota of general "open-door" clinics that the MRC runs - a bit like a GP walk in centre service, combined with a some blood tests and Xrays available on site. About 80 to 100 Gambians queue up for this daily, it is free (though they pay a small fee for prescriptions) and there is a 40 bed ward which deals with medical-type admissions (all surgical things go to the government hospital 15 miles away).

So I was doing my first stretch of clinic on my own this week, with a nurse/translator and another doctor next-door for questions. All kinds of patients came in : young and old, follow-ups and new presentations , but one really stuck in my mind ...

A young woman came in to the clinic and started telling me about the pain in her chest: she had a pain behind her sternum whenever she swallowed for the last few weeks. She looked quite thin and said that she had been losing weight recently... it was sounding suspicious already, and so I asked her about the health of her husband - she said that he died a year ago after having had the same kinds of problem.

I looked in her mouth and there was a massive fungal infection all over the place - almost certainly meaning that she was heavily immunosuppressed with AIDS, and the pain in her chest was probably oesophageal candida. She did't seem too shocked when I suggested that she go to the clinic for an HIV test, I guess she probably knew in her heart of hearts already.



This what oral candida looks like, its an image from the web not my patient. This was the first time I'd seen this since doing the DTMH course in Liverpool, and her mouth looked really painful.

Here at MRC they are running anti-retroviral based treatment programs, so I guess this lady has a better prospect than most Africans with AIDS, but it is still a dreadful thing for her to have. I don't know what will happen to her and her family over the coming months and years, but this week in the clinic was just the start of something that will dominate the rest of her life. Which is a bit grim really.