oh we're halfway there...

yesterday/today marks the halfway point of my trip here...

i'm sad i only have one more month left because it's been the most incredible month of my life. but i also feel like i've been here forever--im getting to know the roads, cities etc even without driving.

nothing new in the exciting entertainment/activities department...but work was cool today too.

so i've finished phase 1 of my research, which was in all actuality, mostly excel spreadsheets and data entry and manipulation. yawn. just tedious stuff...i had about 8000 patient entries to wade through.
after organizing them into an acceptable format, i proceeded to calculate CD4 count differences for each and every single patient--diabetic and non diabetic.
which took another couple of days. and a very very sore left wrist. (harhar)

so now i'm in phase 2, which is the statistical analysis part. they use a program called statistica here, which i am completely unfamiliar with. but i have to figure it out and get some matched-pair ANOVA tests done.

after that though, i'm pretty much done w/ what dr. zeier had originally planned for me to do. since i have a month left, she gave me an option to either continue w/ this HIV/diabetes project or move onto a tuberculosis project. i opted to get more in-depth with one project, so we'll see what happens!

today during clinic hours, one particular patient was really interesting. he was 26 years old and had been a crystal meth addict for 3 years. meth (or commonly called 'tik' here) is actually rather prevalent.

my geeky science guy is coming out...but methemphetamine, the addictive drug as we know it, is chiral--meaning that it has two isomers, an L and D form. the L form is harmless and used i over the counter inhalers i think, while the D form is the addictive drug. the only difference b/w the two structurally is how the molecules are arranged around one chiral center. [side note: larium, the malaria drug i took for my dominican republic trip was similar. one isomer was harmless, the other was bad]

but anyway, meth addicts have really poor teeth and are generally very emaciated. the patient fit the textbook case of what a meth addict looked like. but he was here to turn his life around after finding out he had HIV.
but meth wasn't the only interesting thing about him...he had a huge stab wound that had scarred over (sorry for the graphic reference, but it really did look like vaginal lips) on his left arm, which his 'friend' had apparently given him. what a great friend.
underneath his right arm on his side, he had an 'underwater drain' procedure, which is basically using a tube to release fluid from the chest cavity.

another lady had abscisses underneath her armpits caused by either a fungal or bacterial infection i don't remember. dr. zeier didn't know what specifically caused it, but she suspected it was shaving because women got it far more than men. but they were gross man. huge ugly scars under the armpits.

i'm seeing lots of cases of oral thrush and candidasis all over the body in general, which are fungal infections. physiologically, it's not as shocking as some of the other things i've seen. they usually manifest in red patches on the skin and tongue while another form of candidasis looks white and fuzzy in the mouth.

--------

while HIV is the #1 epidemic here in south africa, tuberculosis is the second. so much so that 75% of HIV patients have had or have TB.
it's not a problem at all in the US, so i didn't know much about it at all. but it's a very difficult disease to treat, especially in tandem with HIV. the treatment regimen can take months to complete and during that time, one is immunocompromised and especially susceptible to other afflictions.

so these poor patients generally have to balance TB and ARV drugs, which is horrible b/c all have nasty side effects. the stab wound/meth addict guy i mentioned earlier also had TB and when i took the stethoscope to listen, instead of a clear breathing like you're supposed to hear, i heard what soudned like paper being crumpled. bad news.

to make things worse, he also had a copulmonary heart issue...because of his severe TB condition and difficulty breathing, the right side of his heart had to work much harder to pump blood into the lungs to get oxygenated, thus making it larger. also bad news. hello high blood pressure and artherosclerosis?
AND! he had deep vein thrombosis in his right arm, which is a blood clot that went loose.

what a shitshow. felt so sorry for the guy. that's complete rock bottom if i've ever seen one, and there he was in the clinic, trying to turn his life around. and he was accompanied by his mom; she was so cute.

--------

the saddest part of the day came when two female patients came in (separately). one was young, in her mid-20's and the other was about 50. the younger one had a boyfriend and lived with her mom because she quit her job after the HIV infection. she was 19 weeks pregnant. she had told her bf about the HIV but not her mom for fear of repercussions.
dr. zeier explained to me that in this culture, the parents are very strict and authoratative, just like asian culture. so she was terrified of telling her mom and taking the ARV's home. but if she didn't take the anti-retroviral drugs, then her baby would most likely be infected, so she wanted to start them immediately. the doctor told her she needed to confront her mom and tell her the truth. the other problem was, she had TB and some drug interaction protocol made it where it would be dangerous for her to take both in conjunction at that time. nevertheless, the woman was in tears and pleaded for dr. zeier to prescribe her the HIV drugs, saying that her baby was more important than her.

the other older woman had 5 kids and didn't know if her kids were infected because she hadn't gotten them tested. the doctor urged her to get them tested because knowing sooner would be better, and she started to cry too.

but ANYWAY, after all that sad stuff...it's my friend jesse's 21st tonight. so we're going outtttttttttttt peace

...woa oh living on a prayer!!