Working on Isolation Ward

This week is my fifth week of being the doctor in charge of our Isolation Ward. It is where the sickest patients in our hospital are resident. Most of the patients have HIV and are in the last stages of the disease so are very sick. They come in marginally better than dead and my job is to try and keep them alive. I first check to see if they have TB (the most common cause of serious illness here). Once confirmed, most patients go home. A few cannot (for instance the amount of blood they have is so low that they are too weak to walk, etc). Some of these I transfer to TB ward. Others I keep an eye on. At the moment I am monitoring a nine year old boy who is so sick and thin from stage 4 HIV that I cannot send him home. On my first day, I thought that he must have a multi-drug resistant (MDR) TB and this past Friday, I found out he did. I should transfer him but he feels safe with the nurses and me and we would all like to keep him (it is very sad – he has no family visiting him – often the case – children get abandoned here). I also have a 21 year old man who came in completely breathless on my second day on the ward. I carried him to x-ray myself where I discovered that one of his lungs was not inflated and the other was riddled with what looks like TB. Surprisingly, he is HIV negative and every day, we chat and I try to help him with his homework (the resilience in these patients is amazing).

Unsurprisingly the mortality rate in my ward is very high. The most difficult patients to treat are those with a combination of MDR TB and HIV. Fortunately, the medical manager, Dr Heese, is a TB expert and always available. I enjoy discussing and solving occasional cases with him.

Henry and I leave for holiday with our friend Eimear in two weeks time and I will miss the ward. By the time I return there will be many different faces – equally sick. And so it goes on.