|Too Young to Die (Zambia Educational Publishing House, 1992, 56 p.)|
By the end of 1983, AIDS had been reported in at least 20 countries world-wide and by the end of 1984 there was conclusive evidence that AIDS was present in the country, though nobody knew to what extent and the Government had not made any official pronouncements about it. By 1985, reports indicated that the number of new cases world-wide were doubling every six months and it was well known by then that AIDS was not confined to homosexuals and intravenous drug users only, but was also present in the heterosexual community. Several diseases could be grouped under the umbrella term AIDS, and there were new ones being added practically every month. We were really adrift in uncharted waters.
The realization that we had AIDS in the country brought alarm, controversies, uncertainties, suspicions and serious questions of ethics. There was an alarming increase in the number of suspected AIDS patients who invariably tested HIV positive. As a Registrar in the Department of Medicine, I was thrust right into the frontline. I was the link between the consultant in our unit and the junior doctors, most of whom stayed for only three months before moving on to other departments. I also spoke a number of local languages and when the crunch came, I had to make most of the explanations to the patients as well as to the relatives of the victims with AIDS. There was no clear-cut policy then and in many cases, most of us were at a loss as to what to say, how much to say and how to say it. It was a situation which needed trained counsellors, but we had none at that time and the doctors, untrained in the intricacies of this skill, had to do the best they could, and did it badly in many cases. Facts were in short supply. Could one get AIDS from kissing? From a tooth brush? From shaking hands? From a toilet seat? From the swimming pool? From a drinking glass? From mosquito bites? From...? Spouses of patients wanted to know if kissing and sex with a condom were safe. Nobody was sure in those early days.
There were several problems we had to tackle and one of the most difficult was denial. Several patients just refused to accept what we told them. They just closed their minds and tried to continue their lives as though everything was normal. Others became very depressed and a few were suicidal. Guilt was also present, especially after explaining the main mode of transmission of the disease. Other patients were determined to spread the disease (sic). Their logic was, 'Why go down alone?' There were and still are immense problems to be tackled, because the disease was incurable and hence brought on severe psychological stresses which we were unprepared to handle. One patient with AIDS later told me that I had been quite curt when telling her about the disease and had moved on before she could fully digest the information. She said I had not spent enough time with her, for she had a lot of questions. Time is always short with so many patients to see, but that notwithstanding, I had to make a belated apology to the lady and I put it down to inexperience. We are all much wiser now, more organized and more able to look after the psychological problems of our patients and we now have a pool of trained counsellors to call upon.
There were also immense logistical problems of looking after so many very sick patients in our already over-crowded hospitals. If the medical profession was slow in realizing and accepting the fact that AIDS was present in Zambia, the public was even slower, through no fault of their own, undoubtedly. I remember giving a talk on AIDS to a Press Club meeting in mid-1985. I told them that from my experience, AIDS was definitely present in Zambia. I was met with total disbelief. This was partly because even at that late stage the Government had not made any official statement on the presence of the disease in the country. I had specifically told the organizers that my views were entirely personal and I was not to be quoted, but I got a shock the following morning when I was quoted on one of the early morning radio programmes. I must have been naive I suppose, for it was the press I had been talking to after all! Fortunately for me, there were no repercussions and the government did announce that AIDS was present in the country a few months later and by then, we had the laboratory kit to confirm our diagnosis of the disease.
AIDS is basically a clinical diagnosis; that is, in the majority of cases the doctors are able to make a diagnosis based on the history and examination of the patient alone. The symptoms and signs of HIV infection usually start singly, then add on until the epiphany, the point where all the available data point at only one conclusion. In the majority of patients, the first stage is that of an asymptomatic infection when they have just acquired the virus by whatever route, but do not have any of the known complaints of HIV infection. The next stage is that of a flu-like illness with fever, usually after one to two weeks after the first stage. Then comes a period which can vary from ten months to ten years and possibly longer. During this stage, the patient can have any number of complaints like fever, enlarged lymph nodes, fatigue, confusion, weight loss, malaise, loss of appetite, long-standing diarrhoea, night sweats, shingles and oral thrush. The last stage is when the patients start developing severe life-threatening infections like fungal meningitis, tuberculosis and cancers like Kaposi's Sarcoma. There were dozens of patients with such complaints from 1985 onwards, for it seemed that for a large number of people, the incubation period was over. It was time to cross the Rubicon.