Monday, December 12, 2011

A day with Gorret

Day 10 – Dec. 12

On Sunday Mama Lynda and I spent the day with Gorret, Hope Again Medical Clinic’s midwife. We sat at the compound and spoke with her about her life, her career, and her culture. 

She then invited us to her home to see where and how she lives. Mama Lynda and I sat on her bed for hours talking, and watched Gorret carefully and meticulously prepare for us homemade donuts, or amandazi, on her floor. 

Gorret (pronounced Gorreti), Faith's cousin, is from Jinja, near Uganda’s capital city of Kampala, and was raised with her three brothers by a single mother. Her father died when she was 2 weeks old. Growing up her mother had 2 friends—nurses—who would come to the house to treat the children when they fell ill. She was inspired by these women and knew early on that she wanted to become a health worker, so she went to medical school and pursued a certificate in midwifery.

After escaping a grueling job at a health center in Busia, the employer of which helped sponsor her education, Gorret came to Hope Again in 2008 to become the clinic’s first midwife.

Most interesting during our talk were her insights on and experiences with HIV counseling.

Mama Lynda: How do you counsel the patients who come in to be tested for HIV?

Gorret: When a person comes in for HIV testing usually we do counseling twice: pre-counseling and post-counseling. Pre-counseling is done before getting the blood sample. Post-counseling is done after testing, when the results are there.

So in pre-counseling, you tell the client what to expect. They will either be tested positive or negative. So you ask them: “In case you are tested negative, what are you going to do?” So you hear what they say. And you ask them: “In case you are found positive, what are you going to do?” Sometimes the person may tell you: “If I’m tested positive, I will just go and kill myself.” That way you know the person you’re going to deal with, so you have to handle that person very well.

When they are found negative, you tell them to use the ABC strategy: Abstinence, Be faithful, and Condoms. In case this person is not married, you advise them to abstain from sex. In case they’re married, you tell them to be faithful to their partners. And in case they can’t control themselves, in case they’re not married or they’re married and can’t do without sex outside marriage, you advise them to use a condom with their partners. And you also advise them to make their partners get tested in case they’re married, because sometimes you can test a woman and find her negative, but when you test the man he is found to be positive.

In case the person if found positive, you tell the results and you first of all give them some time to digest the message, like 2 or 3 minutes, and you see how the person will react. Some of them will start scratching themselves, some of them will start crying—everyone acts in their own way, especially if someone wasn’t aware, or didn’t believe that they can be found positive.

Then you start advising them that they’re not first and they’re not the last to get the virus, and they’re not going to die tomorrow. Because these days we have ARVs and people can stay for 20 years when somebody follows what the doctors and nurses tell them. So you advise this person first to get a CD4 blood count to see how severe the HIV is. If you have less antibodies compared to the virus, you’re started on the ARVS. If you have more antibodies compared to the HIV you remain on Septrin. These people are supposed to take these Septrin tablets—2 every day. This helps prevent opportunistic infections, which can be a skin rash, a cough, pneumonia---all those things are very common in HIV.

Then you advise them on how to stay healthy. They shouldn’t get so much stress, they shouldn’t get so much worried.  You should tell them to get a person who can review their status, like a close relative, who will can help remind them to take the Septrin or ARVs. Then you also advise them to have a balanced diet, like eating all these greens, mitoke, beans---that will help improve their immunity.

Rachel: What’s the youngest age you’ve seen for someone who is HIV positive?

Gorret: Usually there are even those babies who are born with HIV. So a mother may come in with a baby, and the mother maybe didn’t get tested during pregnancy, maybe she delivered from the village, and she has HIV. So when she delivers, since she didn’t take ARVs during pregnancy, this baby is exposed. When you test this baby sometimes you get him HIV positive. So with HIV, it is in all ages.

Rachel: So if you are an HIV positive woman and you take your ARVS, you can still get pregnant and have a child without him or her contracting the virus?

Gorret: Yes. This mother is given ARVs during the pregnancy, during labor, and after birth, to protect the baby. Even after delivery the baby is given a special syrup for 2 weeks, and this will protect the baby from getting HIV.

Rachel: Are there every any problems with people being able to afford the ARVs? Are they costly?

Gorret: No. ARVs are free everywhere.

Rachel: The government pays for them?

Gorret: Yes.

Rachel: They’re free everywhere?

Gorret: Yes. Everywhere they are free.  But some people don’t want to expose…[pause]…they have stigma. Like when we are providing the ARVs here, they don’t want to come to the clinic because people may see them. So what they do is they go to other clinics, maybe other private clinics, so they get them and they pay, which is expensive.

Rachel: Can you talk more about this stigma?

Gorret: Stigma is a condition when someone is tested positive and they don’t want to reveal to others, or they don’t want others to know, that they are positive.

Mama Lynda: They’re either embarrassed or ashamed?

Gorret: Yes. For example a man may be tested and he is positive. What he will do when he has stigma is that he will not even reveal the results to the wife. He will be taking the drugs separately without the wife knowing.

Mama Lynda: He wouldn’t even tell his wife?

Gorret: No. They will hide and the woman will not even know that the man is positive. Unless she comes across the drugs, maybe the woman will inquire, “What are these drugs for?”

Rachel: Could she get HIV?

Gorret: Yes, she can. Because for her she is not protected. Sometimes they even hide from the relatives—even a pregnant mother doesn’t want to tell the husband that she is positive. 

Rachel: Faith’s brother talked to us the other day about Ugandan male attitudes towards HIV, marriage, childbearing and birth control. Can you tell us your thoughts on those things?

Gorret: Men in Uganda don’t want to use condoms during sex. In case the man is positive and he infects the woman, that means the children will be orphaned. But if the man is found positive and he’s counseled very well, he will know that when he uses a condom he will not infect the wife. And that means the wife will stay healthy and protect he children in case the man dies.

We always advise the ladies is to talk to their partners so that they come together with their husband to the clinic so we can counsel them together so that they know the risks of infecting the partner.

Rachel: Do you find that people have accurate knowledge about how they can spread the disease? Are there misconceptions?

Gorret: There are so many misconceptions about HIV transmission. Many people think that when they shake hands with someone who has HIV they will also contract it. Another thing is maybe when they share food with somebody who has HIV they will get it, which is very wrong. Others also think that if they kiss with someone who has HIV, they will get it.

But these days there is a lot of education going around about HIV especially over the radios, the TVs.

Rachel: Do they teach it in school?

Gorret: HIV? Yes, itis taught. They teach about HIV transmission and prevention. Starting from around age 10 and above.

Later, we discussed her experience at Hope Again.

Rachel: What’s the most heartbreaking thing you’ve seen during your time at Hope Again?

There was a mother in later September who came in labor. I palpated her and examined her and I couldn’t feel the fetal heart of this mother. I told her, “Do you know I’ve palpated you and I’m trying to feel the fetal heart of the baby and I can’t feel it, it’s not there.” So we were expecting anything. I stayed with this mother. She came at around 8 a.m., then at around 11 a.m. she had contractions and she started pushing. When she pushed she had a very macerated stillbirth.

This mother had syphilis, which causes stillbirth, and it wasn’t treated during pregnancy. So I talked to her and she agreed to start treatment immediately.

Rachel: Is syphilis something you see a lot?

Gorret: Yes, it is very common. And it’s very bad during pregnancy.

Gorret finished our talk with much gratitude. 

Rachel: Is there anything else you’d like to add?

Gorret: I want to say that I’m also very grateful for Mama Lynda who brought for us the infant weighing scale and the fetal monitor. Because it has been hard for us to check the fetal heart when the mother is in labor. You can’t get the contractions very well. You had to put the fetal scope on the abdomen before. Now we are going to use that fetal monitor, which is going to ease my work and I’m really very grateful for you, Mama Lynda. Thank you very much.

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