All I Eat Is Medicine by Ippolytos Kalofonos

Author:Ippolytos Kalofonos [Kalofonos, Ippolytos]
Language: eng
Format: epub
Tags: Medical, Aids & Hiv, Public Health, Social Science, Anthropology, Cultural & Social, Agriculture & Food
ISBN: 9780520289406
Google: mdgzEAAAQBAJ
Publisher: Univ of California Press
Published: 2021-08-24T03:32:43+00:00

5 Being Seen in the Day Hospital

Prior to the availability of ARVs in the Day Hospital, the NHS was overwhelmed by cases of AIDS, for which no treatment existed. Mozambique’s once exemplary health system had been damaged by the civil war and by the austerity measures mandated by structural adjustment programs.1 Government spending on health care declined from a high of 11 percent of GDP in the late 1970s to only 2 percent in 1996.2 Under these conditions, Fátima, an HIV positive nurse and one-time association leader in Chimoio, recalled a need to have specialized care for HIV/AIDS:

We created the Day Hospital to give special attention to people with HIV. People were not getting good care in the regular hospitals. They kept coming back, not getting better, and the staff just gave up. They told people to stop coming back because there was nothing they could do!

Clinical care at the Day Hospital was delivered by NHS physicians, medical assistants (técnicos de medicina), and nurses.3 Donors financed the distribution of ARVs free of charge, and a foreign NGO trained and employed a specialized staff devoted to the process of enrolling, supporting, and tracking patients: two social workers, two statisticians, and twelve peer adherence counselors (agentes terapêuticos) recruited from the membership of associations of people living with HIV/AIDS. This auxiliary staff was mobilized not only to educate and counsel patients but also to monitor adherence, to avoid what northern donors and aid administrators feared could otherwise turn into an “antiretroviral anarchy” of resistance to ARV medications.4 These fears, redolent with racist, colonial assumptions regarding “uncivilized Africans,” proved unfounded but were baked into the treatment protocols that, after years of delay, finally arrived in Africa.

The Day Hospital mobilized the Vida Positiva language of empowerment and self-esteem to reinforce adherence to a new treatment regime and a new lifestyle. Fátima, the nurse described in the introduction, congratulated patients for increases in their CD4 count: “Keep doing what you are doing. Great job! Keep taking your medications!” Decreases prompted inquiries into causes of the problem and reprimands: “Are you taking your pills? Are you drinking? Smoking? Having unprotected sex? Has your partner tested?” Missed appointments, poor nutrition, worsening health, and especially problems with adherence to medications were seen as individual failures.

The focus on adherence as an individual task obscured the considerable structural obstacles many faced. I chatted with patients as they waited in the bright, bustling foyer of the Day Hospital, a space haunted by the ravages of AIDS embodied by skeletal patients. Crowded from the moment it opened its doors in the morning at 7:30 to when the final patients went home in the early afternoon, the Day Hospital bore witness to lifesaving care as patients recognized those who had gained weight and vitality. But establishing the criteria for acceptance into the ARV program—based on patients’ attainment of individual indicators that made them worthy of treatment—entailed long delays and bitter disappointment, as the Day Hospital proved to be part of an inequitable treatment system

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