I feel drunk but I haven’t been drinking
My first few hours at the HIV Center centred on a lot of clerical work. Patients came & went, I asked about any new complaints they had, had a good look at follow up cases of those with infections & made the necessary entries in their files. A few patients moved on this way. Then came this particular chap whose medication was changed the previous month as the government had no stock of his regular meds. He complained of tingling numbness down his legs, inability to hold his fingers steady, a constant headache & then, “the feeling of being drunk” all the time. Now, I’ve seen a lot of alcoholics & malingering patients over time, but this guy wasn’t either one of them. My senior intern quickly remarked, “So I should continue the meds, right? Who doesn’t want the feeling of being drunk without drinking?”. The patient didn’t see the lighter side of the comment. The fault lay with this drug Efavirenz. I saw hoards of similar patients with the same nervous system complaints. The in-charge went so far as to claim it was a bad decision to let this drug stay in the HIV program, but we don’t really have a large pool of meds to choose from. Every year, HIV meds are stupidly distributed to those who do not need it. Patients have even faked their CD4 counts to be eligible for free high dose meds from the government, not realizing they’re doing themselves more harm than good. The virus continues to spread, to evolve, albeit at a pace medicine has failed to match. So here I was distributing Efavirenz to patients who didn’t actually need the drug; started on it just because the government failed to stock the regular supplies effectively. Years later when their regular meds fail, these patients may not even respond to Efavirenz because the short-term treatment in the past has made their infection resistant to the same. What do I know? I’m just an intern filling up files.
It was my third day at the center when a 40 something local man came into our room. He had been newly diagnosed with HIV while his wife tested positive. Now, his wife may be in the window period of infection where tests are false negative. But, to be sure that she doesn’t contract the infection from her husband in the event she’s actually negative, we had to explain that they needed to avoid sex or at least use condoms for a few months. I thought the conversation would be fairly straight forward until he asked, “Why me? I’m a knowledgeable man. I knew everything about HIV and how it spreads. I’ve never visited sex workers. Why me?”. It would be very easy to assume he lied about the sex workers or has been doing drugs, but no man would be as traumatised if he knew why he had this disease. His history suggested he’d taken multiple injections in the past few years. But he’d never seen the new syringe being removed from its packing, nor the destruction of the needle after. He fell prey to some idiot’s satanic scheme of reusing syringes and needles. The sad part was that this isn’t a new phenomenon. One may assume that such things are restricted only to remote villages like this one, but that couldn’t be farther away from the truth. Just a few years back, we heard of a doctor from Nair hospital finding a repackaged syringe in a store around Mumbai Central. Public care under government undertakings are soft targets so we fight back with “trick” syringes. Once these collapsible syringes are used (drug/vaccine drawn in & pushed out), any further effort to use again results in the piston breaking up. Ingenious!
There’s something very tricky about a public-private partnership in medicine. Often, the institute is held ransom to the guidelines issued by government authorities often randomly or based on utter bullshit (case in point above). Meds don’t reach on time, there’re patient targets to be met, patients don’t follow up, tests aren’t made available on schedule. One thing I learnt is how far a person is likely to go to conceal their HIV status. Every medical center has a “Catchment Area” of a few kilometres radius from where they usually get patients. But, in the case of HIV, patients would travel from remote regions and come to our center to avoid the risk of being spotted by someone lest they visit a center around their residence. So, while our catchment area for the cold and flu are quite small, that for HIV far exceeds it. But I was glad they came to such a center, where they placed patient “care” above all else