Six and a Half Percent

6.5%. Of the Ugandan population, 6.5% are HIV positive. And shockingly that’s very positive news around here. Not long ago, I was told that close to 20% of the country was HIV positive, so great strides have been made to curb the epidemic so dramatically (and George W Bush should be thanked for pouring a huge amount of resources into this arena—this may be his one positive legacy in my book). Yesterday I had the opportunity to work with doctors, nurses, public health workers, and teachers who are on the front line of the epidemic, and to spend a day with an entire clinic for the HIV positive. And I spent a lot of time wondering how this group, mostly women, had contracted the disease when in many cases, their husbands were HIV negative. I look forward to learning more about HIV and AIDS today as I return for a second day of photographic work at the Infectious Diseases Institute. And now would be the time to put in your order for nicely boxed three packs of Ugandan condoms. Smooth. Lubricated. And available free of charge. Perhaps the perfect way to show the one(s) you really love that you’ll be keeping your infectious diseases to yourself on this Valentine’s Day.

Uganda’s improvement in AIDS-related care may be coming at a great cost to other sectors of the health care delivery system. I had a conversation with one of the surgeons in the anatomy department here at the hospital who told me that there are almost no resources for surgical services—quite a marked contrast to how medicine is delivered in the States. He said that a fractured leg, generally addressed within 8 hours in the States, will often take up to 8 months here in Uganda, 8 months that the person misses work, 8 months when rehabilitation could have been taking place, and 8 months of time to develop permanent disabilities. It seems that so many people have gone into primary care and general medicine that there is a real dearth of surgeons and anesthesiologists, the latter’s work often done by people with far less training, leading to a very high fatality rate for such procedures. This has led to some interesting mental gymnastics for me, since I’m not sure that I ever really made the connection between the work of the primary care physicians, in the fields of AIDS care or otherwise, and the surgeons that sometimes are called upon to serve the same group of patients. Nowhere did that become more clear than today during a visit to the cancer ward here at the hospital, where AIDS patients, hundreds of times more likely to contract many forms of cancer than the average Ugandan, were awaiting advanced procedures. I hope that you won’t ever have to see the pictures of the three men who I photographed today whose private parts had become ravaged by disease, the first of whom had a penis that was so swollen that it was the size of a coke bottle…of the two liter variety. You won’t be getting a picture of that on this blog.

I’ve got lots more to say about my impressions, but I think that I’ll save that for another entry. So stay tuned for that.