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Opening Doors : A Veil Lifted

Because of the commonality of death, extended families are crucial in caring for and raising children. I frequently answered questions about life in America, but was particularly struck when a well-educated young engineer asked me: "What is the situation in America—do most people our age support their younger brothers and sisters?"

AIDS is similar to other diseases in Africa—patients get sick and, even with treatment, eventually stop getting better. Then they die. But AIDS is unique in that it carries a social stigma. The number- one medical complaint I witnessed at the IDC was papular pruritic eruption—a skin condition that leaves scars, identifying the bearer as HIV-positive. Patients beg, "Can you give me something to make these scars go away?" not "Can you give me something to stop the itching?" They don't want their neighbors to know that they are ill, and oftentimes even their families are unaware. Doctors play an important role as counselors and listeners, not just as purveyors of knowledge and prescriptions. I watched a high-ranking police officer, who was supporting his children and his nieces and nephews after the death of his sister, sob as he discussed his poor CD4 results. "What will they do?" he worried. He cried openly for what I suspect was the first time. Unfortunately, we had no answers for him.

May 6, 2004
I find that I'm never bored here, even when I spend hours alone. It's a struggle merely to accomplish simple, daily tasks. Just going to the grocery store, getting the goods back to where I'm staying, and making dinner can take all day—it makes me feel like an elderly person. And it takes an incredible amount of effort to get to work in a presentable fashion. I am so hot and tired after riding the daladala [a small, local bus] and walking that I cannot imagine having to come home and cook dinner for a family. This morning I went to mass with Sister Brigid and then had a cappuccino and muffin at the Royal Palm

Left, the clinic waiting room fills up quickly. Tanzanian patients are "accustomed to waiting long periods of time," says Dr. Richard Waddell, a DMS faculty member and coinvestigator of the DarDar trial. "When they come for a visit, they just wait. They come long distances on multiple buses crammed with people . . . and they don't complain." Right, when patients check in they're given a number, handwritten on cardboard, like at a deli counter in the U.S.

The patient above has just been given a slip with the date of her next appointment. "The services available here are excellent," a different patient observed. "The workers are very cooperative and do not stigmatize us at all." As a result, the people who are enrolled in the trial come to the clinic even for care unrelated to the study. "We didn't expect we'd be primary-care providers," says Waddell, "but because of the wonderful working relationship our Tanzanian project staff have developed with people in the study, the patients . . . see our place as a place where they get caring care."

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