clinic

The past few days in clinic have been ridiculously busy. We are seeing a steady stream of patients - over 300 the other day and still at meetings there is talk about how we aren't seeing enough, especially kids. One of the problems is many parents are reluctant to have their children tested or, if they are, to disclose their positive status to them. Access to medications for HIV is still a relatively new phenomenon here and as a result there is a lot of denial. Ten years ago, people didn't want to know their status because there was nothing they could do about it. Its changing but slowly. I imagine this is what it was like in the US in the late 80's and early 90's before there were drugs for AIDS.

Kenyans work an incredible amount - that is, if they are lucky enough to have a job - the rates of unemployment here are quite high. The stalls are opening on my way into work at 7 or 7:30 and many still open when I leave after 6 pm. The bicycle taxis are out all day - my "driver" today was telling me he often works 14 hour days (some of my most interesting conversations are on my commute - amazing how quickly one becomes accustomed to carrying on a complete conversation while swerving amid motorcycles and cars in the semi-darkness while perched on a little plastic seat on the back of a bike). Most of the clinic staff works 10-12 hour days. But no one ever moves very quickly or seems rushed despite the fact that the clinic is literally packed with patients waitng to be seen. One of the favorite expressions here is "pole, pole" - slowly, slowly. Its used often in place of "excuse me" or "watch out" (or maybe I just get it more often because my baseline walking and talking speed is 8 x as fast as the next person's). I saw nearly 30 patients today and felt far less rushed than I ever have in a day where I see half that many at home. Most of the clinicians are in their early 20's and it is hard to imagine how they will not all be totally burnt out in another ten years - they talk about it fairly frequently... and then joke that they are too busy to be burnt out and try to figure out ways to see more patients in clinic.