The Face of AIDS and the Insanity of Bureaucracy

This is a story that will be hard to believe but I promise you, it’s all true. One day, while working in the clinic, a man appeared at the door carrying a frail woman in his arms. She looked elderly but was in fact only 26. She was tall and so thin that we could see every bone. Her eyes were sunken into her head but still, she had a tiny spark of life in her luminous eyes. In East Africa such devastating disease is likely to be caused by one or two infections- AIDS and TB. This unfortunate woman had both.

As her story was revealed to us we were appalled and yet doubtful that it could be true. Here is what the husband told us…

His 26 year old wife was admitted to a hospital in Migori that I’ll refer to as “St. Elsewhere” with AIDS and tuberculosis. She was started on the intensive phase of TB medications which were to be continued for 2 months. Then she would take the second phase of medications for another 4-6 months. The TB meds were started in the hospital and given for one week. Then she was prepared for discharge.

It was at this point that things went awry. The family was unable to pay her hospital bill so the patient was “discharged into the hospital”. This means that she was discharged from care but kept in the hospital until her family could pay her bill. Sounds a lot like she’s being kept a hostage, doesn’t it?

Because she was no longer an official patient she didn’t receive any care or medications- including her meds for TB. I should add here that TB meds and ARV drugs for AIDS are free to facilities. That’s right. St. Elsewhere gets the TB meds for free but wouldn’t dispense them to her because she was “no longer a patient”. It gets worse (if that’s possible). These patients are not fed unless there is food left over after the “real” patients are served their meals. A couple days before she came into our clinic, and 3 months after she was “discharged”, her family was finally able to pay her ransom…er, I mean her bill and she was able to go home.

In the subsequent days and weeks, we were able to follow the paper trail that confirmed her story and the atrocious “care” given at St. Elsewhere. We’ve talked to many people including a man who monitors TB care for the Kenya Ministry of Health in our district. He was “shocked” and unaware of St. Elsewhere’s policy but claimed he would look into it. As for the patient, she struggled to survive for another few weeks before succumbing to the diseases, another victim of the scourges of HIV, TB and Poverty.