Cross cultural medicine

You can't expect to move from a first world to a third world setting without crossing a cultural divide. Here are a couple of recent cases where I have had to be at my most understanging. (In the interest of confidentiality some details are changed)

I'm looking after a young man who is single handedly raising an 8 year old boy. He has HIV which is at an advanced stage. He helps out at the clinics and has had some formal training in HIV so he knows, or should know, that without the appropriate drugs he does not have long to live and that if he waits until he becomes sick it might be too late; even so he refuses to take the drugs. His reasoning is otherwise sound, at the moment he feels fine and looks quite well. He tried the drugs about a year ago when he was sick and also had TB. He had some side-effects and I think the time he decided to stop the drugs co-incided with him getting on top of his TB so all in all he felt a lot better off the medication than on it. While I can see his reasoning I also know that he will be dead soon leaving an orphan if he does not at least give it another go. I have sat with him and discussed all the options including stopping the drugs a second time if we can't get him through the side-effects but he is adamant that his strong faith will see him through. When it comes down to it I am not in the business of trying to force people to do anything they don't want to but I really can't help feeling dreadful for the son.

Slightly less sombre is a new phenomenon we have encountered. We test for HIV using a simple and cheap finger prick test that gives results in minutes, although very good these tests are not perfect. Although we feel that the benefits of this strategy outweigh the costs it is inevitable that occasionally people test as positive for HIV when they are actually negative. The problem is picked up a little further down stream when they have more conventional blood testing and it sometimes falls to me to tell people that after all they are in fact negative. You might expect that this is like telling someone who thought they had cancer that there was a mix up with the test results and they are all clear but the reaction of the patients so far has been far from what you might think. By this time the patients have joined an HIV support group with many members who talk openly about their status and help each other through. Although it can be difficult to get people to join the groups, once they are settled in they often really enjoy it. So these people who are in fact HIV negative don't want anyone else to know and are generally keen to keep attending support group without revealing their status. Maybe one day we will have a support group for people who thought they were positive but are in fact negative but don't want anyone to know!