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“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Monday, October 21, 2002
    More from Malawi

    *Whew* Thank goodness. Something on-topic I can pinch from someone else (Thanks Chuen-Yen!)

    If you think AIDS is a problem here, you're right. But it seems it's even more of a problem where my friend Chuen-Yen is. I had no idea that the disease was still being denied so powerfully by the culture there, and even by the local hospitals, who ought to know better:

    Mwadzuka Bwange. (Good Afternoon)

    Thanks for the messages. Hope you will visit.

    It has been another amusing week of adjustment to Malawian perspectives.

    One of the most sensitive, as well as common, issues is the taboo topic of HIV. At least 15% of the Malawi is infected, people are constantly bombarded with awareness programs, and everyone pleads ignorance when the topic arises. So, when I proposed doing an anonymous survey about HIV testing, the native general practioners told me that I was delusional if I thought I would get answers. The basic message was that people don't want to hear about HIV and will circumvent the topic if it arises. The project would undoubtedly cost our hospital coveted business.

    Within a day of this meeting, my clinic was flooded with HIV patients referred by physicians who had deemed me so insensitive to the very issue. I even had patients referred because their anonymous (that's the euphemism docs use when they don't tell the patient the test is being run) HIV tests came back positive. Though clearly out of touch, I am now the chosen one for management of this delicate topic.

    As THE HIV DOCTOR, I took the liberty of writing "HIV" as the diagnosis on a chart after extensive discussion with an agreeable patient. Subsequently, the business manager of our capitalist mission hospital curtly informed me that I was not to use the terms "HIV" or "AIDS" on any documentation; patients were upset.

    A few days after I had upset other physicians with my proposed project, then become the person to talk with about HIV, then offended patients with my handling of the "immune problem" topic, I found myself on the phone with Television Malawi. The station had sent a letter to our hospital requesting an interview with a medical professional. Certainly, I, the new American Internist, would provide good publicity for the hospital. In discussing the interview logistics with Television Malawi's "Your Health" program coordinator, I revealed my background and that I would be in Malawi for a year. The coordinator ascertained that I could be available one afternoon every week, lamented that the previous "Your Health" host had recently left the country, then genlty eased me into the position of the new "Your Health" host. Starting sometime in November, I will have a weekly half-hour show on TV Malawi. Perhaps you can get it on satellite if it really happens.

    Who knows how the HIV epidemic will play out in Malawi? But, an anonymous survey on the topic will be handed out to all the Blantyre Adventist Hospital patients for now. And, Malawi and its neighbors may get to deny hearing anything about HIV on "Your Health."

    Good-bye for now,



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