Angeleena Esther works as a medical doctor in the Manipur programme of Doctors Without Borders/Médecins Sans Frontières (MSF). She talks about one of her patients whose desire to live inspired her, and shares her experience of providing healthcare to people living with HIV and tuberculosis (TB).
© Avantika Shrivastava/MSF
The first thought that crossed everyone’s mind when they saw her was that she was going to die, soon. About 28 years old, she came into the MSF clinic in Moreh, on India’s border with Myanmar, with her father. The man carried his frail daughter on his back, his hope of her survival dimming a little more with each step he took.
I screened her for every disease I could possibly think of keeping in view her symptoms. I was desperate to give her a fighting chance. She tested positive for HIV. My team also found that she had a brain infection. She had lost vision, vomited repeatedly and tests showed that her immunity level was dangerously low.
A patient who lay on the cot next to hers was going through the same, and sadly she passed away. All the efforts we put in could not save her and I knew that I had to be cautious against raising the expectations of this young woman. I explained the situation to her and told her that she could also seek treatment back home in Myanmar, but her father disagreed. He wanted his daughter to be looked after only by us.
She fought hard for her life through six excruciating days thereafter. She defied our worst fears and went on to complete the two-week long treatment. On the last day, I wished she would walk to us when she came for a check-up again. And she did. She’s gained at least 12 kgs since then and doesn’t miss review sessions. She wanted to see another day and I had to make that possible. She didn’t give up and taught me not to.
Facing the challenge
I’ve been part of MSF’s Manipur programme for eight months now and I think of her every time I come across patients who delay in approaching us for treatment or leave mid-way. There may be many reasons for this, including the fear of stigma. As a doctor, what I want is to constantly monitor the status of those under my care because HIV-AIDS or TB cannot be just wished away.
I’ve had patients who ask pharmacists for antiretroviral treatment for self-medication. They can be duped into paying double. Besides this, those involved in drug abuse seek medical care only when they realise they’re not getting any better. When such people finally ask for treatment, they are often already suffering from side effects and HIV/AIDS-related infections, or are co-infected with TB. Sometimes, there is not much I or my team can do. When people come so late, their immunity is very low and their recovery can be a long process due to this.
It’s also clear that not everyone understands HIV-AIDS. I have come across people who don’t have an idea of what is happening to them, and that receiving medical attention is good for them and their loved ones.
There’s also this enormous sense of expectation from MSF, often the last hope for many. There are times when I have to tell people living with HIV and for instance needing treatment for cancer as well, that they require care beyond what we can give them. I really like to see patients smile when they know they’re getting better. Hence, it’s difficult not being able to help them directly as I write down the referral to a more specialised facility.
But I’ve learnt that no matter what, as doctors, we have to go on.
Angeleena Esther was interviewed by Shagun Nagpal and Avantika Shrivastava.