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A lasting effect

My eyes immediately focused on the bandaged stump and the empty space where his leg used to be. The nurse had warned me before I entered the room, but I was still jolted by the sight. The surgeons had amputated his leg just two days before, below the knee. This was the last resort, a life-saving measure. How must it feel to be seventeen years old with only one leg? I forced my look away from his wound and met his eyes. They were swollen and tired, probably a combination of pain, medications, and the stress of starting a new life feeling less than whole. I tried to hide my sadness while conjuring a soft smile.

“Hi. My name is Bryan. I’m a medical student, but I play music at the hospital every week. Would you like to hear any songs?”

He nodded his head slightly forward in assent. I placed my pile of worn and wrinkled song sheets in his hand, and while he was browsing through the selection, his mother said, “Well, you know he plays guitar, too.” Warm maternal pride filled her eyes.

“That’s great. How long have you been playing?” I asked him.
“Since I was ten,” he answered with a scratchy voice.
“Wow, seven years. I’ve only been playing since my last year of college – about four years.”
I began to feel insecure about playing for a musician with more experience than I had.
“Why don’t you play something first?” I offered.

He weakly nodded his head again. His forearms were pocked with multiple IV lines, each connected to a hanging bag, and his chest had a painful incision that was covered with thick gauze and medical tape. We snaked my guitar through the shield of medical paraphernalia and carefully rested it on his stomach. He contracted his face in pain as he tried to reposition himself in the bed in search of a comfortable position. Once he was settled, he began to pick a rhythm on the guitar. He played slowly and deliberately, trying to fight through the medication vagueness, persistently persuading his fingers to follow orders. After a few stumbles, a tune emerged and danced around the room. Then in the midst of his song, he winced harshly through gritted teeth and suddenly stopped playing. His ailing body had sent his brain a reminder of his condition; he could no longer play through his pain. With a frustrated gasp, he surrendered the guitar. As I returned the guitar to my shoulders, he began to search again through the stack of papers for a familiar song. He looked over my entire catalog before making his first selection. It was one of the most difficult songs I knew how to play. Like a true guitarist, he wanted to test my skills. I took a deep breath and began the song. His eyes were fixed on my fingers as they plucked and strummed, and bent the strings with bluesy inflection. He seemed to critique every move and every note. His face was painted with deep pleasure. We played through several songs over the next half hour, each just as difficult. While I played, his eyes were full of life, no longer obscured by pain or worries. He had transcended his problems and found peace in a musical refuge. The music had provided shelter from his stormy life. As the final note faded, reality began to seep back into the room. His eyes lost their depth and forgotten pains quickly registered. Once again, he was a seventeen-year-old boy in a hospital with one leg and several scars. As I watched his painful transformation, I was sadly reminded that every song must end. My guitar could not undo the harms that he had suffered, and the relief I offered was merely a momentary distraction. My guitar was not a panacea. Regardless, I was convinced that something more than a diversion had taken place. I believed that, in some way, our music would live on beyond the end of that last song. Although he was reeling in pain at that moment, perhaps he felt a trifle less pain because of our music. And later that night when he was lying alone in the hospital bed, perhaps he felt a little less lonely because of my visit. And, someday ahead, when the memories of his suffering have slowly subsided, perhaps he might be reminded of the songs that made him smile on the worst day of his life. And maybe he will smile again and pick up his guitar.

(Adaptado de: SISK, B. A lasting effect. Hektoen International. A Journal of Medical Humanities. Disponível em: http://www.hektoeninternational.org/index.php?option=com_content&view=article&id=402. Acesso em: 25 abr. 2016.)

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(A community health worker takes on the role of the traditional healer in a play warning of the dangers of traditional medicine)

12 November 2015

Worlds AIDS day (1^st December) is fast approaching and with it we have a number of activities planned here in the South Kivu province of Democratic Republic of Congo.

In this part of the world public understanding of the disease is minimal and stigmatisation is a huge. Many diseases caused by bacteria and viruses are seen to be the work of magic or poisoning and HIV is no exception.

The first port of call for most people when they fall sick is the traditional healer or the prayer room. Both warn against the dangers of western medicine and urge people to stop taking the hospitals drugs. The effect of this is very damaging and we often see HIV patients arriving in a terrible state having abandoned their treatment for these alternative healings.

Stigmatisation here is the worst I have worked with, but living with HIV anywhere in the world is difficult.

Taking a taxi in Amsterdam, while attending my mission briefings, my driver made it clear that he believed getting HIV meant certain death. It’s not the 90s anymore and this is no longer the case.

Modern treatment means that people living with this infection, while they cannot be cured, can live a long, healthy life and have a family without infecting them. If this is still poorly understood in the west, then imagine the understanding here, deep in Eastern DRC.

Here, most people are too afraid even to tell their partners of their status for fear of rejection.

Of course the partners are likely positive themselves and may be the source of the infection. Often when people do disclose, families are broken apart and human beings are marginalised.

And it is in that context that we approach World AIDS day with a number of events aimed at improving public knowledge over the next month.

Our teams are visiting schools, putting on theatre productions, speaking on local radio and, most excitingly, we will be hearing public testimony from people living with HIV.

Three of our patients have volunteered to speak out about their disease, to share their story with their community.

This has never been done before here and the courage involved is huge. Each has their own story which they have consented to be published on this blog and in the coming weeks I will share these with you.

(Adaptado de: VERRECHIA, R. The slow battle against stigma and misunderstanding. Congo, in Colour Blog In Medecines sans frontieres. Disponível em: http://blogs.msf.org/en/staff/blogs/congo-in-colour/the-slow-battle-against-stigma-andmisunderstanding. Acesso em: 23 abr. 2016.)

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Pharmaceutical industry gets high on fat profits

Pharmaceutical companies have developed the vast majority of medicines known to humankind, but they have profited handsomely from doing so, and not always by legitimate means. Drug companies have been accused of, and admitted to, far worse practices than making money. Until recently, paying bribes to doctors to prescribe their drugs was commonplace at big pharmas, although the practice is now generally frowned upon and illegal in many places. The rules on gifts, educational grants and sponsoring lectures, for example, are less clear cut, and these practices remain commonplace in the US. Indeed a recent study found that doctors in the US receiving payments from pharma companies were twice as likely to prescribe their drugs. This all may change when new rules in the US and UK will force doctors to disclose all gifts and payments made by the industry. Drug companies have also been accused of colluding with chemists to overcharge for their medicines and of publishing trial data that highlight the positive at the expense of the negative. The rewards are so great, it would seem, that pharma companies have continually been prepared to push the boundaries of legality. No wonder, then, that the World Health Organisation (WHO) has talked of the “inherent conflict” between the legitimate business goals of the drug companies and the medical and social needs of the wider public. Indeed the Council of Europe is launching an investigation into “protecting patients and public health against the undue influence of the pharmaceutical industry”. It will look at “particular practices such as sponsoring health professionals by the industry ... or recourse by public health institutions to the knowledge of highly specialised researchers on the pay-rolls of industry”. No matter what the outcome of such investigations, however, the pharmaceutical industry is facing fundamental change, as the traditional model of developing drugs breaks down due to rising costs and scientific advances. The cosy world of big pharmaceuticals is under threat like never before.

(Adaptado de: ANDERSON, R. Pharmaceutical industry gets high on fat profits. BBC News. Online. 6 nov. 2014. Disponível em: http://www.bbc.com/news/business-28212223. Acesso em: 12 jun. 2015.)

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Pharmaceutical industry gets high on fat profits

Pharmaceutical companies have developed the vast majority of medicines known to humankind, but they have profited handsomely from doing so, and not always by legitimate means. Drug companies have been accused of, and admitted to, far worse practices than making money. Until recently, paying bribes to doctors to prescribe their drugs was commonplace at big pharmas, although the practice is now generally frowned upon and illegal in many places. The rules on gifts, educational grants and sponsoring lectures, for example, are less clear cut, and these practices remain commonplace in the US. Indeed a recent study found that doctors in the US receiving payments from pharma companies were twice as likely to prescribe their drugs. This all may change when new rules in the US and UK will force doctors to disclose all gifts and payments made by the industry. Drug companies have also been accused of colluding with chemists to overcharge for their medicines and of publishing trial data that highlight the positive at the expense of the negative. The rewards are so great, it would seem, that pharma companies have continually been prepared to push the boundaries of legality. No wonder, then, that the World Health Organisation (WHO) has talked of the “inherent conflict” between the legitimate business goals of the drug companies and the medical and social needs of the wider public. Indeed the Council of Europe is launching an investigation into “protecting patients and public health against the undue influence of the pharmaceutical industry”. It will look at “particular practices such as sponsoring health professionals by the industry ... or recourse by public health institutions to the knowledge of highly specialised researchers on the pay-rolls of industry”. No matter what the outcome of such investigations, however, the pharmaceutical industry is facing fundamental change, as the traditional model of developing drugs breaks down due to rising costs and scientific advances. The cosy world of big pharmaceuticals is under threat like never before.

(Adaptado de: ANDERSON, R. Pharmaceutical industry gets high on fat profits. BBC News. Online. 6 nov. 2014. Disponível em: http://www.bbc.com/news/business-28212223. Acesso em: 12 jun. 2015.)