Home Visits

This was my second time for a home visit this afternoon. The morning was difficult. The 09 Center is not a real hospital or prison or treatment center. It doesn’t even work well as a warehouse. I went to see a patient with fellows. Information is scant. When I can’t do the interview myself it is difficult because the subtle hints and the way of asking questions is lost. However, this patient was supposed to have only been infected for a few years and now he is very sick and declining rapidly. Also, he is a professional, an engineer among most of the other patients that a drug addicts. I suspect that he has had the virus for longer than he says and that the route of transmission may be not as he as describe. However, I have seen patients who did have rapid progression of HIV to AIDS in a few years but is rare and then it is hard to judge what else people say as true or not. We must though start where we are which is with a very weak immune system and one of many common opportunistic infections and we will probably just have to do this by empiric treatment since he testing is limited. Your history and physical exam become more important and you have to think about this almost like when you are doing pediatrics. The thing that stumps me is that he has a rash. I know shingles, fungal and a few others but this is not like most I have seen. It is dry to wetting it might be a good plan but with what. Fortunately, the next day it was better and I and he have dodged a bullet.

Hung has arranged for us to see one of his patients at home. However, there is the matter of lunch. I had to ride with helmet on the scooter with Hung since there are just not taxis out where the 09 center is. I am doing ok with this but avoid this whenever possible. We go on a lot of back roads and by a flood diversion gate and finally are in a really nice neighborhood. There are a number of very nice looking cafes that we drive by to get to this kind of run down place that is more open air and you walk to a little cabana for your meal. I just don’t have much idea what to order so let others do that for me. I therefore am at there mercy. I had mentioned I liked corn and we did get some fried corn new experience and some other things that were ok. I was alarmed at the bottle of Vodka that appeared and mostly disappeared while we were there with 4 men consuming most and Dr Thuy and me only the polite glass.

After this we meet the rest of the group to visit our patient. I think that M most have well to do parents because of the treatment and the care they are providing. I did go into his room and discuss evaluation of home safety and particularly the bathroom. He then came out and we had our conversation. I know that he is sick but I think that depression is playing a big role and we discussed better symptom management more exercise and possibly medication. I think this was a pretty big success all in all and I think that Vietnam will have to come up with a plan to provide more homecare. The family asked me if I thought the hospital could provide better care or if he would be in a hospital in USA. I can tell you that the hospital is a dangerous place in the USA and certainly in Vietnam with risk of hospital acquired infections and home is the safest place to be if you don’t have something like surgery that you need to be in the hospital for and then home again as soon as possible.