One of these days, I met (him, whom now may I assign a name, not his real one) Murugan. I had gone to 'take' an Tuberculosis case for the clinical case presentation. As I talked to the doctor in charge of him, it was revealed that recently he was diagnosed with HIV too. Later, I talked with Murugan. He gave a history which was like a textbook history of HIV, fever of 6 months, chronic diarrhea and lately, cough. When I examined his chest, my stethoscope echoed with the numerous rattling sounds his lungs produced. It felt like TB had almost laid both his lungs waste. Still he was unseemingly pleasant and comfortable for someone who had just been diagnosed with HIV-TB.
His wife, Lakshmi (name changed) too was with him. She told me they had 5 children, all girls, the youngest one just 2 & 1/2 months old. I asked Murugan what all diseases he had. He told TB, he dint know how to say HIV, When I mentioned HIV/ AIDS, he shaked his head, recognising the name. I asked Lakshmi, she only knew about TB. HIv, she hadn't even heard about it, dint know what was it, what it meant if her husband had HIV. It was just another thing with a fancy name for her. She went on chattering incessantly how the hospital had sent her back everytime without doing a sterilisation for her and they ended up with 5 kids.
Murugan had been started on anti TB durgs, he would soon be put on anti-retrovirals for HIV infection. He would have to take the drugs on a daily basis. He has not been going for work for the last 1 month, forfeiting his wages. He appeared very calm and composed, perhaps not aware of the gravity of his condition, perhaps knowing it but not showing it.
I was very shaken by what I heard and what I saw. A lone earning member of a large, young family afflicted by the most deadly combination of diseases on the planet. He was a walking- dead man. I'm probably contradicting the advancements medical technology of the day. There are very effective anti-TB drugs, effective anti-HIV drugs, whihc are given free of cost by the government. All the patient has to do is just go and collect them and take them regularly. Easier said than done. A daiily wage earner like Murugan, how can he go daily and collect his medicines? He who didn't even know about HIV till yesterday, how can we expect him to take 2 doses of anti HIV drugs daily for the rest of his lifetime? How do you create such awareness in an illiterate man who never ever went to school?
I felt very afraid for Lakshmi and her young children; a very bad dread, thinking of how she will bring up the girls if Murugan succumbs to his diseases. What if she also contracts HIV tomorrow, for they have never used condoms during their married life and seemed very unconvinced about using it from now on. /suddenly all the NACP (National AIDS Control program) I've studied seemed like academic rhetoric. As a doctor, what could I do here? How can I help him get back to his work, be an active participant in the treatment of his condition? I had told both of them about HIV, how it spreads, how to prevent it, how to take medicines, whom to approach in case of any side effects of drugs.... What I didn't tell was, he wouldn't probably live to see his children grow up, how do you tell that to someone's face? I told them everything but the most important information that would help them to realize the seriousness of their situation. All I can do now is only hope that my fears are unfounded, they not come true and I be provena damned, pessimistic fool.
