A couple of weeks ago a female patient in her late twenties presented for care. She had a chief complaint of left sided weakness for the last three weeks. Not a common combo- young female + stroke symptoms. I was cautiously curious.
She weighed in at a mere 82 pounds. Indeed, she did have left sided weakness. Labs were notable for mild anemia and a POSITIVE RAPID HIV TEST (pictured below). ...Oh... Now it all makes perfect sense- HIV infection markedly increases risk of stroke as it can cause stroke by way of various mechanisms (opportunistic infection, vasculopathy, cardioembolism, coagulopathy, etc.). But, those two parallel lines (ll) shown on the test cartridge should not be mistaken for an equal (=) sign. Now it all makes perfectly no sense. How does one process a situation such as that in such a context as ours?
Young, presumably previously vibrant and healthy, now with weakness affecting half of your body and a chronic infection that will most likely truncate your life. A chronic infection that in resource-rich countries such as the U.S. is now managed much like other chronic diseases and has a negligible impact on life expectancy. A chronic infection that in your small rural community in the mountains of Guatemala is still stigmatized and its victims ostracized. Medications are available, but they are managed by the Ministry of Health. For treatment of HIV, you will need to travel to a larger city... the meds are free, the travel is not. The social isolation comes with an even steeper cost.
Questions, questions, questions.
Questions for the patient:
How do you generate income as a young woman without the use of one side of your body while carrying the burden of a disease whose presence you cannot share with others? How do you explain frequent trips outside of your community to seek care for an unnamed medical condition?
Questions for our clinic:
How do we walk in solidarity with our patient and help her navigate the maze of a dysfunctional healthcare system? How do we ensure that she and all of our patients receive the best possible care?
Questions for you, dear reader:
Reflecting on the opening image of this post and acknowledging that if you have the time and energy to have read this far, you can with an incredible degree of certainty know that you are privileged. Unfathomably privileged in relation to billions of other occupants of this globe. What would you do? What will you do?
Sometimes life serves up more questions than answers.
"Privilege is here. And with privilege goes responsibility."
~John F. Kennedy
"...Much is required from those to whom much is given, for their responsibility is greater."
Top photo by Jon Tyson on Unsplash