World RTA Day & Antiretrovirals

         Today is World Day of Remembrance for Road Traffic Accident (RTA) victims.  We see many RTA victims weekly, usually at night.  Sometimes they are vehicle vs vehicle, tractor vs vehicle and sometimes vehicle vs road.  We worry about head trauma, blunt internal organ trauma, vertebral fractures and spinal cord injury that are often evaluated by CT scan and x-ray in the US.  Here we have no cervical spine collars, no CT capabilities and x-rays are not available on the evenings or weekends, so ruling out brain injuries or fractures can be difficult.  

CN is 12 year old girl who was heading home at night from a school excursion with her teachers and classmates when their tractor overturned on the edge of a steep shoulder.  While her classmates sustained minor injuries, CN had a severe concussion and lung contusion (bruise) and required oxygen for several days.  In honor of RTA victims here are a few pictures below.

CN early in her hospitalization

CN in her pretty dress ready to go home with her aunt

BN, 13 years old and currently in the hospital

                     I have shared about the widespread and devastating effects of HIV/AIDS and wanted to share a bit about antiretroviral medication.  Antiretroviral therapy (ART) makes an enormous impact on the lives of our HIV patients and can keep them healthy for years.  And here patients can get them at no cost.  To initiate ART patients must meet certain clinical standards or blood count standards and have at least 3 counseling sessions to discuss the risks, benefits and necessity of medication compliance.  The medications are usually helpful, but can have deadly side effects.  I have seen several cases of medication induced hepatitis and Stevens-Johnson syndrome (SJS), a potentially deadly reaction involving the skin and mucous membranes.  The skin often blisters as do the lips and mouth and even the GI tract and lungs can be involved.  There is often at least one SJS patient in the wards per week and unfortunately one patient died last month.  Pictures are truly worth a thousand words for this incredibly painful condition.

SJS survivor

SJS survivor