OCCUPATIONAL HAZARDS
I had written this post back in July but I was discouraged from posting it. People felt that the post would provoke unnecessary pity. I decided to wait till I had surpassed the window period of the disease I will be talking about so as not to attract too much attention. That way, it wouldn’t be personal.
The story begins ;
You see, I was covering the hospital alone one Saturday in July. Dr. Gaido was away on leave in Italy. There was a patient who needed a minor surgical a procedure and I had to intervene .
That morning while making my Suhur meal (morning food for Ramadhan), I did cut myself with a knife on the left index finger and got a fairly deep wound around 5mm long. The wound didn’t bother me much.
I was extra careful during this particular minor surgical procedure, as usual. I did not prick myself but I accidentally ‘picked’ the glove with toothed forceps and the double-glove got a small hole. Blood entered directly onto the finger that had the fresh wound. I really did freak out and immediately changed the glove. I proceeded with my surgery and finished successfully without getting emotional. The fact that patient’s blood had come into contact with my finger did not bother me much afterwards. How many times have we pricked ourselves with HIV infected blood and ignored?
At night after work as I was thinking, I realized that I ought to have taken the matter more seriously than I was treating it. You see an open wound coming in contact with infected blood increases the risk significantly to 0.09% (9 in every 100 cases). A small needle prick can be ignored but not this. 24 hours were about to lapse so I had to make a quick decision to protect myself. It’s better if medication is taken immediately preferably within 2 hours but can be extended to 72hours.
There are 58 confirmed HIV infections among health providers contacted in the line of duty in America. The numbers could be higher in Africa.
Body fluids coming into contact with a non-intact skin, mucous membranes or venopuncture with a needle in contact with HIV infected blood or body fluids is considered a high risk and Post-Exposure Prophylaxis is highly recommended. Contact with blood of a person whose HIV status is unknown, whether clinically healthy or not is also considered a high risk factor. Studies indicate that fluids from as source whose HIV status is negative could call for initiation of treatment especially if he/she is thought to be in the window period of the disease; a period in which HIV replication is usually highest.
It was a weekend so the staff at the Comprehensive Care Clinic were not at work. I got a kit in the clinic and got tested by a colleague as per protocol before initiating medication. I underwent the baseline tests needed in the labaratory and then had to quickly figure out which drug combination I needed to take. The new W.H.O guidelines recommended a three-drug combination, Tenofovir, Lamivudine and Lopinovir/ritonavir (Alluvia). That’s a very strong drug combination, it’s actually a full ARV regime. I made the decision to change the third drug to Atazanavir/ritonavir because it’s a once a day dosing and is in the same class with the former. I’m more adherent to once a day dosings, but boy, the ATZ tablet was huge. Had to force it down all the time with thick liquids. It was during Ramadhan so I had to break my fast for the day to quickly take the first dose. I took the drug, felt like ‘shit’, got so weak and had to take the afternoon off to go vomit, eat and rest.
I also tested the patient for hepatitis-B and Hepatitis C after taking consent, just to be sure because Hepatitis has a higher risk of transmission more than HIV.
Immediately after contact with the HIV, the virus replicates in the dendritic cells of the skin and the mucous membranes for a period of 72 hours before dissemination through the lymphatic system to the rest of the body. These 72 hours provide a window of opportunity to inhibit the replication of the virus hence significantly reducing the risk of infection. This is ideally the essence of PEP.
I had to be on Post Exposure Prophylaxis (PEP) for a period of 30 days. Ramadhan had one more week to end and each day was a struggle for me.I felt hungry all the time and there was this irritating strong metallic test that could only be made better by sweet foods (that I couldn’t take due to fast). Of course the side effects wear off with time ( or the body gets used to it). I did not enjoy Eid shopping because I was in the first week of therapy and I was extremely weak and dizzy; don’t forget I was also fasting. My family was my constant support and cheerleaders. Each day I would swear to stop taking the medication but at the back of my mind I knew that I had to a faithful, obedient patient. Eid was low key for me, I was moody, weak, nauseated e.t.c.
I came face to face with stigma. While at home I had to hide my drugs at the car tool kit below my boot mat. I couldn’t imagine the misconceptions and judgements that would be passed on me had my extended family relatives or friends seen the contents of my handbag or my bedroom drawers. I cannot imagine what our patients go through. A lot of public education is needed.
I successfully finished the drugs in 30 days and even took the empty cans back to the HIV Clinic( to the amusement of the staff). I got tested at 6 weeks post-.exposure and at 8 weeks, all is well. I will faithfully go for the testing at 12 weeks and at 6 months. I’m so glad that I’m safe but I’m also grateful for the journey because it helped me understand my HIV patients more. Before I ‘scold’ a patient because of not being adherent to treatment, I remind myself that all they need is support and encouragement to survive the nasty side effects before their bodies get used to it .
I learned a few tricks to pass to my patients. If it’s a once a day dosing, it’s better to take it in the evening after dinner unless otherwise indicated by the doctor. This way, the effects of the drugs would be minimal during the day. I also learned that eating well is important. The effects are nasty on an empty stomach. Sweets and sugary foods help minimize the metallic taste and the nausea.
This experience also made me want to create awareness to the public and to our policy makers of the things that medics go through. It’s not easy. I hope we can be appreciated and respected more. Medicine sometimes involves putting our lives on the line to save other’s.
Let’s not forget that there are other groups of people in different circumstances who take the ARVs for Post-Exposure Prophylaxis. Rape victims, Road Traffic Accident survivors with open wounds and blood contact, Victims of human bites e.t.c. They all need support and encouragement to finish their treatment. It’s all worth the struggle.
Sensitization is needed among members of public and health workers to encourage risk assessment, prompt initiation of treatment and proper follow-up in the event of accidents involving coming into contact with body fluids. Proper equipment for disposal of needles or hospital materials need to be made available in all health facilities. Safety measures such as provision of adequate gloves, goggles to protect the eyes during surgical procedures and safe shoes to be worn during surgeries have to also be made available. Government institutions as well as private researchers need to do more research regarding this issue with a view of enhancing proper implementation of the W.H.O guidelines soas to reduce transmission especially among healthcare providers.
I had to cut out a lot when editing the post I wrote back in July. I realize I was bitter and panicky but right now I’m grateful and mature about the issue. My mum was right, I shouldn’t have posted this on the blog back in July. Everything has it’s own time !