For anybody who has worked with AMPATH or HIV patients, they know exactly what I am referring to when I speak of the Lazarus Effect. Everybody who works in this setting has had the opportunity to witness first-hand how antiretroviral medications for HIV have brought back patients literally from the dead. We often call this revitalization the Lazarus effect as patients who were previously wasted and preparing for their funeral return to living normal lives just months after starting life-saving HIV medications which can now be purchased for less than $300/year. Personally being a part of this on a daily basis is still one of the most gratifying experiences I’ve had in my career and after seeing Joe Mamlin’s (70+ year old program director from Indiana Univ) continued enthusiasm it doesn't seem like this ever gets old.
With all the attention that has been given to the HIV epidemic, it sometimes becomes difficult to address the needs of patients who aren’t suffering from HIV. This “stovepiping” of healthcare resources sometimes prevents us from addressing the whole host of healthcare issues patients from resource poor settings face. It is through the infrastructure AMPATH has created that we hope to begin to start creating a more comprehensive approach to addressing the entire healthcare system and not just HIV.
In typical AMPATH fashion, everything starts with one patient. I’d like to recount the story of one of the patients I’ve been caring for since the first day I arrived at Moi Teaching and Referral Hospital. This one particular patient was situated in the middle of ward and his chart label read “Unknown African Male”. Day in and day out we would pass over this patient as he was in a completely catatonic state and did not respond to any stimuli or have the ability to communicate with us. He was suffering from catatonic schizophrenia and would essentially remain stuck in whatever position we placed him in. He was essentially stuck in a freeze frame for the first two weeks he was in the hospital. The only reason he even made it to the hospital was through the kindness of passersby who saw a motionless young boy staring off into space on the side of the road.
About a week into his hospitalization we were finally able to acquire Zyprexa (olanzapine), an atypical antipsychotic agent which had previously not been available in Kenya. The only reason we had this medication was through the generosity of an Eli Lilly donation program where they provide us with certain Lilly medications free of charge. This medication was added to his regimen of electroconvulsive shock therapy and we had not noticed any signs of improvement in his status and we were starting to lose hope as he continued to lie motionless in his bed.
I returned to rounds on Monday morning, as usual, and our team went through our usual habit of going over the care of all of our patients. We passed by his bed once again and noticed that he wasn’t here. The rest of the team and I immediately assumed that he must have passed away. As we proceeded to the next bed, we noticed an excited young boy sitting with another patient. This boy was writing papers and telling stories in perfect English to the other patients in the ward. We slowly began to recognize that this was the very patient we had virtually lost all hope for. The therapeutic benefits of Zyprexa had finally kicked in and the patient had returned to his normal state. He was also able to uncover the mystery of his identity and narrate his whole life story. Like so many other abandoned children in Kenya, both of his parents had passed away and this 15 year old boy was struggling to go to school and help raise the his orphaned brothers and sisters. He was on his way to school when he was frozen in this catatonic state waiting for the bus. I can’t even begin to accurately recount the impact this one boy had on our entire team. Our entire team was reinvigorated with hope as our efforts in conjunction with the generosity of Eli Lilly had saved this child and given him the opportunity to potentially live a normal life. I’ve never seen an entire team of practitioners smile for an entire rounding session. The more we talked to him, the more we realized how special he was. One of his first questions to us was when he could go back to school. His love of education was evident as he was by far one of the most well educated 15 year olds I had ever encounered. This is one patient I will never forget and it is a patient I will always remind myself of when the frustrations of practicing in a resource poor setting start to get to me. He will serve as a constant reminder to me of what is possible through collaboration and the linking of first world wealth and resource poor hope. Let his picture at the beginning of this blog serve as proof of the truly immense power of collaboration.
With all the attention that has been given to the HIV epidemic, it sometimes becomes difficult to address the needs of patients who aren’t suffering from HIV. This “stovepiping” of healthcare resources sometimes prevents us from addressing the whole host of healthcare issues patients from resource poor settings face. It is through the infrastructure AMPATH has created that we hope to begin to start creating a more comprehensive approach to addressing the entire healthcare system and not just HIV.
In typical AMPATH fashion, everything starts with one patient. I’d like to recount the story of one of the patients I’ve been caring for since the first day I arrived at Moi Teaching and Referral Hospital. This one particular patient was situated in the middle of ward and his chart label read “Unknown African Male”. Day in and day out we would pass over this patient as he was in a completely catatonic state and did not respond to any stimuli or have the ability to communicate with us. He was suffering from catatonic schizophrenia and would essentially remain stuck in whatever position we placed him in. He was essentially stuck in a freeze frame for the first two weeks he was in the hospital. The only reason he even made it to the hospital was through the kindness of passersby who saw a motionless young boy staring off into space on the side of the road.
About a week into his hospitalization we were finally able to acquire Zyprexa (olanzapine), an atypical antipsychotic agent which had previously not been available in Kenya. The only reason we had this medication was through the generosity of an Eli Lilly donation program where they provide us with certain Lilly medications free of charge. This medication was added to his regimen of electroconvulsive shock therapy and we had not noticed any signs of improvement in his status and we were starting to lose hope as he continued to lie motionless in his bed.
I returned to rounds on Monday morning, as usual, and our team went through our usual habit of going over the care of all of our patients. We passed by his bed once again and noticed that he wasn’t here. The rest of the team and I immediately assumed that he must have passed away. As we proceeded to the next bed, we noticed an excited young boy sitting with another patient. This boy was writing papers and telling stories in perfect English to the other patients in the ward. We slowly began to recognize that this was the very patient we had virtually lost all hope for. The therapeutic benefits of Zyprexa had finally kicked in and the patient had returned to his normal state. He was also able to uncover the mystery of his identity and narrate his whole life story. Like so many other abandoned children in Kenya, both of his parents had passed away and this 15 year old boy was struggling to go to school and help raise the his orphaned brothers and sisters. He was on his way to school when he was frozen in this catatonic state waiting for the bus. I can’t even begin to accurately recount the impact this one boy had on our entire team. Our entire team was reinvigorated with hope as our efforts in conjunction with the generosity of Eli Lilly had saved this child and given him the opportunity to potentially live a normal life. I’ve never seen an entire team of practitioners smile for an entire rounding session. The more we talked to him, the more we realized how special he was. One of his first questions to us was when he could go back to school. His love of education was evident as he was by far one of the most well educated 15 year olds I had ever encounered. This is one patient I will never forget and it is a patient I will always remind myself of when the frustrations of practicing in a resource poor setting start to get to me. He will serve as a constant reminder to me of what is possible through collaboration and the linking of first world wealth and resource poor hope. Let his picture at the beginning of this blog serve as proof of the truly immense power of collaboration.
