Monday, August 24, 2015

Infections and Inequalities

It is true that people who are in the ‘same boat’ understands each other more, I am speaking in terms of patients having the same disease. For the past few weeks I have been working at the infectious disease ward at the National Leprosy Centre. It used to be filled with leprosy patients, it now admits patients with the more common infectious disease of today: those affected with HIV/AIDS. Located near Sungai Buloh Prison, the main prison of Malaysia, it also houses a lot of sick inmates and convicts from the prison. My ward, ward 54 has patients which are mostly HIV positive, and some of them have been there for a long time. Sometimes they are just waiting a place for them to stay when they are discharged from the wards.

I have been observing them for awhile now, and I can say that I have never worked in a ward where patients really care for each other. I had a patient with cerebral toxoplasmosis which damaged his brain function to the extent that he could not control his hands while feeding. Every time food is served, the patient next to him would sit beside, and slowly feed him before taking his own meal. Another day, a patient had vomited on the floor, suffering the side effects from the new HIV drug that we started, and the next thing that happened was the patient next to him ran to the toilet. I thought that he couldn’t stand the awful smell, but instead he came back with a mop and cleaned up the vomit right away.

National Leprosy Centre, Sungai Buloh
Last weekend I was letting another HIV patient home, and I saw him exchanging phone number with the patient in front of him. I kiddingly asked him: “eh, tuka nombor ni sebab nanti nak masuk balik ke?” (exchanging numbers because you want to come back here, do you?). His answer touched me. He actually found out that the other patient had been in the wards for months only because of placement issue: he does not have a place to stay if we let him go. So he took the other patient’s number, because he knows a relative who owns a home for the disabled. Once he is out, he said he will persuade his relative to let the guy stay at that home. He is just worried because of his friend’s HIV status, whether his relative would consider letting him stay.

In the beginning I was afraid to work in a ward full of convicts, prisoners, and drug addicts. But it is only after talking to the patients, knowing their social issues, getting to know them as individuals instead of diseases, that I see another side of them. Not all of them are bad. One convict was running away from the police stealing a hi-fi audio player. When the police snatched him, he accidentally dropped the hi-fi on the police’s foot, and now he is charged with ‘police assault’ that gives him heavier punishment and more years in jail. He regretted his act until today. Even if they were bad in the past, it doesn’t mean that they still are. I see some who was constantly reading the Quran and makes the effort to pray 5 times a day. As I mentioned before, some of them really took care of their friends. We cannot stigmatize these people, who we are to judge them based on the disease that they have? Prophet Muhammad SAW once said:

O people! All of you are the children of Adam. You are like equal wheat grains in a bowl ... No one has any superiority over anyone else, except in religion and heedfulness. In order to consider someone a wicked person, it suffices that he humiliates other people, is mean with money, bad-tempered and exceeds the limits.(Narrated by Abu Hurayrah (r.a.), Ahmad, Abu Dawud, 4/331)

These are the people who are the most vulnerable, the most stigmatized, shunned from the outside community. As a doctor, I swore not to treat these patients any differently than how I treat the others: VIPs and ministers alike. My times in Indonesia and Cambodia has carved a different way of how I approach these diseases. I would not jump at the moment a new drug for HIV, or TB, or malaria has been launched. I would only jump in joy if these drugs could reach the ones most vulnerable to these diseases: the poor, the homeless, the prisoners. I know it takes a lot of effort to ditch the stigma that we have towards these people, especially those affected with HIV, but once you talk to them you will realize that they are no more different than you: with hopes for the future, with families, friends and a job to keep. If we keep stigmatizing others and deny them of adequate treatment, I guess as they slowly feed another friend who are much worse than them, in their eyes, all they can their future self

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