Post Exposure Prophylaxis (PEP)

Perhaps, if I am really honest with myself, I would admit that one of the scariest things about moving to Malawi (before we actually did) was the thought of HIV/AIDS. Not the living among it, nor the disease itself, but rather that I was married to a surgeon. A surgeon, who by the very nature of his work would be belly deep in HIV infected blood almost every day of his life. And in the end, how comforted would you be by the “1 in 3,000,000” chance of contracting the dreaded illness, if double gloved, if the patient was on antivirals, and if PEP (Post Exposure Prophylaxis) was started right away?

Yet, as is the case with most ‘dangers’ when living with it day in and day out, the mind forgets the possibilities of problems around each corner. Snakes become a part of the garden watched over by the vigilant Jack Russell, malaria becomes like the common flu where you just take a pill and recover, spiders become houseguests only thought of if one is unlucky enough to be bitten, layers of security bars that once obscured the view of Thyolo mountain become a climbing gym for cooped up boys in the rainy season. And HIV/AIDS is the disease slowly killing your neighbors but so slowly and so quietly, it almost doesn’t exist.

But then on a day like yesterday I’m taken back to our sunroom in Michigan where I remember dreading the unknown country of Malawi, dreading the possibility of ‘danger’ from poisonous vermin and probable robberies, but most of all the dread of surgery on HIV positive patients. I suppose if there’s one thing that Malawi teaches me, it’s that having control over my life is more of an illusion than a reality, we live in a temporary world, which has the possibilities to change and to change us without much thought and void of concern.

Yesterday Ryan came home with that look on his face again. That look that said, “things are uncertain…” and then he showed me his finger. A perfect slice, dried blood indicating a cm long cut on his pointer finger. How celebrated this injury would have been if done while hammering and sawing boards for a tree house, or cutting vegetables in the kitchen! But it occurred in surgery, in the Malamulo theatre, double gloved, on an HIV positive patient.

Then, I heard it again, “1 in 3,000,000” chance of contracting the virus. Double gloved, patient on antivirals, PEP started….and then it was as if Ryan’s lips were moving but I couldn’t hear any of his words… (In four years this is Ryan’s 3^rd time to go onto PEP, but by far the worst case, (the previous two from a small needle stick))…

A single moment can change our lives, or not. Sometimes what happens to us in a split second takes months to realize the impact.  And so now we wait, Ryan will take the horrid PEP daily for a month, (nausea, abdominal pain, diarrhea and lethargy as side effects) and then he will get tested to check the results.

Sometimes I’m not even sure how or if God protects us from these perils. Why would He protect us anymore than the 12 yr old girl, raped in the village by her HIV positive Uncle and consequently infected by the virus?

It’s a choice we made. It’s a possibility we said ‘yes’ to when we signed up for Malawi. I’m guessing most of our surgical residents have also thought of this possibility when leaving the comfort of what they know in the USA to rotate here for 2 months? 2 months that could change their world forever…

So why do I feel I have a right NOT to have HIV in my home when the community we live in suffers daily because it’s in theirs? We’re not removed or immune from ‘African problems’, and I don’t want to be either. We are all God’s people. We are all here (on earth) temporarily, and suffering is part of the human story. Just how we suffer is sometimes different.

(Ryan's cut finger)

* Ryan tested in February and the result is NEGATIVE. So thankful! And to each of you who prayed for us and with us during this time, and sent us love! 

HIV/AIDS affects 10.5% of Malawi’s total population.

But our district of Thyolo has an occurence of 22%.

Of those admitted to Malamulo hospital 70% are HIV positive.

Around 50% of surgical patients are HIV positive.

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