Tuesday, August 30, 2016

HIV-Infected Children Put in Danger by Libya’s Political Chaos

 This article was published in Libya Herald during May/2016 , since then things are getting worse!
HIV-infected children put in danger by Libya’s political chaos

For most Libyans, AIDS and HIV are something that happens elsewhere. They do not want to acknowledge their existence in Libya or even talk about them. There is a string social stigma connected to the disease. But in reality there are thousands of Libyans infected with it. With the right medication people can now live with HIV, but in the current anarchic circumstances where hospitals and clinics across the country have seen their supplies of drugs and medications run out and not be replaced, HIV patients are at great risk.
Dr Elham Elhshik, who works at Tripoli Medical Centre with children infected with the virus, writes of the very dangerous consequences for them as a result from the present political chaos.
At the end of my workday on the paediatrics HIV ward, I flipped through the lab results of the viral load levels of my patients. The numbers in the reports had skyrocketed, my heart ached and my mind wandered. I put the reports away, as if that would make them improve or vanish.
The numbers in the reports of HIV viral load reflect the amount of control we have on the disease. If a child infected with HIV takes his HIV medications regularly, the numbers will be low or even undetectable, the disease will be under control and the child will live a normal, healthy life. When the numbers start to rise, it is the first sign predicting a clinical decline. A drop in immunity will follow; the child’s immune system will collapse and the full ugly manifestation of AIDS will prevail.
This loss of control of the disease course that our patients are suffering is not a consequence of the normal progression of the disease, but because of the interrupted supply of HIV medications. We have more than a hundred children infected with HIV in our care and thousands of adults. The children have mainly acquired the infection from their parents. In some cases, the mother did not know she had HIV while she was pregnant, or she was unaware of the steps she should take to prevent the transmission of the disease to her baby, or she had no access to the medical care that she needed to receive.
In 2010, a programme to prevent mother-to-child transmission of HIV was established at the Paediatric Infectious Diseases Department of Tripoli Medical Centre. The programme was successful in preventing the transmission of the virus in more than 90 percent of the babies whose mothers were HIV-positive. The programme covered all the western and southern parts of Libya. The percentage of success rose every year. Even when there was a shortage of the required syrup used in the prevention, we crushed and ground the solid tablet form of the HIV medicine and diluted it with liquid to administer to the babies. This was achieved by a collaborative team effort of the pharmacists, obstetricians, physicians in the adult departments and the paediatricians. Pregnant women and children were the priority when dispensing HIV medicines, particularly when we faced a shortage in supply.
There are two encouraging times in the care of people with HIV. The first one is the tremendous success of prophylactic medication in preventing the transmission of the disease to the newborn. The moment you deliver the news to an HIV-infected mother that her baby is not infected, there are tears of joy in her eyes and a glimmer of hope shining from her face. The second is watching the “Lazarus” effect of the HIV medicines on infected children. They are literally pulled away from the clenched jaw of death. The medicine restores health, saves the collapsing immune system, raises hope and changes the life of the family as a whole. The problem with this “Lazarus” effect is when you watch it go backward. When the medicine supply is interrupted, as it is now, the caring physician or paediatrician will watch the patient’s health rapidly slip through his fingers without being able to do anything to stop the progression of the disease.
Recently the care for HIV patients in Libya has fallen apart because the demand has far exceeded the interrupted supply of HIV medications available. HIV medicines are supplied through the government via the Centre for Disease Control of Libya. It is nearly impossible for a patient to buy the necessary medications at his own expense. Each patient usually needs three to four different HIV medicines.  One of the medicines can cost $1200 per month. Usually more than one member in the family needs these medications – and they do not need a short course for a few months. They will need it for a lifetime! No matter what the financial situation of the family is, it will be impossible for them to cover the cost of the medicines by themselves.
Another important fact regarding HIV in our society is that unlike other illnesses and diseases, people don’t sympathise with the sufferer. Stigma and discrimination are enormous, even among doctors and the most educated classes of society. For this reason, it is very difficult to raise charity money to help these patients. The families suffer alone, isolated, in darkness.
Nevertheless, we have tried to contact many international organisations to secure a supply of HIV medicines, even for a short period.
But what we have obtained is limited and insufficient. People may be willing to help, but I’m afraid we are confronting the “Bystander effect” when everyone thinks someone else will help, but the victim ends up alone, abandoned, stranded and helpless.
The bitter truth is that the losers in this crisis are not only the innocent children or their parents. The crisis will have a global impact, with the emergence of new strains of HIV that will have resistance to most of the medications we currently use for treatment.

Friday, April 10, 2015

HIV in Children of Tripoli Libya

Light at the end of the tunnel, TMC style :) Tripoli, Libya 2014
After those vivid adventures years , here I am back .. Working again with my most loved creatures, kids! But not any kids ...

About one year ago I joined the Pediatric Infectious Diseases Department ( PIDD), it is a relatively small and new department ( only a couple of years old) taking care of children having infected with or been exposed to Human immunodeficiency virus (HIV) !

Indeed, it is very interesting field ... before working in this place, I knew that we have HIV in Libya but I was not really aware of the magnitude of the spread of the illness.

When I first started working in pediatrics in Tripoli Medical Center in the early 2000s we did not have a special place to deal with HIV kids, we didn't even have a Pediatric infectious disease department , only we had a small out patient care clinic for it .. But now we have! Thanks to those doctors who made this a reality.
The main source of HIV, according to statistics we have in Tripoli is intravenous drug addictions ... But as everywhere else it's not the only source .. Sexual transmission is also a significant source in our very conservative society!!! And when I say sexual, I mean to include not only sex outside of marriage and between homo, but also between husband and wife when one of them is infected ...

In children the main source of transmission is mother to child , but we do have a few heart-aching cases, where we have only one child in the family is infected, while his/her parents and siblings are free of HIV.. Most of these single family member cases have a history of hospital admission in Tripoli in the late 1990s ( suggesting a nosocomial acquired infection, i.e, getting infection from hospital) .. Which for me put a big question mark on the integrity of the health care system at that times. Thankfully, since the opening of the pediatric infectious department no more nosocomial infections were reported in children.

Working with HIV specially in a population like ours, opens a very different window on the society. It opens a window on the most sensitive social fabric in the community. Where all the fakes disappear and the ugliness of the society shows its face with no veils. Most of the times you deal with the executioner and the victim at the same time.. Beside, you genuinely can not decide who is really the victim. Is it the patient or the surrounding environment? The same environment created by everyone in the community, including you!

The other day, I was thinking and questioning with myself, what we are really doing? I believe in the effectiveness of our work, and it is good with tawfiq from Allah, but it is not complete. Yes, we treat the infected kids and make them live almost normal life, and even more we have completely healthy babies with infected parents ( by following the program of prophylaxis for the exposed babies born to HIV positive mothers.) Yet, we send some of these kids back to the same bad environment that made their parents infected. It's needless to say that addicted parents will more likely raise addicted children, with the absence of external intervention.

Moreover, when there is a child abuse we have no authority in our country to take that child from his/her caregivers, nor we have alternative options to move the child to be in a safe place. This will almost lead sooner or later to a failure of our treatment for the infected child.

We have many ideas in mind as a solution for this, need to be done, but because of the unstable situations we have, our progress is miniature. Nevertheless, we don't lose hope, as a team in our department, and despite the absence of social support for our patients, plus the absence of real support from charity organizations to these kind of patients, we still struggle to make our efforts stand solid to support these children as the best we can for them to face the world, healthy and strong.

Sunday, April 5, 2015

Faith, belief, and forgiveness !

Rosslyn, Virginia ... May, 2011

She knew more than she should ...

that might be fine in other place and in another time .. 
but here, at this place and in this particular time , if someone knew more than he should, he .. without question .. will ruin things up .. 

When you knew, you can not forgive, and when you fail to forgive, you will never be able to believe! 
For me, those who can't forgive, their faith is always questionable! ... 

Only if ...
you keep your root deep ..
you keep your belief strengthened ..
your heart will be open to knowledge .. 
forgiveness will ensues ..
and faith will prosper .. 

Thursday, February 12, 2015

Little Wonder!

Some great moments of little wonder can give you enormous energy to continue your walk in this tough path of life

Tiny little moments that can fuel you for years or even decades to come

This was one of my little life wonders, the moment of spotting this Hummingbird in the wildness of Palm Spring California

Recalling the scene of the small colorful bird

Flapping it's wings

With racing heartbeats

Sinking it's face

Dipping it's long beak

To reach deep into the funnel shaped flower

Drinking from it's nectar

To quench it's thirst

And leave you watching wide eyed with AWE the life blossom right in front of you!

Those little wonder moments can not be bought nor can it be sold
It only with the bless of Allah can be owned and enjoyed forever

Captured by Hisham Bumedian Mar 1st 2013 

The best quote about wonder I would like to share here with you as it speaks my mind. It was told by Andrew Stanton, the writer behind the three "Toy Story" movies and the writer/director of "WALL-E," and Finding NEMO, in one of his TED talk:

"I walked out of there wide-eyed with wonder.

And that's what I think the magic ingredient is,

the secret sauce,

is can you invoke wonder.

Wonder is honest,

it's completely innocent.

It can't be artificially evoked.

For me, there's no greater ability than the gift of another human being giving you that feeling....

to hold them still just for a brief moment in their day

and have them surrender to wonder.

When it's tapped,

the affirmation of being alive,

it reaches you almost to a cellular level."

Saturday, January 10, 2015

كلمة طُويت ...

أضواء وأنوار
فرح ومرح
رقص وضحك
هزيج وضجيج
لذة منتشرة
أقداح وكؤوس
سكرة فصحوة

سكون مطبق
أنفاس مضطربة
حشرجة مختنقة
ألمٌ ألم
دموع متحجرة
بصرٌ شَخَصْ 
عقل ذهل
روح انتزعت

نساء وأطفال
بكاء وعويل
أخرق يحكم
أرعن يجيب
نزاع وصراخ
رصاص يُطلق
كلمة تُكسر
هيبة تنتكس

صمت مربك
باب يغلق
نافذة تُفتح
سماء صافية
ليلة هادئة
قمر ونور
نجمة سقطت
وأخرى لاحت

قطرات ماء 
سقطت من السماء 
انتشر عطر
وانتعش زهر
انتفض إنس
رفع الهمة
رسم خطوتين
صبر ونصيحة
ثبتت الوثيقة

و .. رأت الحقيقة


Wednesday, November 6, 2013

من أنتِ ؟ ... من أنتم ! ...

في الطريق بين كلية الطب والمستشفى ، في منتصفها استوقفني صوت سائلا: تعريفك ياطالبة! ... في البداية ظننت أن شخص آخر كان مقصودا ، ، لكن تكرر النداء باتجاهي ...
 فالتفتت لشاب قمحي البشرة نحيل ملتحي بلحية خفيفة غير مرتبة يلبس لباسا عاديا غير مهندم معلق في قدمه "شبشب صبع" يكافح ليظل في مكانه ولاينزلق لحافة الرصيف،  متكأ بكف على السور المنخفض وفي كفه الأخرى بقايا سيجارة لازال بها بعض من دُخان ، ماضغاً للحروف كرر: تعريفك ؟ 
سألت : من تكون؟ 
!قال: الأمن  
قلت باستغراب: ومايدريني أنك أمن؟
 رد آخر جالس على السور المنخفض بتعجب ولكنة فيها انزعاج " حنا مش ملحقين على كرسي نقعمزوا عليه تبينا نحصلوا بدلة وزي"
 قلت : أنا لم اسأل عن بدلة! لكن أقلها هوية معلقة تثبت لي أنك تتبع جهازا أمنياً ..!
 خلال الحديث كان هناك شخص ثالث يسأل الفتيات والشباب المار نفس السؤال و كانوا يمدون له ببطاقات تعريف هوياتهم بكل بساطة  .. تأملت المشهد ومايمكن أن يليه في لحضات " مستذكرة موقف مشابه انتهيت به وكاميرتي عند مكتب الأمن منذ سنتين ربما احكي قصته في تدوينة أخرى " لحظة التأمل السريعة جعلتني استوعب أن ماأسألهم عنه شئ غير معتاد ولم يسبق لهم استقباله وربما ظنوا أني نزلت للحظتها من كوكب آخر كما يظهر من انفعالهم  ،
 فلملمت الموضوع وقلت أنا طبيبة ، وكما تريد ياأخي اثبات لهويتي احتاج أنا أن تثبت لي هويتك كرجل أمن ، رد بحنق ، مع إني كنت ابتسم بهدؤ طوال الوقت أو ربما هذا ماأثار حنقه! " لما كل هذه الربكة ( علاش الدوشة) يكفي إن اخبرتني أنك طبيبة لأدعك تمرين ( قوليلي دكتورة وهادي سادتني نقولك  امشي) " واشار بيده أن امضي!!! فمضيت وأنا أتساءل ،
أي أمن هذا الذي فقط يسمح لشخص أن يمر بكلمة ! أو ربما فقط قال ذلك مشيراً إلى أنه كان علي بالمثل أن اكتفي بكلمته واثق فيه عندما قال أنا الأمن !
 ربما لذلك تمتلئ الجامعة بالزوار والطفيليين ! ...
 وهذا المشهد قد يعكس صورة مصغرة لحالنا وتعاملنا معه ورضوخنا وتقبلنا الكامل برتابة ميتة لأي واقع نجد أنفسنا فيه ، يدَّعي من يدَّعي أنه كذلك ونرضخ نحن ونستمر في نفس الدرب ، إلا من رحم ربي  ... هناك فرق بين الرضا وتقبل وضع لاتستطيع تغييره ، وبين الرضوخ والاستكانة لما يمكن تغييره ... 
 فالذي أثار استغرابي أكثر ليس من يدعون أنهم رجال أمن ، مااستغربته فعلاً هو طريقة المارة وحركتهم الرتيبة الصامتة في تقديمهم البطاقات والتعاريف لهؤلاء الأشخاص المتكئين على سور صغير قصير على قارعة الطريق كأنهم عاطلين عن العمل لم يجدوا مايشتغلوه إلا التسكع على الناصية ، لا ليس كأنهم بل هم كذلك!

ألا نستفيق!؟

Wednesday, March 20, 2013

قطع من الليل

  Palm Springs, CA, Feb 2013 ليلة  شتاء صحراوي

يسدل الليل ستائره 
ليستيقظ أهل المجون
تدور الكأس 
فيتجرع الغافل الجنون
في  ركن قصي يتسرب الظلام 
 يعم السكون
يتسلل للأجساد برد 
 تذبل الجفون
 يأوي أحباب إلى أحضان فراش حنون
تبحث روحه عن دفءٍ
عن طُهرٍ مكنون
فيلجأ إليك ياالله 
 عبدٌ يبغي أجراً غير ممنون