How are you today?

‘I am fine and how are you?’ replies Dumisa when I go to speak to him on St Augustine’s ward on a Thursday evening. However one glance at Dumisa can reveal that he really isn’t that fine. He is one of two in the ward full of forty sick patients assigned the available oxygen cylinders. He is sitting up in bed nasal prongs attached studying his chest X-ray, smiling but looking a gaunt figure.

Dumisa is 33 years old is married and has one eight year old son. He has HIV/AIDS complicated by Kaposi’s sarcoma in his left lung. ‘It doesn’t make me feel good that I have this illness but it is something that I accepted from the moment I found out. There is nothing I can do to reverse it, all I can do is do as I am told so that I can live as long as I can’

Dumisa only went for VCT (voluntary counselling and testing for HIV status) in February of this year. ‘I was coughing and someone advised me that I could go for VCT. I had been unwell for two months’

Dumisa talks openly about his illness, though for many HIV remains a taboo subject. ‘It took me a while to tell my wife but she took it well, she also went for testing and is on treatment but is doing well’ I ask him if it has changed his relationship with his wife ‘It hasn’t changed anything we love each other. I am the one that has been ground here (in hospital) but she has been by my side’. He is also grateful of the support he has received from his extended family. ‘We are a very close family, my brothers, my sister, my dad they have supported me through my illness’

The aspect of his illness that has been most frustrating for Dumisa has been that he has found little improvement with therapy to date.

After testing positive for HIV it was initially felt Dumisa’s chest symptoms were explained by TB. There is a huge correlation between HIV and TB with TB being the most common cause of death among HIV positive patients. Unfortunately getting a definite diagnosis of TB among HIV positive patients can be difficult as X-ray findings are often atypical and many are patients are sputum negative (TB cells are not found in microscopic examination of their sputum).

‘When I was put on TB treatment my condition did not improve, it kept getting worse. Initially maybe they didn’t know what the problem was but now they know I hope that the chemotherapy may help.’ The cause of Dumisa’s chest problems was not TB but a condition called Kaposi’s sarcoma (KS). KS is a tumour caused by a virus and is common in HIV patients. It generally affects the skin and mouth but can occur in any organ including the lungs as in Dumisa’s case. It may respond to ART (antiretroviral treatment used in HIV to help protect the body’s immune function) but often requires chemotherapy treatment especially if it affects the internal organs.

Dumisa feels that a better resourced health care system may have lead to an earlier diagnosis of his KS. ‘I am so happy with the doctors that look after me but I am disappointed it took me so long to get a diagnosis. Maybe if this had been done earlier I would have been better able to cope with the treatment, it took me so long to see a doctor’ Dumisa recognises many of the problems in the healthcare system in Zambia such as lack of resources, experienced personnel and diagnostics. ‘The fact that we don’t have enough doctors in Zambia disappoints me. We have a university that produces doctors but because of the conditions many of them decide to go and work outside Zambia, it is quite shameful.’ Zambia a country of about 12 million people has one medical school; Ireland with 4 million has 5 and in addition often attracts doctors from outside the country to work there.

Dumisa’s life has changed a lot in the past few months since he has been ill. Previously he worked in the copper mines for five years ‘it was quite some experience until I got involved in the Chinese mines. I didn’t like the conditions that is why I stopped’. After that Dumisa worked for a time in Lusaka before returning to the Eastern part of Zambia to start a business. ‘I am a designer, I design clothes, I also ordered fish from Mozambique. I stopped work some time ago. Now that I can’t work I am just hoping I will be getting better, but I still have some business that my wife looks after’

I ask Dumisa if he has spoken to his eight year old son about his diagnosis of HIV. ‘I haven’t spoken to him about it. Initially I told him it was TB and I haven’t changed, he is young. He always tells me ‘Dad will you get well, I want you and I to do stuff like play football’.

Despite being very ill Dumisa remains hopeful for the future. ‘When I just get better I hope to establish myself in a business, build up something for my child.’ He is accepting and somewhat realistic about his disease but determined to make the most of life and remain optimistic. ‘I already know my status I am on ARTs which means I may get better but the truth is it won’t get rid of the disease. So I have to be ready for anything, expect the worst. Right now there is no cure, maybe a cure might be found. I would rather live life just the way it is, face it, live it normally.’

Again I ask Dumisa ‘how are you today?’ ‘Today I don’t feel any pain but after speaking for some time I get a little short of breath.’ He concludes by saying ‘I believe this is not the end for me, it is actually a new beginning. I have been diagnosed, know my status. I have to learn to live healthy, believe there is hope, that is what keeps me going’