7/14/08 - Rodolfo Robles

Kalya and I spent this morning visiting Alex at work. She's been working for almost six weeks now at Hospital Rodolfo Robles, a government hospital in Xela which specializes in HIV/AIDS and TB treatment. Robles has about 100 inpatients at any given time, split evenly into a men's ward and a women's ward.

Now, that should set off a red flag right away. If you have a hospital that specializes in TB and HIV treatment, it would make sense to keep those diseases isolated. After all, MDR TB and HIV is a real public health threat throughout the world. But at Robles, they are all mixed together. (Consequently, all the HIV patients currently have TB as well, but that's a chicken-and-egg question if I've ever heard one. They did not all come in with TB.)

Furthermore, Guatemala has a program called ICA through which anyone in Guatemala who tests positive for HIV can receive antiretroviral therapy for free. (Only certain drugs are provided, and resistance can develop, but still it's better than we're doing in the US.) So, since Robles specializes in HIV/AIDS care, I was excited to see how the free ARV therapy was helping the patients. That's when I found out that none of the patients at the hospital are currently on ARVs. Wonderful. When I asked a nurse why not, she said, "Oh, we only put patients on ARVs when they need them." I was pretty sure that when you had HIV you needed ARVs, but maybe Vanderbilt taught me wrong.

After leaving Robles, we headed out to clinic to pick up some data and education materials saved on their computers. I mentioned to Alexis, the physician, that we had visited Robles. He said, "Robles is a wonderful ace to go, if you want to be left to die in a cold room with seven other patients dying beside you." His take on the hospital basically matches mine. Perhaps patients are getting decent personal attention from the staff, but the medical care they receive is abysmal.

We went to Salon Tecun for our last dinner in Xela, where we were joined by a group of friends for one last night of delicious pizza and cheap glasses of wine. Tomorrow morning we're off to Guatemala City.