Newsletter #6 - J.

Dear Family and Friends,

Today I met J. My Hebrew T.A., Omri, a sixth year Israeli medical student, brought J. to our small Hebrew class because J. speaks some English. Omri's hope was that we could practice our interview skills in English so we could learn the rhythm of asking questions without the complexity of trying to remember the questions in Hebrew. I think Omri also hoped to remind us that patients' stories are far more interesting than we sometimes can imagine....Here's what I learned about J.

J. is 24 years old man who reported to his family health clinic a month ago with chest and throat pain. After an initial blood test revealed a previously undiagnosed HIV infection, J. was referred to Saroka Hospital in Be'er Sheva, a three hour bus ride from his current home. In the hospital where I go to school, it was discovered that J. had cystic thymus. Cystic thymus has only ever been re ported in four other HIV patients world-wide. Actually, the thymus is an organ that J. shouldn't need anymore because, while the thymus is relatively large and important immunity-maturing organ in infants, it generally grows smaller with age and disappears in later adulthood. So J.'s thymus regrew and became full of cysts and, from what I understand, started pressing on his heart and J. had to undergo surgery to remove the thymus a week ago. This is a incredibly story to witness... such a unique medical history... but it is not the reason I am telling you about J.

J. is a devoted husband and father of two children, a four year old daughter and a six-month old son. He is a shy man, softly spoken but quick to laugh. In the five days he has been taking HIV antiretrovirals (since his surgery) his white blood cell count (CD4 count) has gone from 5 to 64. This is an amazing increase and is also important because a normal CD4 counts in adults ranges from 500 to 1500. One is usually considered to have AIDS with a CD4 count of 200 or less because this is the point where the immune system cannot protect itself against opportunistic infections. I honestly didn't think people survived with a CD4 count of 5! But this is also not why I am telling you about J.

J. is a Sudanese Christian from southern Sudan. In April of 2004 his parents and all but one of his siblings were killed and J. was thrown in prison for unknown reasons. In prison, J., a fisherman by trade, was tortured as a spy. They beat him and repeatedly pierced his hands with needles and injected him with unknown substances. They were not hygienic with their torture devices... and J. can only guess that he contracted HIV from the blood of another torture victim. He escaped prison and with his wife, who has also lost her entire family, hid aboard a boat bound for Egypt.

In Egypt they made a meager life for themselves. J. couldn't work because he was increasingly ill, but his wife was able to scrape together enough doing odd jobs for them to have a small flat and food. J. went to the doctor in Egypt and was told that he had Tuberculosis but was not told he had HIV. They gave him the standard six months of Tb treatment but he didn't get better. The situation in Egypt started worsening. J., his family and the rest of the Sudanese refugee community there came under increasing scrutiny from the larger Egyptian society. They weren't Muslim and they weren't Egyptian and they were poor. There were threats to send them back to Sudan. So last April, with his wife eight months pregnant with their second child, J. led his family on an eight day walk across the Sinai Desert in hopes of sneaking into Israel.

Almost immediately after crossing the border they were captured by the Israeli Defense Forces and put in jail for illegal immigration. J. said that the Israeli jail was nice. It was clean and they were given good food. And, after two months in jail, they were tentatively allowed to go free as refugees. J. and his wife found housing and jobs, as part of the the housecleaning staff, in one of the large hotels in Eilat, the sunbathing/partying capitol of Israel. They don't know what their status is and whether they will be allowed to stay. Israel's laws are very unclear about non-Jewish refugees. But in the meantime J. is receiving good treatment that will hopefully bring his CD4 count up above 200. His wife and children have all been tested and they are not infected with HIV. J. is eager to go back to work tomorrow, eager to get stronger and thankful for every day that God has given him.

This is what I learned about J. today.

Love and Blessings,
K.

P.S. Please excuse bad grammer and spelling in the above. I haven't much time to edit this. I am well. I still love medicine, I am learning to be more at home in Be'er Sheva, and I am looking forward to a two week vacation in the Northwest starting this Friday! Happy (Belated) Hanukkah and Merry Christmas!