Last Friday, in my clinic, I discovered something new, something horrifying!
A patient came an unscheduled visit. He wanted to be transferred to another hospital because he will be moving to a new place which is nearer to that hospital. I have never seen this patient although he has been under the follow-up for almost a year. All those times, he was seen by other doctors.
I listened to his request and then had a look at his notes.
I was puzzled because he has been diagnosed with HIV infection for almost 10 years. There was an entry from an earlier referral (for he was transferred from yet another hospital when he moved) that his CD4 count was low and yet over the last one year, I noted his CD4 count was hovering between 900-1100 (the normal being above 500) and that he was gaining weight.
And yet, the patient was never started on Highly Active Antiretroviral Therapy (HAART) which is currently the best bet in treating HIV-infected persons.
That aroused my suspicion and I asked him a number of probing questions. Finally he revealed his secret.
“I have been buying Stocrin and 3TC online whenever I have some money”, he confessed.
“Why do you do that?”, I asked, suppressing the horror that I felt.
“Because I do not trust the medications given by Malaysian government, or the Thai government for that matter! I have seen my friends waste away while taking these medications. When I order online, I get the real deal. They are from the USA and they are the best!“, he replied.
“How long has this been going on?”, I asked, while resisting the urge to try to knock some sense into him.
“Oh, for a while now, maybe a few months, I can’t remember”, he replied tentatively.
“And what happens when you run out of money?”, I asked.
“I stop taking the medications and wait till I have some money, then I order some more”, he replied innocently.
“Do you know you are only on dual therapy instead of three medications? That is very dangerous and it could lead to viral resistance? Furthermore you are not on any close monitoring by a trained doctor.”, I said.
“Yes I do. I hated the taste of AZT and so decided to just take two types of medications. So far I am alright! See I am gaining weight! I am not falling sick!”, he declared.
I can’t argue with that! His CD4 is normal, he was gaining weight and he wasn’t ‘sick’ in anyway!
It took me a while for to recompose myself and then I proceeded to write a carefully worded letter to his future caregiver in the hospital which I was referring him to, explaining what I discovered and apologising for not reassessing the patient further because he insisted to be transferred immediately.
What I discovered is worrisome. If this person could order anti-HIV drugs easily online, so can others and without proper monitoring, these people might just be courting death online.
Houston, we have a problem….