We had a really interesting clinical day on Thursday! Instead of being in the NICU we got to spend a day in Effia Nkwanta's HIV clinic. Here we met a doctor who runs the clinic and also spends a large amount of time educating the public about HIV to dispel the stereotypes associated with it. He gets on the radio and does talks with churches and schools and answers questions and tries to reach as many people as he can with his knowledge. There is currently so much stigmas associates with HIV that babies who so not have it, it is not written in their charts at all on the off chance that someone misreads it and assumes they have it. HIV is a very prominent issue in Ghana and all of Africa, largely because of how it is spread. It has 4 main modes of transmission: unprotected sexual intercourse, contaminated blood products, childbirth and through breast milk. There are several factors which influence the risk of transmission: polygamy is common so if a man becomes infected then there is the risk of spreading it to each of his wives. The most frustrating transmission for hospital staff is medication compliance especially for mothers. If a mother doesn't take her HIV medication before or after pregnancy there is a very high risk that she will spread it to her child. Luckily the hospital pharmacy charges only about 5% of the actual drug cost to the patients so the medication is actually fairly affordable, in many cases if a family can't afford the medication the pharmacy will give it away for free. Where the healthcare system is running into problems is that the government has not paid the pharmacies for any medications for the last 6 months, instead of being able to produce more medication pharmacies are now shuffling meds between themselves to try and maintain their supply. The clinic itself was very interesting to observe. They are one of the first places to start group counseling and they have found it to be very effective! For example they will take a large group of expecting mothers or new mothers and give them information on preventing transmission and then they open the floor to questions and concerns. The mothers who participate in the group have almost 100% success in preventing the transmission to their babies, the select few who fail are the ones who are non complaint with medication. For this reason the clinic also provides med councelling to stress the importance of med adherence and give support to the patients. It was so cool to be able to observe and participate in a clinic that is having so much success with completely eliminating transmission from the area! We are so grateful to have had that experience and one on one time with such an influential doctor!