Through my consistent experiences with patients at the Joint Clinical Research Centre (JCRC), a HIV/AIDS care and research facility just outside of Kampala, Uganda, I am reminded of how complex a patient’s experience can be with a chronic illness, especially when it involves pain.

The pain of living with HIV is not often a story solely rooted in the physical effects of the virus, even if a person appears on the surface to have a primarily physical ailment. There are wide-reaching implications often overlooked by healthcare providers that include the emotional, psychological, spiritual and social consequences of having the virus.

One of the ways JCRC supports this all-encompassing approach to patient care is through weekly “CMEs”, or continuing medical education talks, generally presented by health professionals. Recently, I have really enjoyed presentations by hospice nurses at Hospice Africa Uganda and Dr. Seggane Musisi, a psychiatrist/researcher from Makerere University in Kampala. Although they come from slightly different perspectives and backgrounds, all unwaveringly emphasized how we need to look at the whole patient and utilize a more integrated care model that addresses the core of a patient’s imbalance. As a nurse and future physician, I truly believe that this is the foundation of the highest quality patient treatment. My experience has shown me that patients will not optimally function if all of these aspects of their lives are not in balance. This is especially important now for patients with HIV because a HIV diagnosis is considered more of a chronic illness and people are living much longer than before.

Dr. Musisi mentioned that one must truly be thorough when assessing a person, especially when it comes to pain. A good starting point, he shared, is asking a patient an open ended question such as, “What are you experiencing right now?” This opens up the avenue for patients to discuss their subjective experiences and allows for more fluid dialogue. Perhaps stigma is something that bothers some patients the most. Patients, especially those with tuberculosis, may feel abandoned on the outskirts of society. Tuberculosis is something we see more often here in our patients with HIV as compared to the general population because of their compromised immune systems and the synergistic workings between HIV and tuberculosis. Or maybe patients with AIDS serving as primary breadwinners are suffering the most as they wonder how their families will fare when they pass.

In general, this is a call to get to the core of any dissonance of a person’s firsthand experience as this is the person’s reality. Even if we are not involved in direct patient care, we must remember that quality healthcare will dig a little deeper in order to really address the greatest challenges of the human experience and to assist people in achieving optimal wellness as they define it for themselves.

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