A day in the life of John Jao Majimbo

IAS member and Head of Pharmaceutical services, Kenya Ports Authority
I started working in HIV in 1999 when I joined the Agah Khan Hospital in Mombasa, Kenya as a pharmacist. Back then, ARVs were only available in the private sector and there was little information on the management of the disease or even on the drugs themselves. We had to rely on medical representatives for information.

Currently, I am in charge of pharmaceutical services for Kenya Port’s Authority’s medical facilities. I’m also a resource person in the management of HIV/AIDS patients. I give guidance on the management of difficult cases, failures, and co-infections, as well as guidance on changes or switches due to anti-retroviral drug resistance or adverse side effects. I also follow up on the management of hospitalized patients and offer ARV drug related technical expertise to a network of medical professionals (Gold Star Network).

From 1987-1992, I was studying in the Soviet Union. This was during the early stages of the epidemic, and African foreigners were being heavily stigmatized. Whenever one visited his home country on holiday, he would have to undergo several HIV tests before he could continue with his studies in the host country. Despite being on a medical course, as students on the course we were given absolutely no information on the disease or the virus, and could only read about it from foreign journals. I thus developed a passion for knowing more about HIV and AIDS, which was further stimulated by the suffering I saw when I came back to Kenya, where I witnessed the misunderstanding and stigma associated with the disease even in my community.

I was very touched when I first heard patients who I had helped telling me “thank you”. In fact, when I left the Agah Khan hospital, some of the patients still used to call me privately for advice because of my warmth and the way I served them. We had built strong relationships and this gave me great personal and professional satisfaction.

One of the greatest frustrations for me at the moment is that, despite the Authority covering medical expenses of all illnesses and a vibrant peer education programme, we still get employees and dependants who are diagnosed with HIV in hospital (stage III and IV). This shows that there is still an element of stigma which has not been addressed. Another challenge in Kenya is the cost of ARVs. The government still has d4T in the guidelines despite the adverse effects associated with it. The tenofovir/lamivudine combination is limited and given only when there is lipodystrophy. At this point it is already too late and difficult to reverse such changes. The authority covers medical expenses as long as the employee is working. This cover stops upon retirement or dismissal. This demoralizes me as at times I have to continue giving someone medication which I know is not fit for them but since they cannot afford to purchase the suitable one, then they have to carry the cost of the side effects.

I joined the International AIDS Society (IAS) as a member last year when I was registering for AIDS 2010. I have found it to be useful in terms of networking, and have read a lot of articles on how different individuals and organizations are working in the fight against AIDS. This gives me new ideas which I share with my team during our meetings. I have raised issues such as co-infection and alcohol and drug use, and we (the Authority) now have a policy and programme addressing drug related issues. I also receive updated information on research and learn about HIV/AIDS related conferences well in advance, so that I can be able to plan my work and conference schedules.

I attended AIDS 2010 in Vienna and do not regret it. As a pharmacist, I attended most clinical sessions on management of AIDS related issues. When I came back, I gave a presentation to the staff in our medical department and another one to the medical practitioners in Mombasa (Kenya Medical Association, Coast Division) on the current and ongoing studies on HAART including prevention through treatment approach. The conference made me more confident since I realized I had quite a lot of knowledge, having been able to follow the presentations without much difficulty. I actually felt like somewhat of an expert! I also came back with a lot of literature which I shared with my colleagues who had not been able to attend the conference.