A day in the life of Dr. Edsel Maurice T. Salvana

IAS member and infectious diseases physician working at University of the Philippines, Manila

Today was a good day. John* sat in my clinic with his mother as we reviewed his laboratory results. Viral load undetectable, CD4 count increased from 22 to 54 in six months. He had gone back to work, and was feeling well enough to ask me if he could go on a short out of town vacation. As I told him and his mother the good news, they both broke out in smiles. I remembered how things were very different eight months ago.

I first met John at the intensive care unit of the Philippine General Hospital he was 28 year old.  He was in a bad condition, hooked to a ventilator and he was not responding to the usual antibiotics for pneumonia. The attending physician had referred him to me, and I knew that John probably had Pneumocystis pneumonia. When I looked in his mouth with a flashlight, the tell-tale white carpet of thrush on his tongue and palate all but confirmed the diagnosis. His mother gave me a sorrowful look. I told her that it was serious, but that I had to talk to John alone. She told me before stepping out of the room, “I don't care what he has, or what he might have done to get it. Just give me back my son.”

Shortly thereafter, I received confirmation of his HIV diagnosis. I contacted him to return to clinic. As I opened the envelope and explained his diagnosis, he cut me off and asked if his mother could come in. His mother took the news quietly, a few tears streaking down her cheeks. John was sobbing as well. And she hugged him and told him that it didn't matter what he had, that she loved him, and that they would get through this together.

This is a good day for me. A really bad day would usually be where I have to tell someone's mom that their son or daughter is going to die. This part of my job is awful, and this is the reason why I got into HIV advocacy. My strange-but-true reasoning: the more HIV deaths I can prevent, the less hard my job would be.

When in 2008 I returned back from US, where I studied, the AIDS epidemic in the Philippines was just beginning. Now it is one of only nine countries in the world where disease rates have skyrocketed, and given the historically low rates, we were not prepared at all.

In the last five years we have done many things: we organized a national rock concert to raise funds for a CD4 machine for our clinic (it arrived last month); we appeared in more than 100 media; we gave more than 50 lectures; organized two international symposia on the Philippine AIDS epidemic; established the first and only HIV fellowship in the country and trained over 15 infectious diseases fellows in HIV medicine. But the number of newly infected Filipinos continues to grow, and the deaths are piling up.

Last year, I attended AIDS 2012 conference in Washington, D.C., and felt reenergized in the presence of my fellow advocates. During the closing session I was acutely aware of pieces of the AIDS quilt on the wall of the auditorium, each one symbolizing a beautiful life lost to HIV. We have one in the Philippines as well. It doesn't contain everyone, since not everyone has someone who cared to make or name a panel after him or her, not to mention those who died without knowing their status. Some of those panels have the names of my own patients. All of them were very young. I could not save them. Each one in my mind is a personal failure, and will stay with me throughout my life. But I like to think that there are people who are NOT up there because of what we are doing. Just like John. That is what keeps me going.

* not real name