A few weeks ago the Aids Relief staff came back from a settlement 90km away from here saying that they had had a very difficult clinic. A mentally-deranged women had set fire to the thatched roof of the New Apostolic Church, so they only had had one room for the clinic. The choir was also rehearsing where we usually met and patients did not want to collect their medicine from the back of the vehicle in case they were seen. One member of the Team felt that we should move the neighbouring clinic further south - more convenient for us, but further to travel for most of the patients. We discussed the problem at our monthly meeting but the staff was divided. As chairperson I came in and said that this was not our decision but the decision of the affected community. Our Adherence Counselor took the message back that they should hold a meeting and then we would come to meet the Community and hear of their decision.
Yesterday we set off late at 0930h in the pouring rain, for the two hour trip. The road is usually sandy but today it was just muddy porridge. The trucks picking up maize that had been sold to the Government had churned it up making it very treacherous. We arrived at 1130h with the sun beginning to peep through the overcast clouds. Today, we were given two rooms at the New Apostolic Church, a typical pole and dagga building. Four clients were already waiting for us, three as appointed and one who should have been the week before.
As we began the clinic more clients arrived. One lady came for her CD4 results. She was found to be positive when she delivered her baby recently. I began to fill out the forms with her for enrolling her. She gave her treatment supporter as her husband. When we reached the part that asked who she had disclosed her status to she answered no-one. We stopped and went back to the Treatment Supporter. No, her husband did not know and he would divorce her if she told him. Could she not persuade him to come for testing? No, he is difficult, was the reply.
I called the Adherence Counselor and together the three of us decided that when we come for the next clinic the VCT team would do Door-to-Door VCT in her village and hope to test all the family, including the husband, and also re-test the client so that they hear the results together as a couple.
It was now time for the meeting, the Community were sitting outside; people of all ages and the Headman seated in the middle. We greeted one another and went through the formalities. The Headman then explained that as a community they had held a meeting earlier and this is what they had decided.
The clinic would no longer continue in the New Apostolic Church but that they would build a new clinic. They had already started. Those who could, had donated a bucket of maize which was sold to the Government Agents who are purchasing relief maize. With this they had bought eight roofing sheets. The Headman explained that they had cleared the land and begun cutting poles. They felt that four rooms would be good but that that would take 20 roofing sheets in total. He explained that a few more people had donated but it is a difficult time of year as last year’s maize is finishing and they are all trying to purchase seeds and plant again now that the rains are here.
I thanked them for their efforts but explained that the Aids Relief program was unable to help. I said that I could not promise but I might find some help towards the roof but meanwhile they should keep on trying to raise the money. I also said that I was sorry that not only the church roof had been burnt but also the community school’s roof by the same woman.
From there we moved on to discuss stigma in the community. Why were people afraid to be seen receiving medicines? (A drunk man answered that he did not have a problem.) I said that this was a issue that they as a community should try and address and instead of hiding from each other they should be caring for each other and their needs. I then went on to suggest that they should be thinking of some form of Income Generating Program to help support the Community Health Workers and the clinic. They should also be considering beginning home-based Care.
We ended the meeting and waded through the mud across the road to look at the site that had been cleared for the clinic.
We have a lot to thank God for!
Wishing you all the best for Christmas and a Happy New Year
Glossary
ART: Anti-retroviral therapy, drugs used to suppress HIV virus
VCT: Voluntary Counselling and Testing (for HIV)
CD4 Count: the level of unaffected white cells in the blood.
Monday 20 December 2010
Tuesday 7 December 2010
A day in the life ...
On Tuesday morning I received a phone call from the Home Based Care (HBC) Coordinator. One of their clients who was bedridden was refusing to go by taxi to keep her Pre Art appointment at the Hospital. Could I help? I agreed and drove through the village, along the very narrow sandy road between pole and dagga houses with their thatch roofs. Young children came running out to wave and chase the car. I stopped and picked up Lilly the HBC carer for the clients in that area. We drove on together a very short distance.
I knew the client, Namatama, as we had had her in the hospital and recently discharged her. Namatama contracted TB four months ago and was also at that time tested for HIV. Because of the TB she could not start Anti Retroviral Therapy (ARVs). She had also recently been in the hospital suffering from PCP, a lung-disease linked to Aids. The usual dusty and ill-clad children greeted us excitedly. The family rushed around to bring chairs to her tiny mud and thatch house. I went in to a dim room with a metal bed in the middle with a thin mattress and chitenge ‘sheets’ (cotton wraps) barely covering the bed. In the middle was Namatama skeletally lying with her face to the wall. We sat down and gave the traditional Lozi greetings. I got up then and insisted on greeting Namatama. This broke the ice with Namatama. I think most people discuss her rather than include her.
She proudly said that the bedsores that she got in the hospital had healed thanks to Lilly. Then she told me that she was hungry but could not eat the food that the family prepared for her as they kept frying everything and the Nshima (thick maize porridge) the staple was too heavy. The bag of soya that she was given by the project remained unused, as it was too strong for her. We then tried to discuss what she could eat and the answer was nothing. Anything the family offered her just gave her diarrhoea. She said that the ORS which Lilly had given her was making her stronger. I then tried another tack if she could choose what would she most like to eat? I smiled at the answer, a boiled potato. We are probably one of the few homes in Mwandi that has potatoes!
I then broached the subject of her appointment. She said that to ride in the car would be too painful for her lungs. We continued our discussion for a short time longer but Namatama was adamant that she would die if she went back to the clinic. I then frankly told her that if she did not go she would die anyway!
I stood up and said that we would pray but before I prayed would she agree to come back with me to the Hospital? She agreed and then we prayed.
Namatama sat in the front to the Hospital with her younger sister and Lilly in the back. Her real fear was that we would insist that she was admitted to hospital yet again. When we arrived I fast-tracked her to see the clinician. She weighed only 33kg. She had lost 10kgs in a month.
I left Namatama with the Clinician and went home and found some potatoes, carrots and a litre of milk.
As I was going back into the clinic I was stopped by a nurse to say that there was a mother and baby waiting for assessment. Mum had stopped feeding the baby at six months because she was HIV +. The baby was now 8 months looked very small and anaemic. The nurse said there is a slight problem in that she is from Namibia. She had come across the Zambezi in a mukolo (wooden canoe). I still enrolled the baby in the formula program as the border is only a colonial border. The people are all of the same tribe and often have relatives on both sides.
Namatama had had bloods done the CD4 was now 22. The clinician felt that she might not manage to take the ARVs as Namatama had said that the family were going at the moment to their fields to clear and plough all day and they did not believe that she was HIV+. The clinician and myself went and spoke to the Doctor. I put forward my case that Lily could step in and give the medicine in Namatama’s home until Namatama could manage to take it herself. It was agreed that Namatama would start on ARVs. Lily went with Namatama’s sister to the Pharmacy for Adherence Counselling and to learn about the medicine. Lilly herself is HIV+ so she understands. Triumphantly after two and a half hours we brought a tired but serene Namatama home.
A lesson was learnt. The food on the project did not suit everybody. We will have to buy for our clients what is best for them.
I came home in time for my Lozi lesson. The Lozi teacher, a retired English teacher, was waiting patiently for me. We have been translating together a pamphlet in English about TB into Lozi. The teacher then has lunch with us as he too is in need of a meal.
Keith came home from school worried. Kandiana the old folks home has run out of food. The government have not sent any money since August. He had been eking it out since then but there was no money left. Can the Guild project help? Fortunately, over half of the residents are HIV+ so beans , kapenta(dried whitebait) and a few other things are purchased. The Mission Farm promises to supply maize ,eggs and meat. They have also run out of firewood. We had a storm the night before that caused a large branch to fall just missing our car, so at the end of the day there is the sound of axes chopping up the branch and the old people who are able dragging the wood away.
The day is another testimony to the grace and providence of God in our lives here.
(We changed people's names for confidentiality)
I knew the client, Namatama, as we had had her in the hospital and recently discharged her. Namatama contracted TB four months ago and was also at that time tested for HIV. Because of the TB she could not start Anti Retroviral Therapy (ARVs). She had also recently been in the hospital suffering from PCP, a lung-disease linked to Aids. The usual dusty and ill-clad children greeted us excitedly. The family rushed around to bring chairs to her tiny mud and thatch house. I went in to a dim room with a metal bed in the middle with a thin mattress and chitenge ‘sheets’ (cotton wraps) barely covering the bed. In the middle was Namatama skeletally lying with her face to the wall. We sat down and gave the traditional Lozi greetings. I got up then and insisted on greeting Namatama. This broke the ice with Namatama. I think most people discuss her rather than include her.
She proudly said that the bedsores that she got in the hospital had healed thanks to Lilly. Then she told me that she was hungry but could not eat the food that the family prepared for her as they kept frying everything and the Nshima (thick maize porridge) the staple was too heavy. The bag of soya that she was given by the project remained unused, as it was too strong for her. We then tried to discuss what she could eat and the answer was nothing. Anything the family offered her just gave her diarrhoea. She said that the ORS which Lilly had given her was making her stronger. I then tried another tack if she could choose what would she most like to eat? I smiled at the answer, a boiled potato. We are probably one of the few homes in Mwandi that has potatoes!
I then broached the subject of her appointment. She said that to ride in the car would be too painful for her lungs. We continued our discussion for a short time longer but Namatama was adamant that she would die if she went back to the clinic. I then frankly told her that if she did not go she would die anyway!
I stood up and said that we would pray but before I prayed would she agree to come back with me to the Hospital? She agreed and then we prayed.
Namatama sat in the front to the Hospital with her younger sister and Lilly in the back. Her real fear was that we would insist that she was admitted to hospital yet again. When we arrived I fast-tracked her to see the clinician. She weighed only 33kg. She had lost 10kgs in a month.
I left Namatama with the Clinician and went home and found some potatoes, carrots and a litre of milk.
As I was going back into the clinic I was stopped by a nurse to say that there was a mother and baby waiting for assessment. Mum had stopped feeding the baby at six months because she was HIV +. The baby was now 8 months looked very small and anaemic. The nurse said there is a slight problem in that she is from Namibia. She had come across the Zambezi in a mukolo (wooden canoe). I still enrolled the baby in the formula program as the border is only a colonial border. The people are all of the same tribe and often have relatives on both sides.
Namatama had had bloods done the CD4 was now 22. The clinician felt that she might not manage to take the ARVs as Namatama had said that the family were going at the moment to their fields to clear and plough all day and they did not believe that she was HIV+. The clinician and myself went and spoke to the Doctor. I put forward my case that Lily could step in and give the medicine in Namatama’s home until Namatama could manage to take it herself. It was agreed that Namatama would start on ARVs. Lily went with Namatama’s sister to the Pharmacy for Adherence Counselling and to learn about the medicine. Lilly herself is HIV+ so she understands. Triumphantly after two and a half hours we brought a tired but serene Namatama home.
A lesson was learnt. The food on the project did not suit everybody. We will have to buy for our clients what is best for them.
I came home in time for my Lozi lesson. The Lozi teacher, a retired English teacher, was waiting patiently for me. We have been translating together a pamphlet in English about TB into Lozi. The teacher then has lunch with us as he too is in need of a meal.
Keith came home from school worried. Kandiana the old folks home has run out of food. The government have not sent any money since August. He had been eking it out since then but there was no money left. Can the Guild project help? Fortunately, over half of the residents are HIV+ so beans , kapenta(dried whitebait) and a few other things are purchased. The Mission Farm promises to supply maize ,eggs and meat. They have also run out of firewood. We had a storm the night before that caused a large branch to fall just missing our car, so at the end of the day there is the sound of axes chopping up the branch and the old people who are able dragging the wood away.
The day is another testimony to the grace and providence of God in our lives here.
(We changed people's names for confidentiality)
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