Anti-retrovital Therapy
Tomorrow begins my second week at St. Gabriel's. It feels like I have been here for a month. I began the first week on Male/Female surgery but followed Hamilton to the A.R.T. Clinic from Tuesday until Thursday. Then, I spent Friday on the super busy Female Ward. I am practicing extra cautionary vigilance in regards to exposure to body fluids - always washing hands, wearing gloves (they are in good supply), sometimes a plastic apron over my uniform, and watching for errant needles. Nurses here re-cap needles ( real safety hazzard) and later dispose of them in plastic containers in the nursing station.
Each and every day that I've been here has been an enormous amount of new learning, and I am finally about to find out how this hospital in western Malawi handles the HIV/AIDS crisis.
For three days I watched over 300 patients, men women and some children ( the children's clinic is held on Saturday mornings so that they can attend school mid-week), arrive at the clinic, seat themselves on outdoor benches, and wait to be registered. It is a virtual sea of patients each day, many wearing heavy jackets in spite of the warm temperature. Some appear malnourished, others quite well. It is obvious they come from different walks of life - teachers, itinerant farmers, professionals, and many women pregnant with child. Many have left their villages hours ago, travelling 10-30 km to get to St. Gabriel's. Some come from a great distance to hide their status from their community, others just prefer St. Gabriel's to a rural clinic.
I soon discover that St. Gabriel's has an amazing 2 year old Health Management System that tests and tracks the HIV positive health status of all registered patients. St. Gabriel's monitors a catchment area with over 3,500 HIV clients.
Each client or patient carries a Health Passport. Documentation of all health history is in the booklet plus information on medications and appointment dates. Prior to receiving treatment (if CD4 count blood test is less than 350) patients must attend a lengthy group counseling and education session. That promotes adherence to treatment.
Staging of HIV status is done according to the WHO (World Health Organization).
Patients who present at clinic feeling unwell are referred to an onsite clinician. Medication side effects are taken seriously. Side effects such as peripheral neuropathy are irreversible and could cause an inability to walk. Lipodystrophy (fatty deposits in the face) is also irreversible.
The big issue in the clinic this week is that that ARV drug, AZT is still unavailable. The Malawian government is somehow responsible for the delay. AZT has been unavailable for 2 months now. Many patients (460) who are unable to take a combination of other drugs due to side effects, are anxious and distressed. I talk to a school teacher who stated she was feeling so well on AZT and now worries about a viral break through. It is a sad situation!!
Grace, the HIV Co-ordinator is a wonderful woman who cares deeply about her job and the clients she serves. She too is distressed about the lack of AZT and gives out her personal phone number so clients do not have to make an unnecessary trip to the clinic.
It is a steep learning curve to learn about the combination of drugs used to combat HIV. I learn that all patients receive Co-trimoxazole, a sulpha drug given to prevent "opportunistic infections". I also learn that patients only receive the exact amount of medication required for the time before their next visit. A large number of patients see the clinician, then line up for their medication. It is a lengthy process and I imagine that it is difficult for farmers to be away from their fields all day.
I am able to assist Grace with weights and heights, and endless filing of charts.
According to St. Gabriel's Annual Report, there were fewer new HIV positive clients from their catchment area in 2010.
My impression: St. Gabriel's is doing a fantastic job in educating, counselling, tracking, treating and providing the correct WHO medications for their clients.
If only the AZT would arrive....
Each and every day that I've been here has been an enormous amount of new learning, and I am finally about to find out how this hospital in western Malawi handles the HIV/AIDS crisis.
For three days I watched over 300 patients, men women and some children ( the children's clinic is held on Saturday mornings so that they can attend school mid-week), arrive at the clinic, seat themselves on outdoor benches, and wait to be registered. It is a virtual sea of patients each day, many wearing heavy jackets in spite of the warm temperature. Some appear malnourished, others quite well. It is obvious they come from different walks of life - teachers, itinerant farmers, professionals, and many women pregnant with child. Many have left their villages hours ago, travelling 10-30 km to get to St. Gabriel's. Some come from a great distance to hide their status from their community, others just prefer St. Gabriel's to a rural clinic.
I soon discover that St. Gabriel's has an amazing 2 year old Health Management System that tests and tracks the HIV positive health status of all registered patients. St. Gabriel's monitors a catchment area with over 3,500 HIV clients.
Each client or patient carries a Health Passport. Documentation of all health history is in the booklet plus information on medications and appointment dates. Prior to receiving treatment (if CD4 count blood test is less than 350) patients must attend a lengthy group counseling and education session. That promotes adherence to treatment.
Staging of HIV status is done according to the WHO (World Health Organization).
Patients who present at clinic feeling unwell are referred to an onsite clinician. Medication side effects are taken seriously. Side effects such as peripheral neuropathy are irreversible and could cause an inability to walk. Lipodystrophy (fatty deposits in the face) is also irreversible.
The big issue in the clinic this week is that that ARV drug, AZT is still unavailable. The Malawian government is somehow responsible for the delay. AZT has been unavailable for 2 months now. Many patients (460) who are unable to take a combination of other drugs due to side effects, are anxious and distressed. I talk to a school teacher who stated she was feeling so well on AZT and now worries about a viral break through. It is a sad situation!!
Grace, the HIV Co-ordinator is a wonderful woman who cares deeply about her job and the clients she serves. She too is distressed about the lack of AZT and gives out her personal phone number so clients do not have to make an unnecessary trip to the clinic.
It is a steep learning curve to learn about the combination of drugs used to combat HIV. I learn that all patients receive Co-trimoxazole, a sulpha drug given to prevent "opportunistic infections". I also learn that patients only receive the exact amount of medication required for the time before their next visit. A large number of patients see the clinician, then line up for their medication. It is a lengthy process and I imagine that it is difficult for farmers to be away from their fields all day.
I am able to assist Grace with weights and heights, and endless filing of charts.
According to St. Gabriel's Annual Report, there were fewer new HIV positive clients from their catchment area in 2010.
My impression: St. Gabriel's is doing a fantastic job in educating, counselling, tracking, treating and providing the correct WHO medications for their clients.
If only the AZT would arrive....