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Published: November 5th 2008
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Ngolo crossing
Moving out of the way to let an Ox-cart pass on road to Lemwe I have been quite amazed to find out how aware Malawians are of the term 'CD4 count'. They even have a name for it in Chichewa - Chitetezo Cha Mthupi. They know what the number means for them, and they know that same number off the top of their head. CD4 counts are difficult to obtain in Malawi and the locals here consider themselves very lucky that they can have a CD4 test at St Gabriel's for free. People actually come from all around for this privelidge, even from the capital to this small village of Namitete.
Word has definitely gotten out about the project. Our distinctive vehicle ('the house' or 'the peacock' as some children have started calling it for it's size) is starting to be known. Over the past few weeks we have travelled to 9 health centers, the travel time from the hospital varying from 15 minutes to an hour and a half, the roads varying from beautiful smooth tarmack to narrow, bumpy 'roads' that make you feel sick very quickly, the staff varying from 2 clinicians to no clinicians or nurses but just an 'agogo' (very old man) who moves very slowly and doesn't really speak
any English at all and the patients varying from almost none to almost one hundred. The buildings mostly look very nice from the outside but on the inside....well, there's not really much there at all. One of the places we visited this morning had a labour room but no one to work in there. From there it's a one hour drive to the hospital and, so you know how likely it is that a patient could actually get to the hospital in one hour, many of the kids we met today had never seen a car before, never mind one that looks like a peacock.
Going into the villages provides for interesting days. I learn something new every time. Today I asked what all the school girls were carrying in the bowls on their heads. I presumed it must be their lunch. It turned out to be soil - they carry soil to school with them every Friday to re-do the floor. We also came across the most amazing maize fields. The harvest this year was terrible as there was very little rain and I have not see any maize at all around here for a while so this
Some of the team....
Driver Harold, Lab-in-charge Isaac, Clinical Officer Elizabeth, HIV/AIDs Nurse/Counselor Harrison and Clinical Officer (and Lead Clinician) Vincent. We tried this photo from all directions but no matter where I stood there was too much African sunlight to see faces! place seemed like an oasis in the dessert. All the villagers were in those fields, working together, apparently very very diligently! My Chichewa gets better every day too, as really not many people speak English at all. They also presume I know Chichewa and just chat away to me. I at least know how to explain what we are going to be doing with the clinic to anyone who asks!
Tomorrow we are having our last team meeting before we go on our first outreach visit on Monday. Our team has changed a bit since I first started here as our nurse is unfortunately really ill and our clinical officer is now in med school in Tanzania. However, I'm excited about the team that we have now. There's myself, a driver, a lab tech/phlebotomist, 2 nurses (on rotation) and 5 clinical officers (again on rotation, with one being the Lead). On Monday morning we head to a village called Nthondo. The outreach will begin with a health talk from the Clinician and Nurse. For those who have never been tested for HIV before there will be group counselling. For those who would like to be tested, the nurse will
perform rapid testing (a finger prick and results in 15 minutes). She will also do individual post-results counselling. Those who are positive will be referred to our Clinician, who will take a medical history and do an evaluation and WHO staging before referring to our lab tech for a CD4 test (a result in less than 10 minutes) before going back to see the clinician for a final review. The clinician will distribute Bactrim (co-trimoxazole prophylaxis) to those who meet the national guidance criteria and will refer patients who need ARVs to their nearest ARV clinic. We will be doing our best to keep track of all of our patients so that they can be evaluated on a regular basis and have their CD4 count done every 3 months.
Unfortunately we can't distribute ARVs right now but the hope is that that time will come in the future, once we have shown our project to be effective. It's great that we can distribute Bactrim whilst we're out. Bactrim, or co-trimoxazole prophylaxis, is a simple and inexpensive intervention for people living with HIV and it can be life-saving. It is key in pre-antiretroviral therapy care.
Our truck is now
loaded up and we're ready to go very early Monday morning (before all the patients have to start work in the fields). We are taking the instrument, batteries, a height measuring stick, scales, blood pressure monitor, bactrim (we had a pill packing party yesterday), HIV rapid tests, patient records, instrument records and even a shovel for getting us out of the mud should we need it!
November 3rd is quite a bit later than we originally hoped for but that's nice in one way as I have really gotten to know my colleagues at the hospital and when we've been having our final meetings this week everyone has been really excited to work together and get this project to work for our patients. Everyone at St Gabriel's is excited and proud to be involved in what we're about to do - it's the first outreach CD4 testing in the world. If it all works well then I will be able to walk away and the extremely competetent staff at St Gabriel's will be able to carry on with the outreach for years to come.
Fingers crossed!
Hope everyone is well,
Joanna.
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Gillian
non-member comment
well done cuz, am proud of you!x