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Published: November 25th 2008
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In the first 2 weeks we have visited 9 villages, counseled and tested 258 people (of which 9 were HIV positive), performed 47 CD4 tests (on new and previously diagnosed patients), referred 6 people for ARV treatment and distributed CPT to 9. The conditions, resources, staffing, set-up, patient population, education and attitude has been different everywhere. We have been pleasantly surprised with some responses and events that we have experienced and surprised in a different way by challenges we couldn't have even imagined we would meet.
Patient demographics alone are not straightforward. People who come to the hospital are sometimes unsure of their age. In some villages we have visited recently almost every other person is unsure of their age. Some think they know the year of their birth. Some think they know their age. Some have no idea whatsoever. We like to be given the name of a guardian for the patient - someone who can help take care of the patient if needed and help make sure they comply with their treatment. One patient couldn't remember her husband's name. Some groups of patients are very quiet and sullen as they wait for their HIV or CD4 test (or
These kids hung out all day in Lemwe
This photo was taken in one of the villages where most of the children have never seen a white person before. Some children laugh, some children stare, some children cry, some just run away! wait for the results). Others are highly vocal. Whilst observing the 'waiting room' at one health center our ART clinician commented that the people were treating the place like their local market - cheering and whooping when they tested negative and hanging out all day whilst others received their results. We tested over 80 patients that day and the 1 patient who tested positive left and said she would try coming back much later in the day for her CD4 once everyone had gone home. We didn't see her again but hope to find her. Statistics like we had that day (1/80) sound very encouraging for the situation here in Malawi. However, a week later we tested 24 patients in one village and 7 were positive. This particular village is one of the busy trading centers around here - the type of place (lots of people coming and going to the market to buy/sell) that tends to have a higher prevalence rate.
The number of patients that we see for voluntary counseling and testing at each village varies greatly, partly due to the patients' level of education and willingness to be tested and partly due to level of the
sensitization of the community done by the village chiefs, health center staff, hospital volunteers and ourselves. Even partly due to the rarity of the sight of a vehicle in an area (some people have just approached us through curiousity). At some places we have sat and waited and waited only to do one or two CD4 tests, at others it is non stop. The nurse is always busy as they do group counselling, HIV testing and individual post-test counseling. At one village we ended up testing a large number of patients due to the fact that there was a construction site next to the health center. The foreman gave two workers at a time a break to come for counseling and testing and encouraged everyone to come. At the site where we tested 80 people we found that the one man staff of the health center had made announcements about our coming in all the churches in the area and written a notice on his blackboards. At the other extreme we had not a single patient at one clinic. The health center nurse just laughed and told us she hadn't sensitized the community. We are doing everything we can to
Curious kids in the truck
These were the most well behaved kids I have ever met. I invited them in to watch me run some controls in the morning. spread the word, visiting at least one village on our way home each day to write on health center blackboards and talk to various people in the community to remind them that we are coming. However, sometimes no matter how much communication has been done we have seen few patients for other reasons such as when there were 3 funerals in one small area on the day of our outreach, and the day after the first rains (when everyone was out preparing their fields) and 'fertilizer subsidy day' when all the people who qualified for assistance were away collecting coupons to enable them to buy 50kg of fertilizer for 800 kwacha instead of 10,000 kwacha.
There are also vast variations in the resources that are available to us. At one health center we have full electricity, at some we have solar (which is not stable enough to let us use the fan in our vehicle) and at some we have none. Therefore we use either the invertor from our truck, an extension cable or a generator depending on our location. We sometimes have plenty of rooms available. In the place with the most resources the clinician, nurse and phlebotomist
Taking a break
Vincent, Alfred and Rodney (Clinician, lab tech and nurse). Taking a break with a fanta and a 'chimdelera fanta' or 'bin laden'. These big, dry, hard, pretty tasteless rolls are known to the locals as 'chimdelera fantas' as (through the chichewa translation) they 'defeat' one fanta. You have to drink 2 to finish eating. Alternatively they are know as 'bin ladens' as, at the time, the U.S. were trying to defeat Bin Laden. each have their own room and the clinician has a bed that he can use to examine patients. The clinical officer who runs this center is happy with the way things are working there as it means that the patients do not go into the vehicle themselves and so they do not have to worry about the stigma that still surrounds the disease. In the place with the least resources we have one room with no roof never mind a bed. The roof was removed to solve a bat infestation problem. The smell is still unbearable. At that site we use our vehicle for almost everything (clinical evaluation, blood draws and testing).
Finally there are the variations in the staffing of the health centers we have visited. Most places do not have a clinician or clinical officer, some have a medical assistant or a nurse and some have only a health surveillance assistant. A few of the places are short staffed (or have no staff at all) as 'the villagers are not friendly and practise withcraft on anyone that comes to try to work'. That's a whole other story that I'll save for another time!
Each day brings
something new. Next week we will start visiting some even more remote places - places where we'll be setting things up wherever we are able to!
Tsiku la bwino or Usiku wa bwino depending on where you are (have a nice day/have a nice night),
Joanna.
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