Closer to treatment in Okhahlamba : caregivers and health-workers join hands

Before the government issue of anti-retroviral drugs was launched at Emmaus Hospital in the Okhahlamba district of KwaZulu-Natal, volunteer home-based carers played a vital role in helping their patients to acquire this treatment. In September 2004, HIVAN?s HBC Intervention Programme Co-ordinator, Phumzile Ndlovu, arranged for 10 caregivers, who service most wards in Okhahlamba, to attend an important week-long cross-site visit to The Church of Scotland Hospital (COSH) in the nearby Msinga district, where an ARV treatment programme was well-established.

This group of women and one man worked alongside home-based carers from Msinga comparing their methods of work, and spoke to several patients who told of great improvements in their health since taking ARV medication. They also met people who had stopped taking their ARV tablets and turned to traditional remedies: some of these preparations are expensive and the herbal combinations can be too strong for the patient?s condition. The carers returned to their district inspired by the hope that ARV treatment had given to patients struggling with AIDS illnesses; they were also impressed with the quality of care provided by Dr Tony Moll and his dedicated team at COSH.

The carers from Okhahlamba relayed this knowledge to their own communities, and arranged for some of their patients to make the long journey to Msinga, taking six separate taxi trips to get there and back. Some of these patients passed away subsequently, as they were already too ill to save - but others have survived and thrived. The carers kept written notes of their experiences at COSH, and Phumzile recorded a number of interviews with them talking about the importance of that first visit to the Hospital.

In March 2005, the local Emmaus Hospital in Okhahlamba prepared to provide ARV medication, care and support, and in July, brought services closer to people?s homes, by taking CD4-cell counts and other tests at the five community-based clinics in the Okhahlamba sub-district. Before this, CD4-cell counts could only be taken at Emmaus Hospital, but transport there is expensive for many patients from Okhahlamba, so the clinics are more convenient for them. The Hospital doctors travel to the clinics several days a week to dispense ARVS, to examine and treat opportunistic infections, and to refer patients to Emmaus for ARV adherence counselling and pill collection.

So far, 186 patients are receiving ARVs through Emmaus Hospital. This is a rapid roll-out compared with that reported by other state hospitals across the nation. In five months, approximately 10% of the Hospital?s target of 1 500 patients on ARVS was achieved, covering approximately one-tenth of the total population of Okhahlamba, which currently stands at 150 000 people. According to Dr Bernard Gaede of Emmaus Hospital, national averages for HIV-positive patients who need ARV treatment across all age groups are 7% for rural and 11% for urban populations.

Another partnership between carers and medical professionals has been formed around the small rural town of Winterton, enabling 36 patients from ?Eleven Settlement? to receive ARVS as part of a programme set up by ?Broad Reach?; this independent company - funded for five years by the US government ? aims to strengthen the region?s public health system

by working with a private doctor who dispenses ARV treatment to patients. Eleven Settlement includes the areas of Rookdale, Woodford, Rooihoek, Bethany, Acton Homes, Hambrook, Cathkin Park, Winterton, Oppermanskraal and Greenpoint.

Phumzile has worked in four of these areas and observed the progress of the Broad Reach ARV patients living there; through her knowledge of

local networks, she introduced her group of home-based carers as facilitators of the programme in their own places of residence. The carers run support groups where they live, and inform their neighbours about ARV access through Broad Reach. More people who are on ARV treatment are endorsing the programme, and becoming trainers at the monthly adherence workshops and meetings run for patients who are likely to be enrolled for ARV treatment. By October this year, 66 people had signed up for the drugs, bringing the total of those taking ARVs in Okhahlamba to 252.

?Our people are still battling with the co-infections of TB and HIV,? reports Phumzile, ?and in 2006 we hope to get our carers and ARV facilitators trained in how to help people fight these two diseases with the complex medication they involve. The Church of Scotland Hospital at Msinga has run a successful study combining TB and ARV drugs, using the directly observed treatment (DOTS) system.?

The communities face ongoing difficulties in securing access to social grants without the required Identity Documents and birth certificates; this affects the wellbeing of many children and youth as well as adults, and more campaigning around this issue is needed to forge links between Home Affairs officials and eligible beneficiaries.

Phumzile is very hopeful that these problems will be overcome. The Emmaus ARV outreach and Broad Reach processes are strengthening existing community structures, not only to support ARV treatment but also to be self-sustaining. The participation of community members in the education and recruitment of new patients to the Broad Reach programme has an impact on reducing the stigma still attached to HIV and AIDS.

?Treatment is here now, and the roll-out will gather speed and scale. There is a promising future for the people of Okhahlamba,? she says.

As we turn to look back on another year?s journey through HIV and AIDS, we salute, once again, the unlimited capacity for compassion that these fellow-citizens - and so many thousands like them - enact every day. They display the same nobility and courage as other caring healthcare practitioners who, while facing overwhelming shortages at State rural hospitals, go beyond mere duty and persevere in their work, making many personal and professional sacrifices.

As these role-players continue to build fruitful partnerships, they are preserving our human landscape as a setting of generosity and mutual respect ? and these are the greatest weapons we have against HIV and AIDS.

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