Team PATA

Tisungane Clinic, Malawi (March 2008)

Tisungane clinic's expert patient programme has been operating since 2007. They have now requested funding from PATA for expert patients to fill the roles of translator, ARV clerk assistants and a nursing assistant/ adherence counsellor. As Tisungane clinic has already involved and trained community members to work within their clinic, PATA can learn from their experience to date. Tisungane clinic approached PATA because of the lack of financial remuneration for their expert patients' hard work. "Our six expert patients are extremely dedicated to patient care," said Adrienne Chan, "We are looking forward to any initiatives or partnerships than can help support them as vital members of the Tisungane team."

Where is Tisungane clinic and who funds the clinic?

The clinic is based at Zomba Central Hospital and run by Dignitas International (DI), a Canadian NGO, in partnership with the Malawian Ministry of Health (MOH).

What staffing does Tisungane clinic have?

The clinic is staffed mostly by Malawian MOH employees, including 3 nurses, an ARV Clerk, a Counsellor, and 2 Patient Care Attendants. Clinical Officers from the MOH rotate every 3 months through the clinic. There are also 3 clinical officers and 2 nurses (a Nurse-Counsellor and a Nurse to coordinate a Health Care Workers ARV Clinic) that are employed by DI (national staff) who work as members of the Tisungane team.

How many patients does Tisungane clinic treat?

Since 2004 until present, almost 5000 patients have been enrolled on ARVs, and 250 new patients are enrolled every month. Tisungane is also the mother clinic for decentralization of HIV management to district health centres for Zomba District in Southern Malawi which serves a catchment area of 600,000, the majority of whom live in rural villages on subsistence farms. DI has been supporting the district with training, supervision and clinical mentoring at the health centres since decentralization began in 2007. The plan is to scale up ARV care to all 25 health centres in Zomba District within the next year, and continue to match our decentralization rate with our enrolment rate. The expected total enrolled on ARVs for the end of 2008 will be over 7000.

Tisungane is following one of the largest cohorts of children affected by HIV in Malawi and currently have enrolled over 500 paediatric patients on ARVs with the plan to increase paediatric care through the introduction of the MOH Early Infant Diagnosis initiative (PCR based dried blood spot testing) and through support by a Paediatric ARV specialist, Dr. Kevin Clarke, seconded to Zomba District by the Baylor Paediatric AIDS Initiative in Malawi.

How did the expert patient programme begin in your clinic?

Expert patients were selected and trained after an announcement was made for patient volunteers who had been treated on ARVs through Tisungane Clinic for more than six months. Initial training and orientation of our current expert patients occurred in early 2007, on the tasks identified by the clinic staff as appropriate for the initiative.

What training did you provide these expert patients?

Training in nursing assistance was performed via a short didactic session and clinical mentoring over the course of one day by Mrs. Rose Nyirenda (Nurse-counsellor, DI) in how to appropriately take patient weights, heights and temperatures. The expert patients were also trained in patient transfer and transport. Ongoing education occurs during quality assurance supervisions.

Training in both counselling and clerking was performed using the Malawian Ministry of Health ARV Guidelines for Counselling and Clerking and was performed over the course of two days by Mrs. Rose Nyirenda (Nurse-counsellor, DI) and Mr. Berrington Bandawe (ARV Clerk, MOH). Individual counselling is performed using a checklist on ARV adherence, ARV side effects, and health living issues that is completed for each ARV initiation in the clinic.

What duties do your expert patients perform?

Within Tisungane clinic, the expert patients greet patients and organize patient flow when taking vitals prior to entering the nursing room. In the process, they perform a rudimentary triage from which they can send patients that appear to need more immediate attention directly to the clinical officer's rooms (allowing a more rapid bypass of the line for nursing assessment). One of the expert patients has become a translator for the Clinic Coordinator and for a visiting paediatrician from the Baylor Paediatric AIDS Initiative seconded to Zomba Central Hospital. Two of the expert patients who were initially assigned to filing have now been trained in Clerking and assist the ARV Data Clerk with the management of a pre-ARV database and register, booking of patients for group counselling and initiations, and filling in the main ARV register.

What support has your clinic provided for your expert patients?

The clinic was able to provide bicycles for transport and rain gear for all of the expert patients. The expert patients also receive a lunch snack provided by the clinic and often assist in preparation of the meal.

Click here to read more stories about PATA-affiliated clinics in back editions of the PATA newsletter.