Team PATA

Newsletters

June 2006. Vol. 1 Issue 4.

Contents:

• Your "wish-list"
• Evaluating PATA 2005
• The new TEAMPATA.ORG!
• Mid-year reports – Wits, Port Elizabeth and Uganda
• Personality focus: Loreen Adhiambo
• Feedback from the recent Kenyan Paediatric Association Meeting

Your "wish list"

One of the outcomes of PATA 2005 was a ‘wish-list’ for all clinics. Transport, computer equipment and play-areas for children were three of the main priorities. One to One Children’s Fund has been working hard to secure funding for these wishes.
 
Transport

Transport was identified as a top priority for many clinics. If your clinic would benefit from a motorcycle or bicycle for community visits please send an email to let us know, with a short motivation and a budget.
 
Computers

Most teams highlighted the importance of a good computer for their clinic to enable them to
• access educational materials;
• connect to the PATA e-network;
• getting and keeping their website on line;
• keep easier and more accurate clinic records using databases; and
• use spreadsheets and other e-tools for improved data management, continuity
and care.

We have funding available for at least 10 computers with software and printer. If your clinic needs a dedicated computer for these tasks, please email a short motivation with a budget.
 
Children’s play areas (“Banda’s”)

We are currently working with the Nairobi team to design a prototype of play-area (banda) which will be piloted at three different clinics. The bandas are initially visualised as roofed and enclosed outdoor structures with wooden floors, but modifications can be made as demanded by different needs and conditions. They will serve two purposes: as a clubhouse for children during the day and as a teen centre, after school. “It’s so important that patients feel comfortable in our clinics,” said One to One’s David Altschuler, “and the Kenyan banda is a great concept that we wish to pilot in two other regions.” If your clinic has the capacity to pilot a banda please email us with a short motivation.
 
In the meantime, we have a small budget available for children’s toys which is available to each PATA clinic. So, if your clinic needs children’s toys, or educational play materials, please email us with a short motivation and budget.
 
Please make sure we receive your emails before July 15th at info@teampata.org. Many thanks in advance.

Evaluating PATA 2005

Six months have passed since PATA 2005 and much has happened since. As we are now working towards PATA 2006 it is important to look back and evaluate how PATA 2005 has contributed to our work and our clinics. 

A questionaire is available for download from the website (click here) and we would like to ask each clinic that attended PATA 2005 to complete this evaluation form and send it back to us by 15th July.

Evaluating is essential.

Evaluation is vital for the future success of PATA. It will help us all to ascertain the frameworks, strategies and tactics that have been most successful in your work. It will also guide the support PATA can best provide to your clinic.
 
The evaluation will allow PATA to share information with key audiences, enabling us to tell our ‘story’ to community partners and inform like-minded organizations, boosting support for fundraising efforts by showing impact and gaining public recognition for our achievements.
 
A focussed future strategy for PATA that provides more children, families and communities with improved access to HIV/AIDS treatment and support, relies on evaluating our progress.

We will summarize the evaluation data in the August newsletter and on the PATA website (www.teampata.org).

The new TEAMPATA.ORG

The new PATA website has been developed into a site for professionals and the community to access information about PATA and its work.

It will feature news on paediatric HIV/AIDS care, a library of relevant information and a message board that facilitates easy communication between all PATA members for support and to share case information and experience.  

The site is in the final stages of completion and will be launched soon. We will let you know the date by email and hope to 'see' you soon on the message board!

Mid-year feedback

Over the few months, we will share the mid-year reports of PATA clinics with our readers. This month, we hear from the Harriet Shezi Clinic in Johannesburg, Dora Nginza Hospital in Port Elizabeth and TASO in Uganda.

Harriet Shezi – Wits Paediatric HIV Clinic

On clinic days, writes Claire Egbers, staff has been trying to meet after the clinic (while eating lunch) to discuss patients. Though acknowledging that it has been difficult to achieve and maintain, she says that it has provided them with some time in which to “relax and enjoy each other’s company.”

Their improvement team has also been planning a weekend get-together for team members to cultivate further team-building in a relaxing environment.

Though suffering from a lack of capacity, they are considering the implementation of the Patient Advocate (PA) model, which involves volunteers following up on patients who do not return for further clinic visits. “We are looking at training some of our adolescents to be supporters in their communities, but this is still a new project,” Egbers says.

In the meantime, their counsellors are doing a sterling job at making contact with patients who have defaulted the clinic as long as two years ago – when the current rollout and access to treatment was not available yet – and these patients are now back in active care.

Egbers says that they are aware that they need a designated person to co-ordinate an income generation project such as beading. They have also identified the need for support groups for both caregivers and children while they are waiting for treatment.

Good news on their staffing side is that they now have both their own psychologist (“I don’t know if we or the patients need her more!” Egbers jokingly says) and dietician. Counsellors set up their own training programme with the psychologist to improve their skills and knowledge.

“The improvement in the quality of counselling and referral of our children into psychological services has been amazing,” a positive Egbers writes. “The dietician is new and still finding her feet, but she is young, enthusiastic and willing to improve the programme.”

While constantly facing challenges, their outreach team has been doing a great job in the primary health care clinics. “A team consisting of a doctor, primary health care nurse, pharmacist, data capturer and counsellor have really helped to train staff at their two outreach clinics and are implementing systems that help to run these clinics more efficiently.”

According to Egbers the number of children receiving treatment at their clinics is growing, but their down referral process ensures that clinics are not overloaded. They are looking into issuing medicine for two months at a time at the clinics to reduce traffic.

Another exciting project has been a series of clinic teas organized by Harriet Shezi Clinic. “It sounds simple, but has been really successful,” Egbers says. “The aim was to invite those involved in care of our patients to see our clinic, get some feedback about children on HAART, and improve relationships and referrals and to iron out problems.”

Harriet Shezi also held a very successful Father’s Day, when soccer star Lucas Radebe visited the clinic. Fathers and male caregivers were invited and encouraged to be active participants in their children’s care by being offered CD4 tests for example.

Egbers says they are working hard at adherence counselling, hoping that their continuing research will pay off. Most of their adherence counselling is done at the clinic and, as there is no language barrier, it helps to encourage easier communication.

As far as their facilities are concerned, they are due to move to a renovated building soon.

Harriet Shezi has “well over 1300 kids” currently on treatment. “We continue to see the huge effect that HAART has on the lives of our children and their
families,” says Egbers.

Dora Nginza - Port Elizabeth

According to Nonkosi Ndalasi from Dora Nginza Hospital in Port Elizabeth, the 2005 PATA conference “renewed our minds and spirits”. Six months after the conference, she now shares their progress so far this year.

They have introduced bi-weekly meetings at which workplace challenges are discussed. These meetings are multidisciplinary, attended by everyone from the clerk to the pharmacist and everyone else involved at the clinic. “This has proved to be a success as we correct, support and compliment each other,” Ndalasi says.

There are also monthly meetings with all the stakeholders, including the Head of the Paediatric Department. While the clinic previously only had a Chief Medical Officer, they now have a full-time paediatric consultant with ARV experience. Due to the influence of the Paediatric HOD, they also now have interns rotating on a monthly basis.

Teatime discussions (from 11:00 – 11:30) has also become a valuable time for staff to share their experiences.

According to Ndalasi, response has been “good” to their campaign of disclosure to kids before they reach the age of 5. “We have been blessed by having the services of a psychologist who helps with ongoing counselling,” she says, emphasising the importance of telling kids why they are taking ARV’s.

Upon returning from December 2005’s PATA conference, they started training children on Square Metre Gardening, which entails creating a small garden where one plants nine different types of crops. “It is meant for people who have no land,” Ndalasi says.

This has proved to be very successful, with the kids immensely enjoying the project. Parents have also stopped buying vegetables from the market and are even selling the vegetables from the children’s gardens, generating much-needed extra income.

“The local councillor has offered us a land for the children to continue with the vegetable gardens,” says Ndalasi, highlighting the importance of local government in contributing to the health of their communities. “This helps because ARV’s should not be taken on an empty stomach.”

“We have unearthed many talents from these children,” says Ndalasi. They are encouraging the children to do things for themselves (Vukuzenzele) and not to simply depend on the R180 monthly grant.

Since March, the clinic has been able to provide soup to clients, especially mothers/caregivers and children. On Thursdays and Fridays, the busiest days at the clinic when 60 to 90 people visit the clinic, volunteers prepare and serve soup to clients.

Still on the cards – meetings are under way in June – is a planned move of their paediatric ARV clinic to fall under their paediatric department. They had plans to repaint the walls of their current facility to make it more child-friendly, but this is on hold as they might relocate to other premises altogether.

Ndalasi says they have also decided to motivate for a dedicated social worker as the need for such a position is dire in the face of general child abuse, the demise of the SAPS Child Protection Unit, the abuse of children’s grants by caregivers and the cancellation of the Child Support Grant by Social Development.

The clinic currently has three nursing assistants who are receiving further training for the rest of the year.

Dora Nginza is still looking for a coffee dispenser, so if anyone can help them out, please let us know.

TASO in Masaka and Mbale in Uganda

According to Dr Daniel Bogere from TASO, they have also taken their goals set at the PATA 2005 conference by the scruff of the neck.

They have stepped up community mobilisation through hosting five radio talk shows (on two different stations) every month. These talk shows often feature a paediatric counsellor, doctor or nurse discussing child-care issues.

From the TASO clinic in Mbale, Nelson Eyupa reports that they have now extended recruitment of children to all weekly clinic days, not just Wednesdays as in the past.

Dr Bogere says home-made IEC materials have been developed to assist with adherence and that their children’s play centre has been improved with toys and other playing materials.

Some of their nurses have also received paediatric ART management training by Mildmay, a HIV/AIDS organisation from Kampala.

Challenges still to be met for TASO Mbale include the formation of peer support groups for children in ART, the involvement of traditional healers and the recruitment of a nutritionist/dietician.

Personality focus: Interview with Loreen Adhiambo of WOFAK (Women Fighting AIDS in Kenya)

This month’s personality focus is a bit more in-depth and issue-driven. Loreen Adhiambo, a counsellor at WOFAK in Nairobi, recently paid a three-week visit to Cape Town’s Groote Schuur Hospital (GSH) with the aim of sharing ideas, knowledge and practices with her South African counterparts.

PATA’s Kate Kerber sat down with her for a brief conversation.

PATA: What activities have you been involved with at GSH?
Loreen: I was involved with the daily GSH routine, attending to patients with Drs Paul Roux and Jean Paul Kanyik and also attending support groups. I was particularly involved with the support group about adherence, where I could point out to the women here just how many resources they have at their disposal here in the Western Cape and how they should take advantage of it.

PATA: What workplace trends have you picked up on while visiting here?
Loreen: Many people have sufficient knowledge and tools to do the right thing, but some clients still don’t adhere to treatment. At WOFAK, we have one support group for the more than 80 members regardless of their HIV status, but some people still don’t adhere. I’ve come to realise that you need to start with smaller groups so that more people have the chance to share and also that groups of people, like men and women or people at different stages of treatment for example, might need to be separated.

PATA: What are some of WOFAK’s successes?
Loreen: WOFAK has a strong nutrition programme – they help their members who aren’t yet on treatment to keep their CD4 counts high through fruits, vegetables and vitamins. Some of our staff have been living with the virus for ten years without treatment – they attribute it to good nutrition. WOFAK also runs a feeding programme – we feed about 170 orphans and vulnerable children.

PATA: And challenges you face?
Loreen: To deal with growing numbers of orphans and vulnerable children (OVC) in Kenya, WOFAK sponsors young adults to attend vocational training programmes – for example, one teen attends hairdressing school at the local technical school. It’s really important for us to network with the other treatment organizations in Nairobi. People with HIV/AIDS and WOFAK staff often encounter stigma and discrimination. To combat the stigma, we do awareness seminars in school and churches. We talk to communities and educate them so they are not so afraid of HIV. There is tension between getting the word out about WOFAK and wanting to see patients (who might be nervous about being seen with a group associated with the stigma).

PATA: How do you counter this?
Loreen: We make the driver park the van far from where she is visiting when she does home-based care because people don’t want to be associated with an organization that does treatment. Some shops close doors and don’t let the staff in, like at the hairdressers for example. But they are not phased by the taunting and threats, one member wears a t-shirt with ‘I am HIV Positive’ hand-written on it.

PATA: The next PATA conference will be in your home town. What are you expecting from it?
Loreen: I am very excited at the thought of the conference coming to Nairobi. At the conference, I’d like to talk about adherence and discuss the similar challenges I have witnessed while visiting South Africa.

Loreen’s visit to GSH was courtesy of Sidaction and the ELSA platform. Kate managed to set Loreen up with Treatment Action Campaign (TAC) in Cape Town and she returned home with some TAC ‘HIV Positive’ t-shirts for the WOFAK team.

Read more about WOFAK online at http://www.wofak.or.ke/

Would you like to be featured in our ‘Personality Focus’? Or do you have a question you’d like to ask any of our featured health care workers? Please contact the editor on info@teampata.org

Kenyan Paediatric Association Meeting (27 – 29 April 2005)

GSH’s Dr Paul Roux attended the Kenyan Paediatric Association Meeting and provides us with some feedback.

“I was struck by the versatility and the energy of our Kenyan colleagues and by the practical nature of many of the presentations. I learnt a great deal,” says Dr Roux. The meeting had an excellent programme and was well run and hosted in an interesting venue.

“A number of Kenyan paediatricians now have practical experience of using ARV’s in children and they have a very good understanding of how to use these drugs” says Roux. “The Kenyan paediatricians work very hard, they all have to work in both public health institutions and in private practice in order to earn an adequate income. It is going to be difficult for them to find the time to address quality of care and the improvement of the comprehensive health care package for their public service patients.”

Remember: The PATA Newsletter belongs to each and every one of you. We would like it to become a place where you can feel at home, where you can learn from your colleagues elsewhere on the continent and pass on some of your own knowledge to those who might need it. Please send us any news from you clinic or country – of successes achieved and of challenges that you still face. Anyone can contribute, simply send us an email. Send any news, information, requests or inquiries to info@teampata.org. We are here to assist you however we can.

Paediatric AIDS care workers and researchers contributing to this edition: Claire Egbers (South Africa), Hermien Gous (South Africa), Nonkosi Ndalasi (South Africa), Dr Daniel Bogere (Uganda), Nelson Eyupa (Uganda), Loreen Adhiambo (Kenya), David Altschuler (U.K.) and Paul Roux (South Africa).

© PATA 2006. All Rights Reserved. Published online from South Africa.

Click here to download the PATA and Kidzpositive Western Cape Adolescent Workshop poster.