Team PATA

Newsletters

March 2006. Vol. 1 Issue 1.

Contents:

• Flight4Life raises money for children
• UCT students tackle the desert
• A look at primary goals & needs of clinics
• News from the PATA community:
• Masaka, Uganda achieving some goals
• Paarl clinic gets more space
• Huge challenges in Zimbabwe
• Hamburg team taking year by the scruff of the neck
• Action in Worcester

Flight4Life raises money for children.

Two South African-born adventurers, David Harrisberg and Rodney Dennis, recently arrived in South Africa after an eventful weeklong trip from London in their small single-engine propeller-driven plane. The aim of their audacious journey was to raise funds for the One to One Children’s Fund.

Every year, more than 600 000 children in Africa are born with HIV. Of these, less than 10% receive medical treatment.

David Harrisberg (52) and Rodney Dennis (53) committed themselves to make a difference after seeing One to One’s documentary film on African children born with HIV. David recalls, “The scenes from Nazareth House, where orphans affected by HIV live, were truly shocking. Yet within three months of starting the treatment, the kids seemed to have a spring in their step. I saw that I could really help make a difference here.”

Their trip was eventful from the beginning, as this entry on their ‘blog’ reveals: “Another less serious development was the loss of our auto pilot, but our on-board engineer seems to have fixed it. It is amazing what you can do with a hammer!”

Departing from Elstree Aerodrome in England on the 9th of February, David and Rodney landed in Corsica, Crete, Luxor, Djibouti and Nairobi before coming to a premature halt in Johannesburg thanks to engine difficulties.

Some of the most hostile terrain they crossed were between Luxor in Egypt and Djibouti on the Red Sea. “When we talked about the journey at end of the day,” David wrote, “we realised that we had both spent much of the time wondering where or how we would land if we had a problem.”

In Nairobi they met One to One’s David Altschuler who accompanied them on a tour of Kenyatta Hospital’s AIDS Centre.

Despite dropping oil pressure, unhelpful air-traffic and a huge thunderstorm, David and Rodney managed to land safely at Johannesburg International on the 15th of February. Here their plane had to stay for another week as repairs were made.

They finally arrived in Cape Town on the 28th of February.

Want to read more about David and Rodney’s bumpy ride? Visit their blog and read some journal entries and view some spectacular aerial photographs at http://flight4life.blogspot.com/

UCT students tackle the desert.

On the 26th of December 2006, two intrepid UCT students will depart from Plymouth on a 6 000km, three-week journey to Banjul in the Gambia in the infamous Plymouth-Dakar Challenge.

Why on earth? Well, it’s all for a good cause. David Smith and Andreas Keller have formed TeamRally Kidzpositive and will participate in the challenge to help raise AIDS-awareness and raise money for The Kidzpositive Family Fund.

Kidzpositive is a charity devoted to improving the health of HIV-positive children in Southern Africa and is a PATA Partner.

David, a 3rd year medicine student and Andreas, a 3rd year business sience student, hope to show that everyone can and should do their part in raising awareness about HIV/AIDS. Both of them have travelled extensively before, but the Plymouth-Dakar will offer a few unique new challenges.

To start with, the vehicles in this challenge are not allowed to cost more than £100! Also, unlike that other famous rally, the Paris-Dakar, you are not allowed to have teams of assistants to help you out. In fact, you are allowed no outside assistance at all: It’s just you, your £100 piece of metal and some of Africa’s roughest roads.

To assist TeamRally Kidzpositive, you can make monetary donations or donate items like tents or camping equipment like gas bottles, torches and cookers.

Visit www.kidzpositive.org for more information and to make donations. The PATA Newsletter will keep you posted on any new developments.

Teams list their goals and needs.

During the first successful PATA Conference in November 2005, teams from all over Africa helped to draw up practical lists of what they need to improve their clinics and health facilities.

In this article, we take a look at the core needs. In future editions of the PATA Newsletter, we hope to carry news of Teams’ successes in their ongoing battle to secure sufficient resources for their respective clinics.

First priority for almost all teams was the need to improve administration at the clinics so that they would run more efficiently. In practice, this meant that some teams identified the need for proper data management. Others simply need an electronic (computer based) information management system. Several others felt the need to identify defaulters within 24 hours of missing an appointment. Due to the accessibility of cell phones in their region, the Groote Schuur Hospital team was dreaming of a reminder system using SMS (Short Message Service).

In general, many clinics wanted to draw up guidelines and protocols of how they should use their resources to the best possible benefit of their patients.

Part and parcel of a good child-care clinic is to cater for the specific needs of your patients. So it was no surprise that 16 Teams listed the need to create a special play area with sufficient toys for different age groups at their clinics.

Where it was not happening already, teams (for example, Tanzania and Nairobi) wanted to introduce child-specific counselling rather than just parent/couple counselling. Closely tied in to this is the development of support groups – for adults and adolescents.

Clinics can always do with more and better equipment. The attending clinic teams drew up varying wish lists and it is clear that a lot of the items are relatively inexpensive and could easily be sponsored by a donor, private or otherwise. One of the major problem areas remains transport, which ten teams listed as a high priority. This can be addressed, either by obtaining a vehicle or vehicles for exclusive use of the clinic or simply by getting access to improved private or public transport. Motorbikes are already used by some clinics to conduct inexpensive and effective home visits, something that other teams said they will also consider.

Space is also a widespread problem. Some clinics felt that they could reconfigure the space they already have, but many needed more buildings - and for these they need outside assistance to acquire or construct.

Teams also spoke about the need for income-generating projects. These projects could provide individual families with cash for food and other necessities, or could even fund clinic operations by involving the community on a social participation basis.

Just as the PATA Conference helped people from different corners of the continent to exchange information, communication within the individual clinics was also a talking point. Teams spoke of setting up more regular clinic meetings for the staff, while also looking too improve patient-focused communication. Motivational interviewing and patient guidance could be employed to make patients feel at ease, rather than the directive approach, which tends to exclude the patient from the decision-making process. Disclosure of diagnosis to children was highlighted as an area of concern – and a possible topic for future PATA meetings.

Another badly-needed resource is skilled staff, whether it be administrative or to enhance psychosocial support. Some teams also pointed out that the careworkers themselves require ‘carers’. This need for additional staff can be supplied by outside resources such as NGOs. Tied into this need, is the need for proper staff training and continuous skills development.

It’s a long list – and we’ve just isolated a few general themes here. Please send us your progress reports on how far you have managed to achieve your goals. Also, tell us about your ongoing and additional needs. Let’s see what can be done!

Read the news section below to see how teams from Zimbabwe, Uganda and South Africa have started to make work of their goals – turning needs into achievements.

News from the PATA Community.

• Masaka, Uganda achieving some goals
• Paarl clinic gets more space
• Huge challenges in Zimbabwe
• Hamburg team taking year by the scruff of the neck
• Action in Worcester

Masaka, Uganda achieving some goals.

According to Dr Daniel Bogere from Uganda, he and fellow delegates from the PATA Conference presented their newly established goals to their The AIDS Support Organization (TASO) management team in Kampala upon their return from Cape Town in December 2005.

Since then, they have already achieved a great deal.

There is a play centre under construction for TASO Masaka and they will be trying to get play materials suited for different age groups, because the play area will not be partitioned for the different age groups. They still need some help in getting the appropriate materials.

They have also been very active in their community since their return. “We have done a lot of community mobilisation as far as adherence and other ART related activities go, Dr Bogere writes. Focusing on children, they have had health talks over local radio and intend to build on this good work by having their drama and music groups address burning issues.

Their TASO training centre is also following up on building capacity for their health workers.

“Formation of peer support groups for children and guardians has come up as a serious matter in our centre management meetings,” says Dr Bogere, “but the budget is too tight to allow even simple mobilisation of these children and guardians or to facilitate any of the activities for these groups when formed.”

As yet they also still lack the funds to employ a dietician/nutritionist, but TASO Masako plan to have one of their staff, who has previously received training, attend a refresher course so that this position can be adequately filled.

Despite the challenges, Dr Bogere remains positive: “We continue to appreciate your efforts as per the PATA Conference and we promise to keep the fires burning.”

Paarl clinic gets more space.

According to Dr Janine Karpakis from the Paarl Team, they have been allocated more space which has allowed them to offer better patient privacy and increased efficiency.

“We are also functioning much more as a team,” she writes, talking of the months since the PATA Conference. “Our counsellors Thelma Zungula and Sheila Samuels have been able to apply their talents to the task. We have become a lot more appreciative of each other's value worth and the worth of daily tasks.”

They also now have a monthly debriefing meeting where they put forward ideas towards improving their service. These meetings have been very successful.

“The enthusiasm we were able to glean from the conference has spilt over to the rest of the paediatric department and we are working towards the same goal: ARV's for the kids that need it.”

Patient transport remains a big problem for them and for this they are hoping to get help from NGOs and other organizations. Another burning issue is to secure a proper place of safety for the children.

“Since the conference and especially over the holidays the pressing problem of a place of safety for our children has become acute,” Dr Karpakis writes. “We do have Bowy House in Paarl, but they are inundated and filled to capacity.”

The Paarl Team is still brainstorming as to how to solve these problems of community upliftment and of how to secure a place of safety or half-way house for their patients. They would welcome ideas from other teams who are facing similar situations elsewhere in the PATA Community.

Huge challenges in Zimbabwe.

“We are well, despite facing huge challenges in Zimbabwe,” writes Dr Margie Pascoe from Harare, “Our family HIV unit is being overwhelmed with requests for treatment due to the acute-on-chronic crisis in the public health system in our country.”

Dr Pascoe says that their team is “weathering the storms together” and becoming a stronger unit thanks to what was learnt at the PATA Conference. Starting on the 8th of March, they will have weekly debriefing sessions where – Pascoe says – they can “share our heartaches at our failures and the joy of our successes!”

Gertrude Guveya says that they are fine despite the current economic hardships that Zimbabwe is suffering under. “My visit to South Africa was a blessing to me,” she says. Since September they have been training health professionals on the care and management of children with HIV, as well as adherence and access to ART.

Hamburg team taking year by the scruff of the neck.

The main outcome for the Hamburg Team from the PATA Conference was that they realised that they had to amalgamate their primary care clinic with their present PEPFAR-supported ARV unit.

“It became obvious to us at the workshop when we designed the ideal clinic that we must try and plan ours to be patient and staff friendly,” says Dr Carol Hofmeyr.

But this amalgamation started off on the wrong foot thanks to miscommunication with their donors who thought that they were handing over the building (which the donors helped to renovate) to the government.

“We learnt another lesson in communication,” says Dr Hofmeyr philosophically.

But they have overcome this hurdle and have set off on the long path towards negotiating with government.

The Team also realised that they needed to take breaks as many were “near collapse”. They closed down between Christmas and New Year so that everyone could get some rest and time to reflect.

“For me, the few days in Cape Town actually prevented me giving up,” Dr Hofmeyr writes, “I had felt so isolated and misunderstood up till then and was close to having burn out. I loved meeting all the others with so much dedication.”

Action in Worcester.

According to Dr Colette Gunst, the Worcester Team has been sharing the knowledge and experience gained from the PATA Conference with colleagues at their regional hospital in Worcester. Dr Gunst says that she hopes they will “catch our enthusiasm” for the treatment of HIV positive children. Their Team also listens to the Conference tapes whenever there’s a lull in activities at the clinic.

They have drawn up an action plan and have already achieved several goals. Thanks to a donation from the International Women’s Club of Cape Town, they have been able to make one of their consulting rooms a dedicated child-friendly space. Brightly coloured boxes with toys, a play-mat, a new examination couch and child-friendly ear thermometers are some of the new resources they can now draw on.

They now also have a clinic-defaulter system up and running, with telephone calls or visits by a Community Health Care Worker at the end of each week to patients that have skipped clinic visits.

To help caregivers with the accurate dispensing of medication, they have placed an order for colourful stickers, pill count cards and pill boxes. These should make this often complicated task easier for both patient and care worker.

While they still function as a Family Clinic, they now receive visits by a paediatrician three times per week and are also training a new full time medical officer in paediatric management. This, Dr Gunst says, is to “make sure the children are not forgotten.”

Despite all their clinic’s successes, Dr Gunst remains concerned about “the wellbeing and access to care for children living with HIV in our region of Boland/Overberg in the Western Cape.”

She also says that the team still requires more expertise in their paediatric HIV management as most of their full-time doctors are not trained paediatricians.

Another region-wide problem is to identify children who are either at risk or are already HIV positive. They need to create a greater awareness in their communities and must ensure that Primary Health Care staff carry out HIV tests and CD4 counts on children.

As with most other clinics in the PATA Community (and indeed, everywhere), transport remains an issue. They have started a twice-monthly outreach clinic in De Doorns, but much of their coverage area remains more than 2 hours’ drive away and the reliability of public transport and the availability of ambulance services remain problems.

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.

PATA Community Members contributing to this edition: Dr Daniel Bogere (Uganda), Margie Pascoe (Zimbabwe), Carol Hofmeyr (Hamburg, RSA), Gertrude Guveya (Zimbabwe), Dr Janine Karpakis (Paarl, RSA), Dr Colette Gunst (Worcester, RSA).

Special thanks to David Harrisberg and Rodney Dennis for the use of images and words from their blog.

Contact the editor: info@teampata.org