Team PATA

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2007 Newsletter, Vol II Issue 3

Working together to improve and extend care for children and families affected by HIV/AIDS.

In this issue:

1. Expert Patient Programme Submission Date
2. PATA mentor focus: Sara Stulac
3. PATA clinics reach out and share - DRC clinic visits Rwanda
4. Oshikuku clinic makes excellent progress

1. Expert Patient Programme Submission Date: 15th May 2007

All PATA teams are reminded to submit their Expert Patient Programme applications to Melanie Evans either by email to info@teampata.org or fax to
+27 21 406 6169 or, if within South Africa, to 0866 191 623.

The Expert Patient Programme aims to engage and empower PLWHA to contribute to their community’s health. PATA can provide up to US$200 a month for 12 months starting in June 2007, towards an ‘Expert Patient’ programme at your site.

Clinics are reminded that these employees will not necessarily be working full time, however they should be considered to be official and important members of the clinic team. The monthly stipend needs to be appropriate to the nature of their work, their hours and the local economy. ‘Expert Patients’ can work at the level of the community and/or clinic and clinics are encouraged to think creatively about how this programme could be used within their own clinics to improve practice.

We look forward to receiving your submissions before the 15th of May.

The forms can be downloaded from the following links:

Expert Patient Brief and Application Form
Expert Patient Brief and Application Form (Français)
Expert Patient Volunteer Agreement
Memorandum of Understanding about the Programme

2. PATA mentor focus: Sara Stulac

Sara Stulac, who has been involved with PATA since the first conference in 2005, is this month’s featured mentor. We asked her some questions.

PATA: Briefly describe the extent of the work in which you are involved in Rwanda.

Sara Stulac: Partners in Health works at six sites in rural Rwanda. One site we have helped to rehabilitate into a district hospital, and the other five are surrounding health centres. We have approximately 180 children on ART and a total of 500 HIV+ children being followed across these six sites. I am based at the hospital but there are nurses in charge of the paediatric HIV program at each site, and the team from the hospital goes to the other sites on a weekly basis to supervise their activities.

PATA: What is the biggest challenge you are currently facing in your own clinic?

Sara Stulac: The number of patients to be seen and to follow requires a huge amount of time and attention to detail. Our current staff constantly seeks ways to improve our care for each child, within the limitations of staffing and time that each person has.

PATA: What is the most exciting development within your own clinic since the 2006 PATA conference?

Sara Stulac: We have continued to pursue our goals and have developed a better system for follow-up of HIV+ children who are not yet on ART. These have included putting them in follow up groups with monthly appointments. Our community health workers have been instrumental in finding these children and facilitating their follow-up, and it has enabled us to identify many other children who are in need of ART.
 
PATA: How is your clinic progressing in achieving its goals set in Nairobi?

Sara Stulac: We have established a training and evaluation schedule for all the nurses in our paediatric HIV programs. We have begun constructing a paediatric HIV clinic with a playroom and other child-friendly spaces. We have also expanded our paediatric counselling program. We soon hope to improve and build stronger links between various programs including PMTCT and family planning.

PATA: Which clinics are you mentoring, and with which aspects of their work are you involved?

Sara Stulac: I mentor the teams from DRC, Burkina Faso, Burundi, Malawi, Rwanda, and Cote d’Ivoire. So far this has involved mostly email contact to support work towards goals established at the last PATA conference. Last month we hosted the team from DRC for a week at our hospital. The DRC team worked alongside our team for the week, observing and participating in all aspects of our paediatric HIV program.

PATA: How do you see the mentorship programme add to PATA’s scope of involvement with clinics across Africa?

Sara Stulac: Many clinics are very isolated and have few resources in terms of materials or information. We hope to help link teams with resources and with other care teams to share ideas, give support and to build momentum to improve programs.

3. PATA clinics reach out and share expertise - DRC team visits Rwanda

In April, the Rwandan team hosted a team from Heal Africa DRC. The main aim of the visit was to train the team from Heal Africa DRC in paediatrics HIV treatment based on the PIH-Rwanda model, particularly the community-based model and team approach to comprehensive care for paediatric HIV treatment.

Small groups from other clinics in Rwanda have been hosted over the last year, but this was the first visit from a group outside of Rwanda to be trained in paediatric HIV care. Each day the three visitors (Dr Elulalie and two nurses) were paired with a Rwandan doctor, nurse or social worker to observe and participate in activities including the following:

• Paediatrics ARV management: starting medications as well as monthly follow-up visits.
• Community follow-up of HIV+ children, including home visits.
• Paediatric HIV counselling and support groups, including sessions on disclosure of diagnosis.
• PMTCT programmes including care of pregnant women during pregnancy and delivery.
• Replacement feeding program for infants born to HIV+ mothers as part of PMTCT program.
• Complimentarity – in other words, the way in which different clinic services must be mutually supportive of each other and not function in isolation.
• Accompagnateur program of community-based HIV treatment.
• Electronic medical record.
• Inpatient care of HIV+ children.

The leaders of each program were scheduled to spend about an hour each describing the program to the visitors during their stay. They provided the team with copies of all documents used in the Rwandan program. They had a wrap-up meeting on the last day to get feedback and see how their clinic could provide further support.

The visit appears to have been a great success and was much appreciated by the visitors and the hosts. The DRC team would like to see the program modelled in other parts of Africa as they felt that the patients received a very high standard of care and were eager to implement aspects of the Rwandan program. The DRC team was very eager to implement many of the programs they observed but cited a lack of resources as their greatest obstacle. Discussions were held on ways that aspects of these programs can be implemented immediately in small ways, while working to advocate for more resources.

Sara Stulac felt that an exciting outcome was the opportunity to build and strengthen an inter-country collaboration, and to make plans to continue this support and exchange in the future. Two or three members of the Rwandan team hope to visit the DRC team’s clinic over the next few months to follow up and provide further support, particularly in implementing the counselling program for HIV+ children and parents.

If resources are available for similar exchange visits, they could be valuable for other PATA teams, particularly for teams with limited resources at their own sites.
 

4. Oshikuku clinic makes excellent progress with their goals

The HAART clinic at the St. Martins Oshikuku District Hospital (Namibia) has drawn up a progress report which shows the fantastic work they have done in the three months following the PATA 2006 conference.

One of their main goals set out at the Nairobi conference was to decentralize their ART services in order to reach other constituencies in their catchment district. Especially important was the area around Okalongo, from where a lot of the Oshikuku patients came.

Since March this year, they have twice weekly HAART clinic outreach visits to the Okalongo Health Centre. Patients have responded positively and appointments are streaming in – the number of patients here is expected to increase significantly over the next few months. This makes their current need for a proper waiting area much more urgent, though they have made representations regarding this to their government’s Ministry of Health’s Regional Directorate as well as the main donors of their programme.

A second goal set out last December was to improve teamwork at the clinic. Instead of the planned monthly ART meetings, they have gone even further and now have a weekly meeting every Friday morning.

The clinic has been using these meetings as platform to discuss the implementation of their 2006 PATA conference initiatives.

One thing that really grabbed the clinic team’s attention at the last PATA conference, was the need to introduce more child-friendly processes in order to improve the non-medical aspect of their treatment.

To start with, it was decided to always treat paediatric patients first during clinic hours in order to reduce waiting time. The clinic also wants to make the experience more pleasant for the children and plans to hand out sweets or biscuits to draw their attention away from the pain or discomfort they might suffer from injections or other medical procedures.

This plan has been approved, but it will only be implemented in the new financial year when funds from the petty cash budget will be allocated towards it.

The Oshikuku clinic had hoped to set up and conduct practical nutrition classes in order to help both patients and care givers to know which locally available foods are best for patients.

While the nurses trained in nutrition have not been able to spare time from their already hectic schedules in order to set up the classes, two volunteers have been trained as tutors. These tutors should have the classes up and running within the next three months.

Finally, the clinic is also planning to foster growing cooperation between other local support organizations in order to avoid duplication and/ or competition while helping patients meet their non-medical needs through income generating projects and psychosocial support initiatives. A stakeholders meeting is yet to be arranged, but the District Co-ordinator has agreed to head this initiative.

Contributors to this edition:
Dr. Henry Phiri, Klaudia Inghepa, Veikko Kuutondokwa, Spencer Makwangwala,
Dr D.M. Kangudie, Sara Stulac, Melanie Evans & Paul Roux.

P.O. Box 13657, Mowbray,
South Africa, 7705.
T: +27 21 404 3020
F: +27 21 406 6169

www.teampata.org

Published online from
the Republic of South Africa.
2007 © PATA

© Published online from South Africa.