Sunday, March 30, 2014

Reflection on week 2 at the ART Clinic

Good Afternoon from beautiful Zambia!

This week Lauren and I were at the Anti-retroviral Therapy (ART) Clinic. This clinic has 18,000 clients and provides care for those in Mongu and the surrounding communities. The clinic provides counseling, CD4 counts, adherence support, medications, and follow up check ups.

When looking at how HIV affects the individual’s health, the CD4 count and viral load done. To be eligible for anti-retrovirals (ARVs) in Zambia, the client needs to have CD4 count <350 .="" font="" nbsp="">The WHO has stated that to be eligible for ARVs one needs a CD4 count of <500 font="">. The lower the CD4 count, the more susceptible the person is to infection and illness. The viral load tells how fast the disease is progressing and more accurate picture. The demand is already overwhelming for this clinic and I am not sure how they would be able to support the increase in CD4 count.

So even though client is given the diagnosis of HIV, the client has to wait until the CD4 count is low enough to eligible to receive the ARVs. ARVs are not a cure, however, helps to extend the individual’s life. I have compared the treatment of ARVs to being like receiving chemotherapy or radiation to treat cancer. Unfortunately the clinic has to send viral loads to Lusaka and have to wait for the results. They have worked around this by determining if a CD4 count is still not improving on first line ARVs , then they will start them on second line ARVs while waiting for viral load results to come back in order provide treatment in the mean time. An example of how a limited resource clinic continues to provide the best care and work around challenges.
I have interest and would like to work in public health at some point in my nursing career and really enjoyed my time at the ART clinic. I enjoyed working the with staff and keeping busy in the clinic, however, I would be hit with moments when I reflected on that every face that I had seen (one day 500 clients went through) is the face of HIV. The clients sometimes wait 8-9 hours before getting through the clinic, after having traveled from far distances. One client had come from the flood plains across the Zambezi River, dealing with a hippo that was challenging them and then still had to get to the clinic. This client left at 0400 and didn’t arrive to the clinic until 0800 and was in the clinic until about 1300 for her medications. I thought  about every time I have ever been frustrated with traffic, like when I was heading across Vancouver to get the ferry.
Tuesday it is reserved for the pediatric clients. I started off the day with taking part in the education session about HIV status disclosure. The children want to learn more about the HIV disease, and have a day where they have a picnic and play games. The staff member providing the education is fantastic, she is so passionate and can see how much she puts into her job. I went over to adherence with her and other staff members who were running the adherence department are just as great. They answered all my questions and also took the time to translate and include me in the conversations. In adherence you are to provide counseling surrounding the client’s health and finding out how the adherence is going. It was here that I would see children come in and fill out the paper work and assess how they were managing. I would get caught up in being happy to be working with the children that again I would be hit with a ton of bricks and realize that all these children have HIV. I think of the term “ child poverty” and how it relates to the situation the children are born into.  The child didn’t have a choice to have the disease transmitted to them and have managed to live past the age of two. I have been trying to imagine what it would be like to be a child with a disease that is unfortunately carries a large amount of stigma. I have had to reread our resources many times to try and wrap my head around this complicated disease. Through discussion we talked about how the rash makes it easier to identify the children that are HIV+ and how this contributes to the stigma. We talked about the children that are orphans. These children were at the clinic managing their own ARV therapy. My parents know how I easily forget to take my vitamins at home and to think that this child is managing his or her complicated disease that has changed his or her life forever. I asked about the challenges that the staff member recognizes. These included transportation to the clinic, the clients having money to buy food and the stigma of HIV. Another challenge has been with retaining clients who are deaf, because of the communication breakdown and thinks that it would be good if there was training to teach sign language. Specifically to the children’s clinic day he stated that they do not have toys to help attract the children to come to the clinic and help fight the stigma. It is also important to promote play and give these children the opportunity to be children. I see this being very important when the children already have to grow up so quickly. It  is neat to see the concept of conducting a needs assessment in reality and not just in a textbook. The idea of creating a toy box came from the clinic itself and trying to connect and gain an understanding.
The language barrier can be funny at times. For example in the Art clinic this week I kept hearing “ twin towers”. I sat there just thinking, what are these twin towers are they talking about, is this where someone lives ? and of course New York ran through my head,  so I finally whispered to Lauren asking what about this. We started laughing because they had been talking about 20 hours.
Yesterday the team visited the chitenge tree and bought our fabric to have our dresses made. I would say that we are becoming more comfortable here in Mongu. I had a great experience with the Zambian women in the market today. I had replied the Lozi greeting for the morning and clapped my hands and had the woman in the market laughing and helping me with my pronunciation. I was thanked for trying and was asked where I was working. After telling them about being here with the school and nursing at Lewanika hospital they thanked me for coming and that I am welcome here. It is moments like this that can help take a layer off of the minority label and feel more at ease and see the beauty in this community.  
Off to Save A Life this week with Darien and looking forward to it.


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