An Educational Approach

Our week at the ART clinic was very short, but it still gave us a new perspective of an HIV clinic in Zambia. In our two days there, we witnessed the systematic approach to caring for those with HIV that is necessary when a small clinic serves thousands of people. Despite the lack of resources in the hospital, they have a system that provides for the needs of HIV patients and promotes prevention of HIV. We witnessed this system first hand by following the ART process of a newly diagnosed patient.

The process of a newly diagnosed patient includes:
-being counselled prior to being tested
-being tested
-opening a file at the clinic
-further counselling
-getting bloodwork drawn
-education about medications and possible prescriptions

This man had come in to be tested for HIV. He was counselled before the test with two other men, which raised concerns for us in terms of confidentiality.  We realized after that it was actually a wise use of time. The counselling before getting tested is based on education of what the virus is and how it is transmitted, which is relevant regardless of the status of the client post-test. The most important thing was that privacy was provided when receiving the results of the test. Even though some of the men were not positive, we appreciate that they still received education about prevention and protecting one's health from HIV, while being encouraged to be tested on a regular basis.

The following day we met this man again in the clinical officer's assessment room, where they did an initial assessment with emphasis on signs and symptoms of HIV. This is a time where the patient gets the opportunity to share abnormal health findings. Often patients will get tested in the first place because they notice something abnormal about their health. Unfortunately, the first stage of HIV is asymptomatic and by the time the patient gets tested, they could already be at stage 2 based on the WHO's staging of HIV. We made an educated guess that this patient was stage 2 since he was complaining of a severe rash, which ended up being herpes zoster.  As we assessed him we also concluded that he was having eye sight difficulties, which is another indicator of the progression of the disease.

What we have learned from this experience is the importance of prevention and teaching. One of the HIV counselling teachers had mentioned to us that the percentage of HIV patients in Zambia is 14.7%, whereas at its peak, approximately 30% of the population was infected. Although this decline is largely attributed to antiretrovirals, adherence counselling and education about transmission and prevention of HIV has also made a huge impact.  We have been influenced by the counselling and services provided at the ART clinic as it applies to upstream healthcare and our future practices. 

- Gillian and Rebecca