Bringing HIV Help Into Homes
November 16, 2007, MOMBASA, Kenya —By Debbie DeVoe
MOMBASA, Kenya — Margaret Nyangasi is in bed today. The typically vibrant woman, who serves as both treasurer and secretary of her HIV support group, is suffering from a piercing headache. The severe pain coupled with Margaret's swollen face has community nurse Marion Wakesho Mangale concerned.
"Please take your mother to the hospital immediately," Marion advises Margaret's daughter, ensuring that she has the 50 cents or so needed to pay for a public matatu, or minivan, ride each way. Marion is worried Margaret may have contracted a type of meningitis or possibly malaria. In either case, she needs treatment right away, especially because Margaret's immune system is already compromised by the HIV.
Aid From AIDSRelief
The importance of early medical referrals is one of the many reasons the AIDSRelief consortium places a strong focus on community-based care. A consortium of five partners, AIDSRelief is led by Catholic Relief Services and funded through the U.S. President's Emergency Plan for AIDS Relief. The consortium is providing HIV services to poor and underserved clients — including delivering free, lifesaving antiretroviral treatment to more than 132,340 patients — in nine countries in Africa, Latin America and the Caribbean.
"Facilities supported by AIDSRelief are often in outlying, neglected areas where many people struggle each day to put enough food on the table. Living with HIV can compound everyday problems resulting from poverty," explains Carmela Abate, deputy chief of party for AIDSRelief programs in Africa. "By helping to increase the skills of health workers and providing HIV services to those most in need, AIDSRelief is helping clients receive the lifesaving care, treatment and emotional support they need."
AIDSRelief programs accomplish this by taking a holistic, client-focused approach to care and treatment. Project sites prescreen program participants, ensure they live in the service area for ongoing outreach, and even require "treatment buddies" at some facilities to confirm drug adherence. Pretreatment classes, counseling and support groups provide additional support.
Most importantly, however, are community outreach volunteers — dedicated community members who volunteer their time to visit AIDSRelief clients in their homes and assist in care and treatment activities. These volunteers enable AIDSRelief to add a personal touch to client care, with a volunteer, for example, heading out to check on a client who misses an appointment.
This community-based approach to HIV care is paying off. In Kenya in late 2007, for example, the 20 faith-based health facilities receiving support from the consortium were achieving a cumulative treatment retention rate of 85 percent for 21,000-plus patients on antiretroviral medications, not including those patients who chose to transfer their care to other health facilities. This means that once clients enroll in the program, they are consistently coming back for follow-up appointments, picking up medications and taking them correctly — and ultimately, it means they are fighting HIV and surviving.
Health Care On Foot
Down in Mombasa on Kenya's coast, 250 community health volunteers trained by the Archdiocese of Mombasa's AIDSRelief project are regularly visiting almost 900 AIDSRelief clients. These dedicated volunteers also visit scores of other clients receiving HIV services from other local health facilities.
Today, volunteer Josephine Nyambu, counselor Sister Peninah Wangari, nurse Marion and I cover a couple of miles on foot winding through dirt roads and narrow pathways to visit a dozen clients. Marion conducts a quick medical checkup, Sister Peninah helps with pill counts to ensure clients are taking their drugs correctly and Josephine takes notes to return the next day with needed medications and nutritional support.
Our first visit is with a frail, middle-aged woman referred to the project by a community member because she continues to fall sick. After discussing symptoms, Marion encourages her to come in for HIV testing, but the woman simply isn't ready. The next client lives just a few doors down. He shares that he's experiencing some body pains from his TB drugs. Marion again encourages HIV testing, and this time the client agrees to come in on the next testing day.
To reach the other clients on today's list, we walk along the train tracks for a quarter mile, cross over and then head down a hillside dotted with small shacks. When Marion passes a man with a telltale eye infection along the way, she stops him to introduce herself and encourage him to visit the project's partner clinic. Moving on, the sun getting hotter with each minute, Marion briskly leads the way to the next home.
This client has been taking antiretroviral medications for the past year. A widow with two children who receives no help from her other family members, the client has a boyfriend but hasn't disclosed her HIV status to him yet. The boyfriend, however, just tested positive for HIV. Marion encourages them both to come in for counseling, stressing the need for them both to be aware of the risks of a pregnancy, which would lower the woman's immunity further.
In the next home, we sit down with client Aggrey Kamala and his wife Naomi, one of the growing numbers of "discordant" couples. Aggrey discovered he was HIV-positive last summer, but fortunately his wife has tested negative. Because this situation can put strain on a marriage, Marion arranges for them to come in for additional counseling as well.
A Soft Touch for Hard Problems
As we move from house to house, I'm deeply touched by the care offered in each home and by the gains made by clients. Antiretroviral medications are enabling people to become healthy once again and return to work to support their families. But I'm also troubled by the magnitude of the problems they face. The families we visited typically live in a one-room plywood shack or mud hut, have no electricity or running water, and struggle to feed their children, pay school fees and afford transport to a local health facility when anyone falls sick.
AIDSRelief clients must also deal with the side effects of drugs, low energy that keeps them from earning a living, possible abandonment by their families and friends, and the complications of having intimate relationships while preventing further transmission of the virus.
In the midst of these challenges, partner staff and community volunteers supported by AIDSRelief are helping to ease some of these troubles. It is work that takes enormous heart, patience, commitment and compassion.
As one client explains, "When things are really bad, I can go to my community health worker and the nurses, and they help me."
Debbie DeVoe is CRS' regional information officer for East Africa. She is based in Nairobi and recently joined partner staff on visits to clients' homes in Mombasa, Kenya.