When Dr. John Haloka was a child, he wanted to be a doctor, a pilot or an engineer. Thankfully for the 1.1 million Zambians with HIV, he settled on a medical degree. Now 34, Dr. Haloka is one of four experts who graduated in September 2009 from Zambia's first medical residency program for advanced HIV care and treatment.
"Our clinic is running far better since Dr. John's return," says Fredrick Chitangala, programs director for Chreso Ministries. "He's able to handle the more complicated cases."
Chreso Ministries is a Zambian organization that provides HIV services through support from AIDSRelief, a consortium that in Zambia includes Catholic Relief Services, site manager Children's AIDS Fund, Futures Group, and the University of Maryland School of Medicine's Institute of Human Virology.
Hope for HIV Patients
Dr. Haloka's journey has been one of faith and commitment. While completing his medical internship in 2003, he began working at Chreso Ministries because of its affiliation with his local church and his interest in HIV care.
Chreso has been helping Zambians with HIV since 1996, when it first started providing counseling and testing. Up until 2004, however, Chreso's hands were tied. Few antiretroviral medications were available in Zambia, and those that were remained beyond the financial reach of most residents. As a result, Chreso could only offer basic nutritional advice and emotional support to clients when informing them of positive test results.
The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) radically changed this desperate situation. In November 2004, Chreso entered a partnership with the PEPFAR-funded AIDSRelief consortium to begin providing antiretroviral treatment.
"People were doubtful that antiretroviral therapy could be done successfully by a small site that wasn't a hospital. Now we are serving more than 8,000 clients with HIV, including 5,000 on treatment," explains Chreso founder Reverend Helmut Reutter. "More than 100 clients come to the center each day. It's very strenuous."
"We were optimistic this would work," Dr. Haloka adds, remembering how they spent their 2003 Christmas holidays preparing the AIDSRelief proposal. "We were given an initial target of 200, but we felt it was very low because we had a backlog of patients to get on antiretroviral treatment. We hit our numbers soon after we started."
Partnering for Excellence
As the Chreso antiretroviral program grew over the years, so did Dr. Haloka's HIV expertise. But he still lacked the advanced knowledge needed to treat complicated cases, such as patients who had become resistant to their initial drug regimen because they failed to take their medications consistently each day, enabling the HIV virus to mutate. When AIDSRelief staff encouraged Dr. Haloka to apply for a space in Zambia's first HIV residency program, he jumped at the chance.
"The training really changed my work. I feel so excited about how I look at my patients now."
~Dr. John Haloka
"It was demanding," says Dr. Haloka, who is now the medical director for Chreso Ministries. "We'd attend lectures from 8 to 9 in the morning, then go see patients until 3 p.m. for practical learning, and then return for more lecturing." Four facilities, including Chreso and the University of Zambia's teaching hospital, served as centers of excellence for the hands-on care and treatment training.
Through University of Maryland School of Medicine's Institute of Human Virology, AIDSRelief collaborated with Zambia's Ministry of Health, the University of Zambia and the United States' Centers for Disease Control to create the one-year HIV residency program, which is now in the process of being certified as a master's program. Next year, the program will be taught mostly by local University of Zambia staff, with University of Maryland staff shifting from being the program's primary professors to becoming program advisors and guest lecturers. An additional eight doctors are scheduled to graduate from the program this April.
"The residency program staff really mentored me, particularly stressing the need to document every action taken with patients and the reasoning behind it," Dr. Haloka adds, explaining that this documentation provides clear explanations for subsequent visits and provides legal protection for doctors as well. "The training really changed my work. I feel so excited about how I look at my patients now."
Strengthening Health Systems for Long-Term Success
AIDSRelief has also introduced special training sessions for clinical officers and nurses at partner health facilities. This advanced training helps to reduce doctors' workloads by enabling other medical staff to prescribe monthly antiretroviral medications to existing patients and treat basic opportunistic infections that affect many HIV-positive people. Along with the HIV residency program, such training is helping to strengthen Zambia's overall health care system and prepare sites to manage HIV programs directly for long-term sustainability.
But for the gains made under AIDSRelief to continue, partner facilities must continue to receive sufficient funding to keep existing patients on antiretroviral treatment and to start new patients on the lifesaving medications.
"You can imagine the trauma for HIV-positive people when they see their friends doing better, but they aren't," Reverend Reutter explains, adding that it's also very traumatic for providers when they don't have the resources to enroll new patients into treatment. "Hopefully with the transition to local partners, the funding will continue to flow like it has—or better. The dying has reduced, and that's thanks to the PEPFAR program."
Dr. Haloka is also deeply grateful for the advanced care and treatment the AIDSRelief program enables him to give to patients with HIV.
"I find great joy in bringing a smile to someone's face. If someone is happy, at the end of the day, I'm happy too," Dr. Haloka says. "Laughter is also good medicine for the bones."
Debbie DeVoe is CRS' regional information officer for eastern and southern Africa, based in Nairobi. She recently visited project sites in Zambia.