Pictures are of HIV+ children that are recieving treatment at the support club, and HIV+ patient recieving home care, and Childrens ward at Mengo hospital
Hi all as most of you know I have been working at Mengo Hospital HIV clinic in Kampala, Uganda for the summer. The more time I spend her the more I am impressed with the work that Mengo is doing in their work with addressing the HIV epidemic within their country. Mengo tests and treats patient for HIV, but their job is not so simple as that. 1st to find patients, they test patients (with the patients consent) on all of the wards of the hospital for HIV- this is where they find many of they patients. Once a patient is confirmed as having positive HIV test they are given counseling and education about HIV and referrals to the HIV clinic, or a clinic that can assist them near their homes. Once a patient is confirmed HIV + the staff makes sure to follow up with the patient and have them come to the clinic. If patients have a high CD4 count, (the white blood cells that fight opportunistic diseases) they are monitored and placed on a medication called Septran ( an antibiotic that fights the opportunistic infection). HIV attacks a person's immune system so this is very important in maintaining the health of an HIV+ person. Patients are monitored until their CD4 count drops below 350 for women and 250 for men. This actually is quite low, in the U. S. treatment would start immediately if a person was detected to have HIV. This is because of the expense of ARV treatment (it is a very expensive treatment) and due to all kinds of drug patents etc... it remains expensive,even for those most needing it.
Mengo monitors these patients every month for complications and also monitors the CD4 count. Once the CD4 count drops to the low enough level they start the ARV treatment. They give patients a lot of education and counseling before they start the ARV treatment, and continue to monitor and educate once treatment has been started. Patients are to come in initially every month and monitored for their adherence to taking the ARV's, then every 2 months... If a patient stops taking their meds and then restarts they can become resistant to the medication, so this monitoring of adherence is very important.
Patients are also monitored for side effects, and opportunistic infections, nutrition and willingness to disclose their status to friends and family. If people disclose their status they are much more likely to maintain adherence to their drug regimen.
Mengo also tests pregnant women and makes sure the women will take ARV treatment if they are HIV positive (and also give the newborn ARV's) to prevent mother to child transmission of HIV. Much education is given in this area. Many children I have seen are on ARV's and are becoming healthy kids that can go to school and have a good life. Many of the children may have lost their parents and are living with older siblings or relatives or even neighbors and having HIV gives the child difficulty because of the stigma attached with having HIV. Mengo works with the caregivers in helping these children stay on their ARV's and deal with the stigma. Nutrition is also an issue with these families because it is important for HIV+ people to have good nutrition, but because of the poverty level, it is difficult for them to have enough food.
The clinic also does outreach testing, which means it goes out into the communities and tests people, so people dont have to make the trip to the clinic,which they often wont do because of stigma, money and time to travel to the clinic. Counseling is done right onsite.
They also do home based care and care for patients at home that are too sick to travel to the clinic. The doctor and a nurse and a counselor travel to the pateints home and may administer IV fluids and meds and give counseling to family and assistance as needed. A spiritual counselor will travel with the team also.
Education is given to the community in many ways also, several of the physicians travel to schools and give sexual and lifeskills training and inform the adolescents about prevention. I recently attended a workshop in which Mengo was teaching the police officers in Kampala about HIV and post exposure prophyaxis. This is a very important population to educate because they may be the first responders to a rape victim who needs PEP treatment or they themselves may need the treatment because they have been helping people in an accident that involves a lot of blood exposure.
What I have seen here at Mengo has been quite impressive, given the lack of resources. The staff is committed, caring and very knowledgable, I feel quite grateful to have this opportunity to learn from the real experts in this field.