Swaziland

 Health & Nutrition programme
 Also read: Malanda Community Awareness Project.


Introduction - Piggs Peak - Swaziland.

 Swaziland is a rural country with aprox. one million inhibitants, and one of the highest HIV infection rates in the world. 38% of the population is estimated to be HIV positive. (Government official 2002 studies).
Pigg’s Peak is one of the few towns in northern Swaziland.
The population in the Pigg’s Peak area is widely spread, and people have to travel up to 80 km to come to town. .


The Hospital
The Pigg’s Peak hospital directs the HIV/AIDS policy for the entire region. Rural clinics do not have access to testing or treatment.
The division of the hospital dealing with HIV/AIDS consist of 2 main independent units:
-The New Start counselling and Testing Center (NS)
-The Hospital ARV unit

Testing & Counsellling

A small bulding on the hospital premises has been built to accomodate the New Start Counselling and Testing Center.
New Start is a non profit organisation run as a hospital supervised unit by a branch of the Ministry of Health, HAPAC (HIV AIDS prevention & care), and financed by the European Community.
It’s both a testing center and a counselling office.

It is run by 3 dynamic counsellors, who spend almost one hour with each patient coming for a test, who provide a preventive psychological preparation before testing:
85% of the 12 to 15 people coming for testing per day test positive.

Support Group

A support group was spontaneously put together at the New Start Center, initiated by the teamof counsellors from the New Start Center.
They are voluntiers, who have been tested positive or negative at the New Start Center, and accepted to give some of their time to support the new comers, and the patients under ARV who come regularly to the Clinic.
7 months of food support for the patients of Piggs Peak hospital, who have tested HIV positive.
Desiging Hope's action is centered around the Support Group in Piggs Peak.
Medical survey and ARV availibility at the clinic

There are only two doctors working at the Pigg’s Peak Hospital, and as a result of the lack of staff, only one doctor devotes now 2 days a week to the HIV/AIDS patients (520 patients, April 2005).


 New patients being tested positive
Patients tested positive at the New Start Center get a full blood test,
sent to a referal center in Mbabane for more accurate analysis.
The clinic follows the national guidelines for ARV.
The CD4 count decides if a patient needs ARV or not (below 200).
However, if some opportunistic infection is obvious, such as critical TB or caposis, the ARV treatment can be started no matter what the CD4 count is.
This is because once one has an opportunistic infection it is known that one's CD4 count will drop dramatically.
 
Monthly visits to the hospital
Every Tuesday and thursday, between 60 and 80 people come to see the doctor, for diagnosis, or to get their ARV treatments for the coming month.
Patients will then have to come monthly to personaly get their drugs.
People from the central medical stores demand that the drugs should be given in person to the patients.
The fear is that the treatment could be shared with other people if it is distributed outside from the clinic, (even if the same thing could happen after a visit at the hospital...)

 

Notice at the desk of the Clinic.
The lack of staff doesn't ease
the follow up on patients.
Approximately 520 patients are under ARVs at the clinic in April 2005 (versus 240 in July 2004).
This figure is constantly growing. 1000 people, according to the government objectives, should be under therapy by the end of 2005.

 ARVs availability
The availability of ARVs is not the main problem, according to the hospital administrator.
The doctor has to order every Friday what he needs and is delivered on the next Monday.
People on ARV are mainly women (80%), because they are encouraged to be tested and treated, if they need it, to significantly decrease the risk of mother to child transmission of HIV.
For cultural reason, men are much less likely to submit to testing and treatment.

Limits of action

The number of visits concentrated on one single day create an uncomfortable situation for the patients.
Many of them come to the clinic as early as 6 in the morning, and might have to stay the entire day.


People coming to the hospital have nothing to eat, they just sit and wait to get their medication,
see the doctor and go back home.
The distance problem is huge, some people live far away, and transportation is relatively expensive.
Medication is not distributed from the local rural clinics for security reasons,and these clinics are generally not equipped to do testing.
Therefore, patients have to drive all the way to the town hospital.
Some patients are not physically able to come to the hospital to get their monthly treatment. In such emergency cases the doctors can provide therapy to a third person.
But most of these patients are left unattended far away in rural areas with no assistance.


 Designing Hope Action - Piggs Peak Hospital.

Objective: Make the monthly visit to the clinic as rewarding as possible.

Going to the clinic is considered and experienced as a burden, and might create a psychological trauma:
The first visit, when people come to get tested, 85% get bad news.
This is then followed by a second visit a week later to know if they need treatment or not. Later the patients have to come every month for either ARV’s or CD4 counts. Many have to wait for hours to see the doctor.
The situation is extremly difficult to cope with for most people.

The main problems are the distance, the commuting to the clinic, the cost of it, and the physical status of the patients. Some of them are too ill to walk, and to spend all day at the clinic. Most of them are also so poor that they can not afford more than one meal a day, and spend all day at the hospital without eating. They get their treatment, but are not able to feed themselves properly.
A programme financed by Dessine l'Espoir with local support of Designing Hope Africa .


First step: Common meal in the waiting area on the weekly meetings at clinic.

All patients coming for their monthly visit have been receiving food in the morning since August 2004.
This boosts the energy after the trip to the hospital, and prepares the patients for the hours of waiting.

The food support organized at the Voluntary Testing Centre of the Piggs Peak Hospital has brought incredible support to a growing number of patients, aknowledged by all the staff of the hospital.
It is seen as invaluable encouragement for the patients who come for their monthly visit to see the doctor and get their treatment.
The programme started with a basic sandwich-drinks-fruit distribution, once a week, for 240 patients.
Since January 2005, the number of patients increased to more than 500, and a second day of visits has been arranged with the hospital doctor.



The food programme has been therefore adjusted, adding new content:
-1kg of peanuts and raisins
-10 bags of carrots, served washed and uncooked
(good for increased fiber and gastic motility, preventing diahrrea)
-70 Bananas
-15 bags of sliced bread
-2kg of peanut butter
-2 kg of tuna fish, with Mayo
-12 liters of 100% pure mixed juces
-60 bars of soap, for personal and laundry use.
(suggestion of the counsellors, to promote hygiene)
 
The purchase and delivery of these products has been organized every Tuesday and Thursday morning using a local grocery, with proper delivery forms and monthly invoices accruing.
Sponsorships have to be negotiated with known brands, for donation of a portion of the food, especially non-perishable goods, such as peanut butter, tuna fish, and also soap.


Second step - Substitution meals and vitamin complexes.

- Cans of substitution powder meals (complete nutrition) have been purchased for patients in physical states that prevent them from eating any solid foods or citrus juices.
(We were able to have several maciated women drink this preparation, who where unable previously to swallow any food).
- Bottles of 30days’ supply of Vitamin complex have been donated to the doctor in charge of the HIV+ patients,
as well as pain relieving tablets, such as acetaminophen, ibuprofen, etc.

These items are available at the pharmacy of the clinic, but not for free.
Desiging Hope leave it at the discretion of the doctor to give these tablets to patients who
can’t afford to buy them at any cost and need this kind of simple supplement .


Third step - Healthy-Food cooking on the premecise of the clinic.

This is an initiative of the people running the support group at the hospital.
The Red Cross owned small building at the entrance of the hospital, that already has been used as a canteen, but been left empty for some time.
With limited investment, this place has been turned by Desiging Hope in March 2005 into a small canteen again, targetted to people living with HIV AIDS, but open to anyone in town in order to avoid stigma.

This canteen functions as an educational nutrition and health centre. People living with HIV/AIDS can receive there information regarding nutrition.



This has reinforced the food distribution programme provided by Designing Hope Africa twice weekly when people come for treatment at the hospital or counselling centre.
Since April first, Sandwiches distribution has been replaced by real meals.

2 members of the support group now use the cooking facilities available, and prepare food on these two specific days for the VCT visitors.
They focus on orienting the menu toward more traditional foods, chosen for their nutritional qualities, cost efficiency and availability in rural areas, to encourage people to learn the recipes and use them at home.

Fourth step - Restaurant run every day by the support group

After a trial period, the support group will then have the ability to develop activities targeted for any visitor to the clinic, with low budget meals, in order to cover the cost and to enable some of the volunteers of the support group to gain income out of this activity.
The support group will also use this venue, as needed, for support group meetings in a safe environment.


© Designing Hope Africa - Dessine L'Espoir France - C Brown / C Varet
Last update: April 2005