Sunday, September 13, 2009

CHIPS – Mbabane Chapel 13.Sept.2009

1. HIV in Swaziland. Everyone knows the extent of the problem here through a constant barrage of advertisement and news articles. There is no need to belabor the issue of HIV in Swaziland.
2. And there are many groups and organizations here doing exceptional work in the areas they have budget and mandate to work.
3. But, because of the size of the problem, it has completely overwhelmed all coping mechanisms and service delivery in the country; whether these are cultural, social or governmental.
4. So there are still many gaps and holes in care and service delivery.
5. Our original work here was focused primarily on children and youth in the urban and peri-urban areas.
6. What we found was that even in these areas, excellent HIV care, while readily available, was not necessarily easily accessible. Especially for children.
7. As we moved to work in more remote and rural areas, we found the problem of accessibility exacerbated.
8. Last year, about this time, we approached Pastor Ken with a proposal to Claypotts Trust to fund a pilot program to address the issue of accessibility for isolated groups of children. In “isolated” we mean isolated from available heath care.
9. We chose to begin the project in the Maphiveni area which is at the junction of the road past Simunye to Lomahasha and the road coming past Mhlume from Tchaneni. This may not sound like an “isolated” community. Until you look at the economic make up of the community and the distance and therefore cost of transport to the available HIV care, which in this case is in Siteki.
10. From an economic standpoint, the community in general is impoverished, made up of displaced sugar cane worker’s families and refugees from Mozambique. They are typically assigned plots that are nowhere near the size required for subsistence farming.
11. Good Shepherd Hospital has several community outreach initiatives. They are limited to an area of roughly 30 km around Siteki. Maphiveni is closer to 45km away. There are clinics at Simunye and Mhlume. However, these tend to be more of a dispensary than true clinics.
12. To give you an idea of cost to access the care at Siteki, consider the following scenario:
 A caregiver has a sickly child and wants to have the child tested for HIV
 The trip from Maphiveni to Good Shepherd for both the caregiver and child is around 50 Emalangeni if the child is under eleven, over 100 otherwise.
 Let’s assume the child tests positive. There are typically at least 5 trips required before the child will start on ARV’s. And then a monthly trip for drug refill and adherence checking.
 That is a huge burden on a family that may not have the means to put a regular meal on the table.
 So given the scenario, will the child be tested or treated? Probably not.
 And if not, what is the outcome for the child?
13. So our program, dubbed, CHIPS for Children’s HIV Intervention Program in Swaziland was started to address this issue.
14. The program serves two primary purposes: to manage the HIV care of children and to bring awareness of HIV treatment for children to the community.
15. The program includes training for community workers: teachers, health motivators, and caregivers, providing transportation to Good Shepherd, managing appointments, continuous counseling for strict adherence to drug schedules, an advocate for the patients at the Hospital.
16. What have we found?
 PMTCT has seemed to help reduce the number of children being infected at birth! Older infected children are followed by younger siblings who are HIV free! (Good news!)
 The “C” in CHIPS has moved from children only to children AND caregivers. Leaving a caregiver to cope with the disease will invariably lead to disablement and death and ultimately more orphans and uncared for children. So we’ve expanded the nature of the program to manage the care of caregivers as well even if the children in their care are HIV free. 5% child infection rate, 50% caregiver infection rate. (Bad news!)
17. Our three year goal is to move out into squatter and informal settlements in Vuvulane and Lomahasha. Ultimately to have a model that can be replicated in other regions of the country
18. We appreciate the confidence placed in us by Pastor Ken and would covet your prayers for wisdom to see CHIPS grow and provide care on a larger scale!
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