Oh yeah, I have a job

So I’ve been here almost a month now, and you’re probably wondering, is she actually working? Didn’t she go all that way to do research? And yet here she is, busy writing about safaris and fairs and dances as if she were on vacation? Have no fear, the work has begun. I thought I’d write some more about it, just so that you all know what I’m really doing.

Project #1

OPD-ART Integration

I think I’ve already written a bit about this, in relation to the street drama I attended. This is week number four of the experiment that is the new, multi-purpose, integrated ART and regular outpatient clinic at Ng’ombe. In some ways, it’s going well. The file problems of last week have been worked out this week. Some of the staff is getting better and more efficient at the new system. But in other ways, it’s rough, and we’re far from finished. Change is never easy, but I think that’s particularly true here. From talking with my roommates, it seems that workplace dynamics here are very different than they are at home.

Here’s the glaring example. Understandably, the staff at Ng’ombe is stressed, and somewhat bitter, about the new system being tested out on them. It involves a lot more work and dedication on their part. New systems and clinic flow needs to be ironed out. Patients wait longer. Staff needs to stay later. But instead of sticking with it, of continuing to try and be the pioneer, the leader in this change, they decide they want no part of it. Since Thursday, there have been absolutely no, that’s right, none at all, medical officers (MOs) or clinical officers (COs) at the clinic. They have all called in with the excuse that their children are sick. ALL OF THEM. But really, I believe, all of them have decided they just don’t want to show up and deal with the stress of the new systems. So then what happens? All of the nurses are left to care for the patients as best they can. There are some things they can do, and some things they can’t. If a patient shows up at 7 am, and waits until 4 pm, and the nurse cannot help with his ailment, he has little choice but to go home and hope there may be an MO or CO tomorrow. Then the staff gets even more bitter and more helpless with the new system. My heart goes out to the nurses who stick with it. My heart goes out to the poor patients who wait all day long to see no doctor at all. I wish there was more I could do. At this point, I’m too new to know who to contact, or how to tread carefully, or how not to step on anybody’s toes. Our CIDRZ supervisor is away in Mexico City for the International AIDS Conference. Hopefully, when she gets back, some of this can get sorted out. But it highlights this pervasive feeling that people will not do any tiny bit more than their job description or what they are paid to do. And often, they do less.

What’s so frustrating is that we are working out the kinks. Last week it was the clerks and the filing system slowing down the patient flow. This week they are wonderful. But the MO and COs aren’t there to see it.

We’re planning to set up integration of another clinic in October. I think we still have a lot to figure out.

What I want all of you to take away from this current state of affairs is this: the next time you show up on time to your doctor’s appointment and are forced to wait 30 minutes because they’re behind schedule, don’t complain. Be thankful there’s a doctor to see. Be thankful you have more than 4 minutes to spend with them.

Project #2

TB/HIV Peer Educators

Over the past few years, as the number of ART clinics has grown, the number of people taking ARVs has grown as well, and there is a need for more and more personnel to help treat and monitor all those people. There have never been enough nurses and doctors, and the number of new patients only exacerbates the problem. Yet much of the work that needs to be done can be done by people other than healthcare workers. In addition, this massive HIV epidemic has required creative approaches to help get it under control. Enter, peer educators (note: certainly not a novel idea for HIV treatment, peer educators have been used for years for all types of public health problems).

The community branch of CIDRZ has a strong HIV peer educator program. The peers are all Zambians, all members of the community, and are all living positively with HIV. They are trained in all aspects of HIV- etiology, medical issues, treatment, management and most importantly, counseling. The thinking is, that because they are going through it themselves, they are in a unique position to guide and counsel their newly diagnosed peers. In reality, they often end up taking on more responsibility than their job description entails. They encourage those to test who have not, they counsel those who receive a life altering positive test, they run support groups. They have been fabulously successful in increasing testing rates.

So here’s the TB part. Many people with HIV develop TB. Many people with TB are found to have HIV. Our goal is to make sure that testing and diagnosis goes both ways. Almost every clinic has what’s called a TB corner, the area of the clinic where patients go to get their TB treatment, as well as education and support. At this point, we’ve gotten pretty good at ensuring that all patients at TB corner are tested for HIV, or at least counseled to test. But many people who test positive, for many reasons, never actually enroll in HIV care. We want to fix that.

My project, which has been two years in the making, is to monitor and evaluate a pilot program to train new TB/HIV peer educators. The ministry has given us the okay to train four educators in two clinics. We have to prove, through a thorough programmatic evaluation, that they really make a difference and hopefully scale up the program to more than two clinics. Will more people from TB corner agree to get HIV tests at their clinics? Will more people enroll in HIV care? Will the peer educators be satisfied with their jobs and feel that they are making a difference? Ask me in April and hopefully I can give you the answer.