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Dr Jason Christopher
GP Dr Jason Christopher swapped Kent for Kampala in Uganda to work as an HIV and AIDS specialist for Reach Out, a community based organisation delivering holistic care to people living with HIV and AIDS. Here he describes his experiences just four months into his volunteer placement.
Tell us about Reach Out.
Reach Out started in 2001 with one doctor doing home visits one day a week for ten clients living with HIV and AIDS. Now there are 1,800 HIV positive clients, with over 780 receiving free life-saving anti-retroviral drugs (ARVs) in a holistic package delivered by 230 workers. 75% of these workers are clients themselves and as such the clients feel like they own the programme. There is no discernible ‘them’ and ‘us’ between the providers and the consumers. As a result there is a real unity in the place that isn’t often seen in programmes caring for those with such a stigmatized disease.
I feel lucky to have been placed in such a great organisation. Reach Out has arisen from community initiative in a low-resource setting. Money hasn’t gone on vehicles, buildings and extras - even the nurse-run clinic still operates from an empty church room with no water supply, a container being brought in every day along with fold-up tables and chairs.
So who uses Reach Out? Can you describe a typical client?
The typical new client at Reach Out is a sick 35-year-old jobless widow, often homeless, yet caring for several of her own children and several from extended family members who have been orphaned because of AIDS. Her needs cannot be met by ARV drugs alone, which do not work in somebody who has no food. Hence the importance of holistic care, where consideration is given to the wider needs as follows.
Holistic care – what exactly does it involve?
Emergency food is provided to those in whom home assessments have revealed them to be food insecure. Each new client is allocated a community ARV supporter who lives in their village, is on ARVs themselves and acts as source of emotional support. ARVs demand great discipline to take them properly. If more than one or two tablets are missed each month viral resistance can quickly develop, rendering them ineffective. These supporters are usually visual testaments to the success of life-saving ARVs and are well placed to inspire new clients to adhere to the treatment regimen. Pill counting has recently shown that 98% of all prescribed ARV tablets in a 3-month period at Reach Out were actually taken. This is a level of adherence unheard of in the Western world.
Tell us about your working day.
About half of my time is spent in the clinic where 150-200 clients are seen each day by 8-10 nurses. I rotate amongst the nurses observing their practice and informally training individuals or pairs. This has exposed many areas of training need, such as: use of ARVs, history taking and examination, consultation and communication skills, use of sputum testing to diagnose TB, awareness of extra-pulmonary TB, how to diagnose opportunistic infections, awareness of drug side-effects and more…
These topics are being covered by a six-month training programme of weekly seminars which I’ve been facilitating. The senior nurses and I have also established weekly case presentations where a nurse presents for general discussion a case which they found difficult or illustrates some area of deficiency of the clinic. The seminars and case presentations have been going for four weeks now and are very popular. I am encouraging the nurses to lead them - with plenty of support! I try to assist the nurses rather than do everything myself, which passes on no knowledge. If I had a personal working motto it would be ‘Jason - don’t do any work by yourself’.
How does your current job differ to work you’ve done before?
It differs greatly! Reach Out is an uplifting place to work with many young people, much singing, fun and laughter - a far cry from the gloomy picture many of my UK friends and colleagues imagined when I told them I was going to work in an African AIDS clinic. The warmth and tenderness my colleagues have with each other and me gives a family feel to the workplace I haven’t had in any of my past medical placements. I plan to continue into a career of public health in developing countries and my experience at Reach Out is showing me how a community programme treating HIV and AIDS can really work.
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