Today I participated in a home-based visit trip to see clients within the surrounding area of Jinja. We left a little late due to the St. Francis mass which they hold on the last Thursday of the month with both clients and staff.
The members of the home-based visit team were: a Clinician (Joyce), a Counselor (Betty), a Nurse (Lillian), a volunteer (today it was me), and a driver. The goal of the home-based care visit is to try and see a patient who cannot travel due to cost or road conditions about once a week – but this is often difficult due to a variety of reasons. The villages that surround Jinja are up in the hills and the roads are all dirt which requires a good 4-wheel drive car and a skilled driver (which we had).
We went to twelve villages today visiting clients. The way it works is that the clients are informed which day that St. Francis will come to visit them when they first enroll or after they visit the clinic. The staff then travels around to each village and the client will then approach the car. Several times we were informed that the client was feeling fine but with poor communication, the staff still had to stop by just in case. I will highlight some of the cases I witnessed:
- The first village we stopped at was for an orphaned girl who was 11 years old. Her mother is HIV+ as well but she gave her up to the grandmother to watch over her. Ironically, the mother is still a current patient at St. Francis! She is HIV+ with a high CD4 count. She needed Septrin but the clinic was out so she was given a referral form to go to a local pharmacy. The counselor noticed that she had a cough and was expelling sputum (which could be a sign of TB). The clinician did prescribe Ciproflaxin which we did have.
- In another village we stopped at a home area to see a HIV+ child that was just enrolled the day before for treatment for HIV and malaria. The child is a 6-year old girl. She was found sleeping against the side of her house. When awoken she was lethargic and one eye was cloudy and glazed. The clinician examined her and found her to be severely anemic and she needed a blood transfusion. The staff at St. Francis offered to talk her child to the Children’s Hospital in Jinja. The mother refused because she had no money to pay for medication. This is apparently a common issue where the hospital can treat you but you must pay for any medication or you will not get it. I was informed it would cost about 5000 Ugx. This was turning into something of an impasse. This is where I stopped being a bystander and offered to pay for the child’s medication. The mother agreed to the transport. As we were getting ready, I noticed that the mother was stripping the girl of her clothes and then bathing her in a tub that contained water and various types of leaves. The clinician pointed that that is very common in this area to treat with some type of herbal concoction. Also, while we were waiting, the counselor started talking to an old woman nearby in the village. It was discovered that she was caring for several orphans that were abandoned by their parents who either could not or would not support the children. The grandmother had little herself to support the children and they did not even attend school. The counselor took down her information to later assess her for the Grannies program. After that, we all piled into the St. Francis truck along with the mother and the young girl and headed to Jinja. While we were traveling there, the nurse had received a call that there was rioting going on in Jinja due to the recent mayoral elections. So that added a little to the tension. However, we didn’t run into any trouble. We got to the hospital and dropped off the nurse (she wanted to check on her relatives staying in Jinja), mother, and the daughter. I gave the mother 20,000 Ugx which was enough to pay for medication, food, and transport home. The rest of the staff and I then continued on to other home visits.
- In another village we called upon the help of a local volunteer or Community Counseling Aid (CCA) to help locate a client. This is where I am especially impressed with what St. Francis is doing. What they realized in the past was that it was difficult to penetrate these rural communities and advocate for HIV awareness, prevention, and treatment. They are chosen after talking to the community leaders and they are then trained by St. Francis to understand HIV and to help support clients in the field. St. Francis tries to keep them motivated by buying them bicycles to visit clients. They then report back to St. Francis with updates, etc. It has been hard to hold onto CCAs though for a variety of reasons. So in this instance, we picked up the local CCA to find this client. The client is a 49 year old HIV+ man living alone in his house. His main complaint was that he was feeling very weak and dizzy. The clinician checked his record and saw that his CD4 count was just above the level to issue ART medication. His last check was in September and it is done every six months. The clinician indicated that he was likely iron deficient and prescribed folic acid.
- In another village, we met a 25 year old HIV+ woman with several children. She needed her ART treatments refilled which was done and she asked for Septrin which again we did not have so she was issued a referral. The counselor explained that she had recently had problems with her second husband (her first husband had died). He came home drunk one night and set the house on fire with her and her two children in it. They escaped and now lived with another family. Later on the counselor pointed out the burned out house down the road to me.
This is where Betty, the counselor, pointed out that they normally should be charging each patient 2000 UGx for a treatment fee as they do when patients come to the clinic but they rarely charge and never deny service. The issue is as simple as looking at their living conditions and the fact they need home-based visits. The money itself, even if it was fully paid, does not even come close to offsetting the operating costs for St. Francis. It is often merely a way of encouraging clients to show good faith and to try and avoid those that may want to take advantage of the services.