Day-to-Day in South Africa

I thought for this blog I would update people on the day to day for me. Most days I spend time with an HIV consoler named Makhosi. She is pivotal in making sure that patients are seen in the Siyaphila program. So Tuesday-Thursday I am in her office helping her and seeing patients with her. 

On Monday mornings I work with Dr. Sunpath, who is an HIV and TB specialist physician. While with him, we see patients who are failing on HIV treatment. Most of these patients are quite complex. We decide which regimen of antiretroviral (ARV) drugs the patient should be switched to and we also determine if the patient needs to be seen by any other medical support staff for treatment adherence or support. In the afternoon on Monday’s I spend time doing research. Currently I am helping create two databases, the first is for patients that have failed treatment and are being switched to a more advanced therapy and the second is made up of patients that are on TB treatment and HIV treatment concurrently noting the interactions and side effects.

On Tuesdays, while most of my time is with Makhosi, I also follow around the rest of the Siyaphila team, which includes a dietician, psychologist, pastor, and social worker. From my time with each of them, I am working on a report on how to fine tune the program so that patients are seen in a timely manner and so work isn’t being over done or under done.

On Wednesdays, I get to see Medical Clinic patients with Dr. Edwin. The majority of patients are patients from the hospital that have been started on ARVs through the Siyaphila program are coming back for follow-up visits. Then in the afternoons I spend time with Makhosi.

Thursdays are normally the busiest days. In the morning, I go to continuing medical education (CME) meetings with all of the medical doctors and medical students. Most of the time these sessions only last an hour to an hour and half. The topics are both HIV and TB associated topics. Along with Durban being the HIV capital of the world, I have heard it is also the TB capital of the world. Following the CME meeting, I go on ward rounds with Dr. Sunpath and the medical team. Following the ward round the Siyaphila multidisciplinary team meets in the hospital and we round on the Siyaphila patients to discuss their treatment and care. We then meet to discuss each patient needs and when the patient will be ready to start ARV treatment and factors impacting adherence to treatment.

On a side note, apart of this discussion is whither or not the patient has disclosed their status to someone. Which may not seem important, but research shows that if a patient discloses his or her status, they are more successful at adhering to treatment. A majority of patients disclose their status to loved ones, but due to stigma around HIV many new diagnosed patients are scared to disclose their status. There is a saying around McCord that HIV doesn’t kill people, stigma kills people. Some patients don’t want to take life saving medication just because they are terrified of what others might think or say about them. What is ridiculous is that over forty percent of the population has HIV, which to me means that there should be no stigma. One of Makhosi’s many jobs in the Siyaphila program is to help dispel the stigma around HIV for the patients and family.

Fridays, in the morning I work with Dr. Edwin. The majority of our time is spent starting patients on HIV treatment or following-up patients that have been initiated on treatment. It is extremely important that each patient is followed-up closely, due the side effects of the ARV drugs.

Within the past few weeks I have been able to see patients almost independently of the Dr. Sunpath and Dr. Edwin. Which has been rather exciting and challenging. In any free time that I have, I do research and work on a standard operating procedure that will be used to get medical aid (similar to medical insurance companies in the states) companies invested in sending their patients into the Siyaphila program. Which will in turn help even out the costs for patients that can’t afford the Siyaphila program. I have to say though, that if patients can’t afford to stay and get the treatment through Siyaphila, Loving South Africa pays for their stay so the patient can get the much-needed treatment.

I hope this has given you an idea of what I do during the week. At times it can be very painful emotionally, at other times it can be mundane, and at other times it can be encouraging and inspiring.

There are a few things that I would appreciate prayer for. Within the next few months I am wanting to help the hospital with training for the nurses and other medical staff- most of it has to do with patient satisfaction (this is a new standard the national health program is looking at for hospitals) and practicing excellence. I will be approaching the nursing supervisor and HR staff to talk about training staff on this. I am hoping to work with them to put together a program or an educational piece to teach practical ways of applying this. I would also appreciate prayer for clarity on how to proceed with the standard operating procedure for the Siyaphila program and the steps that the program needs to take to continue to provide the much-needed care to the Durban area.