Mhlangana Clinic

Today Kun & I had our first session of teaching at one of the 15 government/department of public health community health clinics in the extensive area surrounding the hospital. The session included approximately 30 of the 300 volunteer home based caregivers (HBC). The 300 care givers are each clustered in a group around one of the 15 clinics, the closest clinic to the community in which they live. These HBCs go out into the community and act as liaisons from the community health clinics. They link the community to the nurses, called "sisters" here, that predominantly run the community clinics. The HBCs are in essence an extension of the clinic & nurses, in that they go to visit people in the community that are either too sick to travel the distance to their local clinic, or far enough away that they cannot afford to pay for transport to the clinic. They are not medically trained, but they are trained in the work that they do as home-based caregivers. These women work very hard in this position for free. Mary, who is our liaison here in Tugela Ferry, is responsible for the HBCs, as well as so many other wonderful things. She is full of life, energy & selfless compassion, and she has become over this brief time here, our friend. One of the many things she coordinates, is the training of the HBCs. She drove us this morning the hour long drive to Mhlangana Clinic, where a group of HBCs were awaiting our arrival. She also acted as our interpreter. At the clinic Kun & I gave a talk covering basic information on the following topics: the pathophysiology of HIV/AIDS, ways for the caregivers to protect themselves when working with patients, the significance of the use of gloves, signs of tuberculosis, ways to protect themselves from TB, procedures for disposing of or cleaning linens & supplies that have had contact with bodily fluids, nutrition support for patients with AIDS and TB, including specific foods, the significance of hydration, ways to detect dehydration by brief physical assessment (thanks Linda Pellico!), the importance of assessing for pressure ulcers, caring for them, and the ways to prevent them. It went very well. Kun & I had very little prep time & we pulled if off wonderfully- a very good team. After we finished we asked the women if they wanted to share any of their stresses or concerns. This was one of the best parts. After a slight pause, women began to raise their hands to speak. They discussed fears regarding limited access to TB masks amidst the rise in MDR & XDR (multiple drug resistance & extremely drug resistant) TB in the community. Several women discussed patients' concerns regarding privacy & the stigma of AIDS. They shared that some patients worried that if the caregivers used gloves to care for them, than their neighbors would know they had HIV. They complained that sometimes when they left gloves in the home for the primary caregiver/family member to use when caring for the patient, someone in the family would use them for such things as mixing cement instead. It was an eye-opening & invigorating day. I felt so welcome & grateful to be there with them. The meeting closed with the women singing a beautiful song.