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Lesotho: 'Expert' patients lighten load for clinic staff


[This report does not necessarily reflect the views of the United Nations]

MASERU, 18 October (PLUSNEWS) - Seated at a table recording blood samples in a tiny, overflowing waiting room at Phoholong HIV/AIDS Clinic, about 40km from Maseru, the capital, Miriam Phoofolo could be mistaken for a nurse, but she is in fact a patient.

How to provide care and treatment to the estimated one in four adults living with HIV in Lesotho, in the context of a severe health-worker shortage, demands creative solutions.

An approach being piloted by the Clinton Foundation's HIV/AIDS Initiative is to train HIV-positive patients like Phoofolo to assist overworked doctors, nurses and pharmacists with tasks like filing, taking vital signs and counselling patients on how to take their antiretroviral (ARV) medication.

The 'expert patient' initiative was launched a year ago to coincide with the Lesotho government's efforts to decentralise delivery of free ARVs from hospitals to local health centres. Phoofolo is one of 10 expert patients in the country, but if the experiment proves a success and additional funding can be found, the programme could roll out to clinics nationwide and even provide a model for other countries in the region to manage similarly high health worker to patient ratios.

According to Dr Mphu Ramatlapeng, the Clinton Foundation's country director, there are just 40 practicing physicians, most of whom are foreigners and don't speak the local Sesotho language, for Lesotho's 1.8 million people, including an HIV-positive population estimated at 288,000. The country does not have a medical school, and those who train in neighbouring South Africa or elsewhere rarely return. Locally trained nurses are lured to countries with better pay and working conditions.

Phoholong means 'a place where people are saved', but the clinic has just one nurse, one nurse's assistant and one doctor, who is only available in the afternoons, to care for 995 HIV-infected patients. "It's not enough," says Lucy Tseka, one of the nurses.

Phoofolo began working at the clinic in December 2005 after joining the rest of the staff on a 10-day training workshop in managing ARV treatment. The training, combined with her experience of living with HIV for the past 10 years and taking ARVs for the last two, have made her indispensable.

"Miriam helps us with weighing the patients, taking temperatures, filing, counselling and translating for the doctor when I'm not around," said Tseka. "She's helping a lot - I couldn't manage without her."

Phoofolo receives a small stipend of just 500 Maluti (about US$65) a month from the Clinton Foundation, but after several years of being too sick to work and having to depend on her family, she is glad of the income and the opportunity to share her experience with others.

"I decided to work here because I want to encourage other people who are HIV positive that life continues and we have to live positively ... I'm always telling them where I'm coming from and how many years ago I learned my status."

Denise Thomas, coordinator of the expert patient programme, describes patients like Phoofolo as a "natural fit" for helping to alleviate the pressure on overwhelmed HIV/AIDS clinics. "Patients are getting better [on ARVs] and wanting to share their stories," she said. "Expert patients are morale boosters to clinics; they're living success stories."

The experience is also often empowering for the expert patients. Most have been unemployed and value the income and the credibility the position gives them in their communities. "They become advocates and they're sought out," said Thomas.

A nurse who worked with AIDS patients in her native Vancouver, Canada, Thomas came to Lesotho in November 2005 as part of a second initiative of the Clinton Foundation that matches experienced doctors and nurses from overseas with local health workers at newly opened ARV clinics, and mentored Tseka through her first two months of prescribing ARV treatment. At the time, the clinic was providing ARVs to just six patients.

"We were really new at the time," recalls Tseka, "so she helped me with organisation of the clinic and some questions I had. I went for a workshop before we established the clinic, but I didn't know things practically."

By the end of the mentorship period, 67 patients were receiving treatment. Ten months later, the figure is 400.

In its first year the clinical mentorship programme has brought 37 doctors and nurses from Europe, Canada, the US and other African countries to volunteer for up to 12 weeks at new ARV sites. Thomas, who now coordinates the programme in addition to the expert patients initiative, said the eventual goal was to create enough local expertise to recruit mentors in Lesotho.


Copyright © 2006 -Integrated Regional Information Network, Publisher. All rights reserved to Integrated Regional Information Networks (IRIN) . Reproduction of this article (other than one copy for personal reference) must be cleared through the Integrated Regional Information Network.

Information in this article was accurate in October 18, 2006. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.