[This report does not necessarily reflect the views of the United
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
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.