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Duration:3 min 35 sec
KHOPOTSO: I arrived at the Johannesburg General Hospital at exactly 11.30 a.m. on Friday. Dr Francois Venter, a busy, fast-talking specialist physician seconded to the hospital, was already waiting when I got there. Immediately, he invited me into an office where we began the interview, with a rowdy reception area outside the door.
DR FRANCOIS VENTER: The hospital itself has felt the effects of HIV really intensively over the last few years. Certainly, within the medical wards the rates we’re seeing of HIV positive patients versus negative is probably anything between 15 and 80 percent of the patients are HIV positive. And the vast majority of those adults have got an AIDS-defining illness’¦ And those numbers are not going to get smaller. They’re in fact going to probably increase. The same can be said for almost all the hospitals around the area, and in fact, we’ve just finished a study at one of the hospitals in the area ‘ Helen Joseph Hospital ‘ which, has shown that at least, half of all the deaths are HIV-related in the hospital. And these are 20, 30, 40-year old people, young people who are dying of pneumonia, TB ‘ all the other markers of HIV. So, we’re hoping that the antiretroviral roll-out will have some impact on that.
KHOPOTSO: Dr Venter says antiretrovirals are not a panacea in treating HIV. But, he says experience has shown that they can take people from the edge of death and give them back their lives. Here he explains how the treatment programme will work at Jo’burg Gen.
DR FRANCOIS VENTER: What we’re going to do here at the Jo’burg Gen is to stream them through an adherence counselling course. Anybody who’s eligible for the antiretrovirals will be people who’ve got advanced AIDS-defining illnesses or people with very low CD 4 counts. People who are healthy with HIV will be inducted into a Wellness Programme and then referred off to the primary health care clinics in the area. People who do have these serious illnesses or have low CD 4 counts will then go through an adherence preparation-type counselling process, which, in my personal view is probably more important than all the doctors and nurses combined in terms of the clinic. That’s where we teach them about side-effects, we tell them what’s going to happen, what drugs they’re going to take, why adherence is so important, and after that they see doctors and nurses who assess them medically and patch them up and sort them out in terms of what they need.
KHOPOTSO: Can you tell us about the numbers of people that are going to be ready for treatment on the very first day?
DR FRANCOIS VENTER: We are planning to start on a smallish size of between 20 and 50 patients in the first week. Nobody’s ever done it on this scale before, so we’re pretty much winging it, we’re not sure what’s going to happen, we will see. But we’re looking for 20 ‘ 50 and then we’ll start looking at improving the system, so that we can increase the numbers steadily after that.
KHOPOTSO: In this province we’re starting with only five centres, Jo’burg Gen being one of those. There’s a fear that in other communities where the service will not be provided people will actually be moving towards the centres where provision is being made. How are you going to cope with that?
DR FRANCOIS VENTER: That’s a huge problem. It’s been a problem for hospitals for all sorts of diseases, whether it’s kidney failure or haemophilia. There’s been a general movement towards strong urban hospitals’¦ There’s a guy I’ve seen next-door from Aliwal North who’s asking for therapy. And that’s clearly not appropriate, but unfortunately there’s nobody else there to help him, so we’re going to make a plan. We’re going to try and help him and when the time is right we’ll refer him to there.
KHOPOTSO: Dr Venter is upbeat about the programme, but is concerned that without the necessary staff it might run into problems.
DR FRANCOIS VENTER: I think the most critical areas are the nursing staff. I think we need good, hard nursing staff who are able to manage big, complicated programmes. I think doctors are needed, but I also think that we need really good counsellors, dieticians, psychologists, the works. There’s never been a disease quite requiring a team approach. And in fact, my opinion is, particularly with the ARV programme, that the doctors are the least important part of it. The nurses and the counsellors are probably the most important.
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