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Duration:4 min 37 sec

Transcript

DR ALAN KARSTAERDT: This is the reception area, which has to seat a hundred-and-twenty people sometimes. So, there’€™s obviously an overflow into the corridor, which is alright in summer, but is problematic in rainy weather and in winter. There is a TV set, which people can watch, but it’€™s rather uncomfortable. We do provide meals on the clinic days, so that at least people who have to sit here for many hours are catered for in that way’€¦

KHOPOTSO: Back in his office, which also doubles as a consulting room, Dr Karstaerdt explained further about the clinic.

DR KARSTAERDT: We established this clinic in 1989 and it’€™s been running ever since’€¦ We see people who come here, we don’€™t book people, but that may well have to change with the roll-out of antiretroviral treatment. So, whoever comes on a particular day will be seen that day’€¦

KHOPOTSO: How many people have you seen, so far, over the years?

DR KARSTAERDT: We stopped counting because it was of no great value. In the last year about 4 000 people passed through our clinic ‘€“ 4 000 patient contacts, which included a thousand new patients.    

 KHOPOTSO: Dr Karstaerdt believes that that figure will increase exponentially when the clinic offers treatment on the 1st of April.

DR KARSTAERDT: I’€™m sure that there’€™s going to be a huge rush’€¦ In other places like Botswana the initial booking periods were up to three or even six months and the problem with that is people may get sick in that time. So, what we need to do is try and have a system that allows us to manage people correctly, while not postponing their visits to initiate treatment for too long. And that’€™s going to be a huge challenge because not only will we be treating people who’€™ve been clients at this clinic but we’€™re expecting people from within the hospital, from the clinics, and many patients are being sent by General Practitioners as well.

KHOPOTSO: As in many public health facilities, expertise in the administration of antiretroviral treatment at the adult AIDS clinic at Chris Hani Bara is limited. But over the years they have built up some expertise as a consequence of a small-scale treatment initiative.

DR KARSTAERDT: We initially started in clinical trials in 1996. We have several hundred people on antiretroviral treatment at the moment. The majority of them are people who’€™ve been able to afford to buy the treatment themselves now that the prices have decreased, either using their disability grants, or with help from family members or friends’€¦ Obviously, the big challenge for us now is to be able to take these relatively small numbers whom we’€™ve been able to treat with success and translate that into thousands of people each year, where we will know them less well, where the doctor-patient, and nurse-patient, and counsellor-patient relationships may not be as strong as they have been where we manage much fewer people.    

KHOPOTSO: How many people are you expecting to be able to put on treatment when it hits the sites, here at Bara on the 1st of April?

DR KARSTAERDT: When we were asked initially we said that we thought we could manage 50 new patients a week, comfortably, in the adult clinic, and paediatrics said around 12 a week. We’€™ve been told that the hospital’€™s been allocated a hundred patients a week. More of them will be coming into adult medicine. We will be getting more staff that I know of already in April and May, but the question is what extra staff we’€™ll be getting on the 1st of April’€¦ The issues are going to be seeing people who’€™ve never been seen at the clinic before.        

KHOPOTSO: If you can talk some more around that, what will be happening on that very first day, are people going to be straight away put on treatment?

DR KARSTAERDT: Within the register that’€™s being run at the clinic we’€™ve now got well over 200 people whose names are there, who’€™ve had their safety blood, CD 4 counts and viral load done, and who’€™ve expressed an interest in treatment. So, we’€™ll be calling them in from the 1st of April according to the numbers that are allocated. And that first day will be spent explaining the treatment to them. And we think that by calling them back fairly soon and by the amount of education they’€™ve had before and together with pamphlets that we’€™ll be able to put the required number of people on to treatment each of those days. It does require that those of us who work in the general medical units will be freed from those kinds of duties. That hasn’€™t been done yet. But we need a lot of dedicated people sitting day in and day out in this clinic ready to put people on to treatment, to see new referrals and to prepare them for treatment because the turn-around times are going to be very quick if we’€™re given those numbers of 80 ‘€“ 100 a week.  

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