Duration: 4min 04 sec

Transcript

 ‘€œFx’€¦(Door opening, ambience of clinic’€¦)’€

DR PAUL PRONYK: On Wednesdays and Fridays we run our HIV Clinic in this site. We have about 650 ‘€“ 700 patients that we’€™re looking after right now. We began our work as a pilot programme for the national and provincial department of Health back in 1998. That’€™s how our project got off the ground. They were looking for a typical rural site where we could look at the modelling and implementation and evaluation of a comprehensive prevention, care and support strategy for HIV and Tuberculosis, the dual epidemics’€¦ Currently we provide a whole range of care for people living with HIV, including peer support, social support structures, disability grants, access to the prevention and management of opportunistic infections’€¦

KHOPOTSO: Dr Pronyk says it’€™s been a long haul since the HIV clinic was established at Tintswalo.

DR PAUL PRONYK: In 1998 you couldn’€™t even get an HIV test in this area’€¦ Hospitals routinely didn’€™t have HIV tests done and primary health clinics didn’€™t have it done. So, our first intervention was to work with the national and provincial departments of health to introduce the rapid HIV test’€¦ Every clinic in this area now has access to counselling and testing using the rapid test. They went from doing no test to about 6000 tests over the course of the last three or four years using these new rapid tests.  

KHOPOTSO: A rapid HIV test is performed by extracting a sample of blood from a tiny prick on a finger. Within 10 ‘€“ 15 minutes it can be detected whether one has HIV anti-bodies in the blood or not. Dr Pronyk says as the demand for HIV and AIDS care and support continues to increase, more resources are needed.

DR PAUL PRONYK: We’€™re trying to develop a four-day a week clinic because everyday we open up we fill up automatically. We’€™re currently seeing between 50 and 60 patients a day’€¦ So, we’€™re currently in a process of renovating some space where we can have a full-time comprehensive HIV clinic, and hopefully, in the very near future, antiretrovirals.

KHOPOTSO: Tintswalo Hospital is a collection of outbuildings, some very old, judging by the peeling paint on the walls. Work on the new building that will house the HIV clinic is still underway.

‘€œFx’€¦ Sounds of men hammering away’€¦’€

DR PAUL PRONYK: Let’€™s walk in here. This is gonna be our new HIV clinic, which we don’€™t call an HIV clinic, of course. We call it a medical clinic or a chronic care clinic’€¦ So, we’€™re gonna have a nice courtyard out there, a couple of nice trees, a reception area here, there’€™s going to be five consulting rooms’€¦              

KHOPOTSO: Back outside, Dr Pronyk explains why it’€™s necessary to have a separate HIV and AIDS service away from the other hospital services.

DR PAUL PRONYK: Our patient load is just way too high, so we need a dedicated HIV clinic that’€™s five days a week. It’€™s the only way to meet the demand. A lot of people question the idea. Do you need a dedicated service for people living with HIV? The idea of vertical programmes is almost a swear word in public health these days. They want everything to be integrated into primary health care, so that if you have HIV, you should show up at the emergency room with everybody else, receive your care there.

KHOPOTSO: So, how would an integrated primary health care service not benefit AIDS patients and health care providers?

DR PAUL PRONYK: You’€™ll end up seeing a different doctor, a different nurse everyday’€¦ none of the providers get very, very good at managing HIV because they see it sporadically. There’€™s no opportunities for peer support because you don’€™t co-ordinate all your patients coming together. It’€™s hard to co-ordinate social support, nutrition, disability grants. So, I think I’€™ve come to the conclusion over the last five years that the only way you’€™re going to provide decent care for folks, particularly if you’€™re talking about monitoring something as complex as antiretrovirals, is to have some kind of dedicated Wellness Service.                          

KHOPOTSO: Dr Pronyk further went on to say that in order to provide proper and effective AIDS treatment brick and cement structures are not the only crucial need.

DR PAUL PRONYK: I still really have serious concerns about the capacity of the health service to effectively, not start antiretrovirals, but more the monitoring of adherence that’€™s got to go on alongside of it and the frequent feed-back and evaluation. In one sense antiretrovirals can be the best thing that’€™s ever happened to the health service in terms of being a vehicle for developing health systems. But extra doctors, extra pharmacists, and whatever else, where are these people going to come from? I think it’€™s going to be a real challenge for the government to try and fill those posts with folks that have the capacity to deliver a high-quality service.        

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