Duration: 4min 25 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: Ngaka Pronyk o re ha ho a ka ha e ba bonolo ho simolla tliniki ya ho hlokomela bakudi ba Phamokathe sepetleng sa 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: Ka rapid HIV test motho o dumela ho ntshuwa leqeba le le nyenyane feela monwaneng wa letsoho ka nalete ho ntsha madi ho hlahloba hore na ho ena le bopaki ba hore motho o ena le tshwaetso ya HIV kapa tjhee. Ho nka metsotso e leshome ho isa ho e leshome le metso e mehlano ho tseba hore sephetho ke sefe. Ngaka Pronyk o re jwalo ka ha batho ba hloka hlokomelo le tshehetso ka ho ata mosebetsi o mongata o lokela ho etswa ho ka thusa setjhaba.

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: Jarete ya sepetlele sa Tintswalo ke matletsetletse a meaho. E meng ya yona e tsofetse ho bonahala ka pente ya yona e kgobohang. Tliniki e ntjha ya bakudi ba Phamokathe e sa ntse e hahuwa.

‘€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: Ha re boela ka ntle, ngaka Pronyk o ile a hlalosa hore hobaneng ho le bohlokwa hore tshebelletso ya tsa Phamokathe dipetleleng le ditliniking e lokela ho ikemela e le nnotshi hole le ditshebelletso tse ding.

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: Ha ho le jwalo, na ebe o bona hore bothata e tla e ba bofe ha ditsheblletso tsohle di ka kopanngwa ho sebedisana mmoho?

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: Ngaka Pronyk o ile a tswela pele ka hore ho fana ka hlokomelo e nepahetseng e matla bakeng sa bakudi ba Phamokathe, ha se meaho a metjha feela e hlokahalang.

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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