The Past 2 Months

Alright, so I know its been almost 2 months since I last blogged but in my defense it was the holidays and then the beginning of the year was quite hectic and I have barely had a spare moment… with an internet connection… to keep this thing updated.  So I think its best if I just dedicate this post to a semi-brief update for the last two months. 

Christmas Day on top of Table Mountain in Cape Town

Shopping at the Pan-African Market Cape Town

I spent Christmas and New Years in Cape Town with Krista, the other MVP in South Africa, and Winrose, a nurse from Kenya who works for CMMB’s Medical Male Circumcision project in KZN with Krista.  It required a 20-hour bus ride from King Williams Town, but it was totally worth it!  We had a BLAST!  Cape Town is easily one of the most beautiful places I have ever been and we spent our vacation touring around, laying on the beach, and of course, eating lots and lots of seafood.  Highlights included a Christmas Day on top of Table Mountain, Hiking out to Cape Point, seeing penguins, daily time on the beach, and a few days hanging out in Stellenbosch (wine country).  I think the general consensus by the end of the trip was if we had a choice, we would never leave Cape Town. 

South Africa Strategic Planning Meeting Group Shot

So all in all, the holidays were great but I was quickly snapped back into reality when the office opened in January.  The TB project that started in August had really been gaining momentum in December, and when we came back from the holidays we found that our fieldworkers had been working over the break and were ready and raring to go.  The beginning of the year also brought lots of planning for the projects and several meetings with all our partners and the communities we work with to prepare for the needs of the coming year.

TB Nurses ready for testing at Walter Sisulu University

The end of January brought a last minute invite to Pretoria for CMMB South Africa’s yearly strategic planning meeting.  The meeting consisted of the staff from the South African head office, project managers, MVPs, staff from the US offices, and regional directors as well.  The point of this week long meeting was for everyone to come together and make a plan as to what issues need to be addressed in the projects and how will CMMB SA as an organization move forward and develop during the course of the year.  The week was extremely productive and I personally really enjoyed the opportunity to collaborate with staff from different countries, specialties, and projects. 

Training on the new PIMA machine to do CD4 counts in the office 

Despite the fatigue following a week of all-day meeting everyone seemed to leave Pretoria ready and raring to advance our projects throughout the coming year.   As a result, February was insanely busy.  Per usual, the month was filled with community events and trainings.  I am really happy to report that our fieldworkers and nurses have really gone above and beyond this month, providing services to more clients than any other month the project has been running.  Of course reaching and exceeding our targets is impressive, the truly exciting fact is that those “targets” are people who are directly benefiting from the services that CMMB is providing.     

Field Trip

Kid trying to figure out why I am pointing my phone at him

This week I was able to spend some MUCH needed time in the field.  Don’t get me wrong, it’s not that I don’t  loooooovvvveeeee compiling data and writing reports in the office, but I am always happy to have the opportunity to visit the communities where we work.  I think it gives me a much better perspective of how the TB project works.  Sure I can look at the numbers and see how many people are benefitting from our services each month, but going door-to-door lets you see who these people are and how much of an impact providing something as simple as an HIV test or TB screening can have.  

Fieldworker counseling a client in her home

This week I went to Sweetwaters, which is an area just outside of King Williams Town, mainly to observe our fieldworkers in action and help identify/correct any problems they are having with the project.  Let me just say, our fieldworkers work SO HARD.  They are so great at interacting with the clients and you can tell that they really have a passion for what they do. 

Mrs. Ntutu explaining how to followup with clients

One of the best parts about being in the field is that you get to see the people our programs reach.   For me, it’s nice to actually put faces to the numbers that I deal with all day especially when you can see the impact providing door-to-door services provides on an individual level.  Even more awesome is seeing Mrs. Ntutu in action.  She is the project supervisor and she is SO good at her job.  When she is in the field, you can just tell she is totally in her element.  She loves teaching the fieldworkers and interacting with the clients.  She is the person who definitely goes above and beyond the services of our project to make sure that our clients are being linked up with the services they need.  The world could definitely use more people like her.  

World AIDS Day

Bongiwe and Ntando posing with CMMB car

On Saturday, CMMB was invited to be an exhibitor at the Eastern Cape World AIDS Day event in Mdantsane.  There was a huge build-up for the whole month prior to the event to engage the community in health education surrounding HIV/AIDS as well as encouraging them to attend the event.  CMMB took part in this build up during the month of November by going to the taxi ranks in King Williams Town and offering testing services to people coming and going in and out of town as well as promoting the event in Mdantsane.  We also joined with the Department of Health’s door-to-door services (obviously our specialty) and visited homes in the areas surrounding Mdantsane.  During this outreach CMMB did their normal practice of offering counseling and testing for HIV as well as screening and testing for TB.

Ntando setting up his testing station

On World AIDS Day, the event was held in an outdoor stadium where the finals for the youth soccer, netball, and boxing tournaments that had taken place in East London during the previous week were played.  The events also included speeches from keynote speakers and focused on youth outreach to promote their goal of a generation with 0 new cases of HIV.  Unfortunately, the weather was not on our side.  It was cold, rainy, and windy which definitely put a damper on the festivities.  But still, all things considered, the event was pretty well attended.  CMMB had a tent set up and offered HIV counseling and testing as well as general health information pamphlets.  We had to get creative to create private areas for people to test.  Solutions included creating makeshift partitions in the corners as well as using the CMMB car as a testing “room”. 

Timbela counseling a client

Family poses while waiting in line for testing

For me, I rarely get to go to the field so it was fun to watch our fieldworkers interact with clients.  They are all so passionate about what they do and so good when it comes to interacting with clients.  Even though it was a busy day from start to finish, it seemed like everyone on the team really enjoyed themselves.

This might actually be working!!

I just wanted to share a really awesome story that was shared with me yesterday.  Im sure it won't give you all the "warm fuzzies" that it gave me but I am going to share it with you anyway....

I was at a meeting yesterday with the sub district office for SA Department of Health (they have partnered with CMMB for the TB project that just started a few months ago) and the clinic programs manager, Mrs. Nelani, shared a great story with us.  She was at a funeral (this is not the "great" part of the story)this past weekend in Ndevana, and area where CMMB provides testing services, for a man that had died from TB (also not the "great" part I am referring to).  At the funeral they spoke about how sad this death was because it could have been prevented.  Then as more people got up to speak they kept talking about how TB is a disease that needs to be taken seriously and pleading with people in the congregation who are on TB treatment to stick to their regimens.  They also talked about the importance of people being tested for TB and that, as a community, they can prevent this disease etc etc. 

After the funeral Mrs. Nelani was so impressed with the information that these speakers were sharing with the congregation.  She asked one of the speakers how he and everyone else knew so much about TB.  The man told her that he and his community had learned about TB from "some Catholics" that have been coming door-to-door offering HIV and TB testing.  As soon as he said that, Mrs. Nelani knew the "Catholics" he was referring to was actually CMMB.

From my own perspective, I think it is really encouraging to see that the education we are providing to clients is really helping people to understand more about TB as a disease.  Of course the testing services we provide are important, but in all honesty, the health education that accompanies testing is the sustainable piece of this program that is going to last when project is over, hopefully helping to prevent new cases of TB in the future.  And after all, that's why we do what we do.  

Training Day(s)

Field Workers and Nurses learning about HIV Counseling

OK.  So just a little background on CMMB’s TB project before I get into the important part of this post.  CMMB started their TB project, which involves door-to-door screening for TB and HIV testing aiding in the South African Department of Health’s intensified TB case finding campaign, in late August and really had to hit the ground running.  Approval for the project was wrapped up in red tape for quite some time (shocking, I know) so as soon as it was approved there was a lot of ground to make up from the original plan.  Because of this, there was little time to prep our field workers and nurses leaving most of them to have the bulk of their training on the job. 

Mama Gwiji Demonstrating how to collect Sputum

In order to make sure all the teams were on the same page and adequately armed with the information about HIV and TB, a mass 3-day training was held last week for all of our field workers and nurses.  Topics included a review of HIV and TB symptoms and disease processes, counseling methods, HIV testing procedures, specimen collection, etc.   Questions were addressed and solutions for some of the issues being experienced in the field were implemented. 

Overall it was an extremely successful training.  Our Field workers are so motivated and were so enthusiastic about participating in the training sessions.  I think they all left with a much better picture of HIV and TB as well as the impact they can have on their communities through CMMB’s project.  I am really excited to see the progress we make over the next year! 

Happy Thanksgiving!!!!!

Yes, yes I know I am a few days late but since it was just another workday in South Africa, festivities with my host family had to wait until Friday night.  Can I just say, I found it somewhat difficult to properly describe Thanksgiving.  I feel like I must not be doing it justice because most of my coworkers said it sounded a whole lot like Christmas to them.  Even more challenging was describing Black Friday, and now I’m pretty sure they think Americans are crazy.  They might be right… 

Anyway, last night I cooked a small feast and my family and some friends came over to partake in my make-shift holiday.  I of course made everyone join in with the cliché Thanksgiving tradition of going around the table and say what you are thankful for this past year and it was pretty clear that we are one lucky group of people who have been blessed with love, family, and wonderful experiences. 

Turkey Day Spread

I think the success of my Thanksgiving was best summed up by my host mom, Bomza.  This morning she told me,  “Nikki, your Thanksgiving meal was so wonderful last night, but I ate so much I almost died!”

And now just a few things that I am thankful for this year:

I’m thankful for a host family that entertains my requests for celebrating American holidays.

I’m thankful for the friends that I have made in South Africa, I don’t think I would be surviving without them.  

I’m thankful that I have such wonderful friends at home who have made me feel like we are just in different cities not on different continents.

 I’m thankful for my wonderful host family that has made me feel right at home since Day 1.

 I’m thankful for my family back home who has been so supportive and encouraging of this adventure.

 I’m so thankful to have this opportunity and excited to see what will happen during the rest of my time here! 

TB or not TB?

Many of you who know me, especially my fellow MPHers, know that I have a ridiculous obsession with Tuberculosis.  It's truly a fascinating and quite complicated disease posing many issues in the way of both treatment and prevention.  South Africa has one of the highest rates of TB in the world mainly due to its massive population of individuals infected with HIV.  TB treatment and prevention is one of South Africa's Department of Health's top priorities, which is why CMMB has recently started their TB project which consists of going door to door to screen people for the disease.  Naturally I gravitated to this project and I have been trying to use what I learned in my Masters program and what I gained from my experiences working in TB in Kenya to contribute its development

TB Poster in Grey Hospital Clinic KWT

I know finding and treating someone with TB seems simple enough, but its really a quite complex process.  The first round of screening is a questionnaire about TB related symptoms.  If someone appears to have symptoms, then our field workers collect sputum and send it to be tested.  But, of course, that can't be the end of it.  Because TB is difficult to detect, the standard procedure is to collect 2 samples from each patient on 2 separate days, meaning two trips to each person's house for our field workers.  Once this step is complete, the samples are sent to the lab where they are observed under the microscope.  From this the lab gives you a positive result (they saw TB bacteria under the microscope) or a negative result (no TB seen here!).  Simple right? Wrong.  Now there is the issue of using microscopy to diagnose TB.  It really isn't that great of a test.  For one, TB is easy to miss under the microscope not to mention the many issue that can arise with sample quality and contamination issues.

So what do you do if a patient has a negative lab result but suffers from TB symptoms?  Some of the rural clinics in my area say "that's it, nothing more we can do" while others will refer the patient for an xray and doctors visit.  However this happens at another clinic, which adds cost and travel time for patients that have little time or money to spare.  At every turn TB control becomes more and more difficult.

Sign on Exam Room Door Zwelitsha Clinic

Now lets say your patient's test comes back positive.  Great! They have TB so let's start them on treatment, problem solved.  If only it were that simple... First off, to cure TB a person needs to be on treatment for at least 6-9 months.  That's taking a pill every single day for at least 180 days straight.  If you start missing doses then your problems get WAY worse.  Improper TB regimens lead to drug resistance, and let me tell you, drug resistant TB is not something you want to mess with.  You'll have to go back on treatment for much longer and you're going to have to take more drugs than you did before.  Drop the ball again, you are likely to cause further resistance leaving you with very few options for treatment.

Much more than making sure that drugs and doctors are available goes into successful TB treatment and prevention.  You have to think about the barriers patients face when it comes to accessing these services.  Do I have transport to get to the clinic? Can I afford the associated costs? Can I leave work? Am I worried about stigma if someone sees me in the TB section of the clinic? How will I make sure I I have a continuous supply of medication?

The list seems ENDLESS.  My hope is that through this program we can address and eliminate many of these barriers by bringing clinic services directly to the people in our communities and having a well-defined referral system for the services that are beyond the scope of what CMMB can provide.  Establishing this should make for a VERY busy year.