Tapologo and the DOH collaborate in the Bojanala District, North West Province
Tapologo ART project has been granted a one year extension on its treatment programme, allowing for improved collaboration with the Department of Health and the provision of quality ART services. Most patients now receive ART drugs in DOH clinics, but ongoing psychosocial care and support is provided by Tapologo caregivers and counsellors. Five hundred patients continue to receive ART drugs at Tapologo itself. New patients can be initiated when stable patients are transferred out to DOH clinics. Tapologo hopes to be accredited to provide DOH supplied ART to its patients. This would enable the programme funded by PEPFAR till now to continue rendering needed services.
Rustenburg – Tapologo
Reporting period: January – March 2013
1. Current Status and Progress:
2. Staff issues:
– 2 Professional Nurses
– 1 Auxilliary Nurse
– 1 Social Worker
3. HIV testing:
4. HIV Care:
|Patients in our HIV Care (Outreach Programme) are still being traced and monitored during home visits and also during Support Groups that are held in each community. Patients that have been transferred to Government for ART are continuously encouraged to attend our ART Clinic days whereby they will continue to receive Psycho-social, Opportunistic Infection and clinical care and treatment.
The referral system to Government facilities is still running well. We are working on developing an additional external referral system between Tapologo and various mining and corporate organizations in our areas by using the newly established Rustenburg Health Forum as an avenue to address these issues and that of collaboration between the Public – Private – NPO Sector.
Tapologo continues to Home Based Care including support groups, and psycho-social interventions in the following community clusters:
5. Treatment preparation:
|We still undertake the 4 pre-treatment preparation sessions with each patient. We also use this opportunity to explain to the patient and family why they will be receiving their ART from Government and how Tapologo will continue to assist the patient even once the patient is on treatment with Government.
We have received special authorization from SACBC to initiate critically ill patients that are admitted in the IPU on ART with immediate effect.
6. ART provision:
|Patients ART Adherence is still monitored in the home and the caregivers continue to encourage the families to all be tested.
Due to SACBC extending our contract for another year, we will start planning to initiate patients on ART, however, our succession plan is still in place in that we can maintain 500 patients on ART with the SACBC extension, but we still have not received a number from the DoH.
|Cotrimoxazole is given to all patients admitted to our HIV Care Programme (Outreach) except those presenting with allergies thereto.|
|Many of our female patients are still complaining that their partners (men) do not want to be tested and that these men blame the women for infecting them. We do however find that many of our terminal patients admitted are men due to the fact that they wait for such an extended period before consenting to HCT and finally ART. We have also found a very low attendance number of males during awareness campaigns. This obstacle is not one that can be easily resolved however gender issues are discussed during support groups and home visits. Tapologo has embarked on a campaign to encourage “couples” testing.|
11. Prevention-Mother-to-Child Transmission:
|Pregnant mothers are being referred to Government clinics for ART initiation.|
12. South African Government collaboration:
|Since the last visit and report (submitted with the previous quarterly report), the Department of Health officials have visited Tapologo again on 2 separate occasions. The outcomes from these meetings are as follows:
– Covering of the existing floor of the wing allocated for this purpose with a vinyl flooring system used in hospitals etc.
– The construction of a Cool Room inside the building using a Dry Wall system with a PVC ceiling board. The ART’s will be stored in this room until repacked and sent out to the clinics.
– An 18000 BTU air conditioner that will keep the temperature in the Cool Room below the required 25 degrees Celsius.
– Adequate shelving in the Cool Room to pack the ART’s on
13. Monitoring and Evaluation:
Due to the above preliminary results, COHSASA will determine our official 5 star accreditation in April 2013.
15. Wrap around:
|The objective of providing ongoing operations and maintenance activities is to create and maintain conducive and supportive spaces, environments and systems for those working for Tapologo in order that they may effectively render services pursuant to the Tapologo mission.
During January the O&M team routinely visited the following sites to determine maintenance needs not identified by site personnel. A number of O&M requests were received during January and February. Most of these have been attended to the O&M Team.
The new 12m long converted shipping container was delivered to Boitekong on the 15th February which forms part of the Boitekong clinic extension, which is funded by SERVE. It had since been electrically connected as well as the water supply coupled and the waste water system constructed. Work has also commenced on the roofing structure for that will extend the waiting area and cover the container.
New container at Boitekong to meet patient demands.
In January a water shortage was experienced at the Tapologo centre. This was due to both the borehole supply as well as the Phokeng reticulated supply not being available. The problem with the borehole was eventually traced back to the float control switch in the water storage tanks having been tampered with. The switch was tested and then replaced back into the tank and the borehole has run normally since then.
February saw us spending more time and resources on the Tapologo Centre in light of our COHSASA audit in March. The team erected scaffolding and scraped off the peeling plaster off the vault roofs in Admin and repainted them. Paving flagstones were laid at the chapel and Admin to place the existing concrete benches and tables on LM grass runners were planted between the chapel and the IPU garden as part of an ongoing project to complete the landscaping around the chapel area.
Seating outside Admin Seating at the chapel
An Occupational Safety, Health and Environment committee meeting was held on 24 January 2013 to ensure that all centres are functional and operational within the legal requirements.
16. Significant successes, changes in approach or challenges experienced:
|Many of our ART patients that we have transferred to DoH simply do not re-visit our clinics. When our Caregivers visit them at home to find out why, they are informed that it costs them double for transport to visit the DoH clinic to collect their drugs, and then to also visit our clinic and it is more time consuming. They also feel frustrated and in a way have lost “faith” in Tapologo because we are “throwing” them away and sending them to another institution.
The word of mouth in the communities is that “Tapologo can’t help anymore”. They understand that ART can save their life, but if we can’t provide it, then why bother being admitted to the programme or staying in the Programme? Our patients simply do not understand/comprehend what is actually happening and the reasons why we have to send them to the DoH clinic for ART drugs, but we are working very hard in explaining all of this and educating the patient and community about the situation.
Due to all this, we have made a strategic decision (which the DoH has endorsed) that Tapologo would become an “Initiation Site” for ART and provide all the counselling, clinic visits, support groups, nutritional support, home visits, adherence monitoring, etc for a period until the patient is “stable” and has a good adherence rate.
Then the patient will cease to get ART drugs directly from us, and be “transferred” to the DoH Clinic to collect the drugs there. But again, they can still stay in our Outreach / HBC programme and receive our other services. By doing this, we can “create” an opportunity for another patient to start ART with our support etc. and so the cycle will continue.
Our belief is that if we do this, then we will be able to ensure that more people in need of ART can get treatment sooner through our system than at the rate at which Government is able to initiate patients on ART.
NB! 17. Referral systems and follow up!