Sacred Heart Clinic, Senwamokgope, Limpopo
1 July – 30 Sept. 2012
Clients have continued to be tested for HIV using the finger prick test and a confirmatory test supplied by the Government. We no longer use the mouth swab test. New SAG guidelines are followed in the provision of ART to clients with CD4 levels of 350 cells /ul and under.
Our clinic has continued to receive anti retroviral drugs from the government. This change has continued to be challenging for us, as it means labeling and making up individual packs for patients. Printing labels for individual drugs and names of patients in advance has helped. ARVs are often delivered too late for our clinic days, so we have had to collect them from Kgapane Hospital 200 kms away. Not all the drugs we requested have been delivered, necessitating phone calls and further travel. This has continued to be the case. The Hospital pharmacy staff informs us that there are insufficient drugs in the supply depots.
The numbers coming for testing are steadily increasing, as our clinic is now the only clinic serving Senwamokgope. The numbers of children tested has not increased. We are not sure why this is the case. More men are coming for testing. All clients who test positive for HIV have blood drawn for CD4 immediately. They are screened for TB by their carer at that time. Screening is repeated when the client returns to see the doctor 2 weeks later.
Fewer patients have defaulted or are lost to follow up. Intensive efforts continue to be made by the carers to visit these clients, and assess their situations. A small number have died, others have moved to the big cities for jobs, or moved elsewhere. Patients that left to work in the cities, receive their treatment there, but sometimes return to our clinic when they return home. They do not always have referral letters making it more difficult for us to assess them. Patients with high CD4 counts are advised to attend a wellness clinic which has recently started in Senwamokgope. Our home based carers attend this clinic to support our patients. HBC cards continue to be used.
The TB infection control plan in place is being rigidly adhered to. There are open waiting areas, patients are routinely screened for TB and coughing patients are triaged. Sputum is collected from patients who have 3 or more symptoms of TB on screening. Patients are also referred to Government hospitals for chest X-Rays and treatment of TB if diagnosed with Pulmonary TB. Patients who have no money to go to the hospitals for chest X Rays are given money for the taxis. Extra pulmonary TB is not commonly found in our clients. We now have several patients on both TB treatment and ARV’s. Our clinic does not yet initiate TB treatment.
We have one patient, who was transferred in, on INH prophylaxis. He has continued to receive this.
Numbers of men coming for testing and treatment continue to increase. Many of those who come have very low CD4 counts, and are in WHO stage 4. Some die quickly despite being started on ARVs. Some have pulmonary TB and are on concomitant ARV and TB treatment.
Data flow, site based procedures/SOP and PDS use is fully in operation.
We are now using the Government drug order sheets, and statistic sheets. We are also completing the antiretroviral treatment Registers, the Wellness Registers, and the Children’s Register. Presently we are completing our first NIDS ART TIER Quarterly paper based report.
In October we hope to start using the Government Tier.net system for capturing data from patients’ files. This system will network with the present PDS.
We refer patients clinically suspected of having pulmonary or extra pulmonary TB to government clinics (Raphahlelo, Mamaila, Muwawela, and Middlewater Clinics) or local hospitals (Elim and Kgapane). A detailed letter giving clinical details, including results of blood tests, is given to the patient. If they do not have money for transport it is given to them. At their next visit they are asked about reports from the relevant institution. Sometimes the report is given verbally, but rarely a written report is received. In the near future it is hoped that our clinic can initiate treatment of TB infections.
Some patients request referral letters for clinics or hospitals in Johannesburg, Pretoria, or Polokwane, if it suits them to go there. They are given the referral letters, and some come back with details of their clinical management at a later date.
Patients with general medical problems, which cannot be managed by our clinic, are referred to local general medical clinics, for ongoing management.