Posted by: rhoban | March 13, 2009

Day 12 – AIDS

Today’s story focuses on the care for AIDS patients provided by UNC. Take a listen here or here:

“… so high you can’t get over it,
So low, you can’t get under it,
So wide, you can’t get around it…”

When I started researching this project, I was determined that I wouldn’t be yet another reporter parachuting into Africa to do stories about the tragedies of HIV/AIDS. I’ve worked in the developing world, I know that there are other problems – the issue of health worker out-migration, malaria, tuberculosis, substance abuse, you name it.

But when you arrive in Africa, you find all pales compared to HIV. So in the end, I find myself doing stories about care for people with HIV or AIDS because the problem is just so big, I can’t get around it… just like in the old song.

What I found refreshing here at the UNC Project, is that in addition to providing care for patients with AIDS, researchers from UNC are intently looking for ways to solve the problem of AIDS. It’s not just a band-aid approach.

Hundreds of women wait outside the Bwaila prenatal clinic every morning to be seen

Hundreds of women wait outside the Bwaila prenatal clinic every morning to be seen


And this isn’t just research. The reality is that you can’t just study people without doing something for them in return. That’s one of the driving forces behind a concept called “community-based participatory research,”  a process whereby the ‘experts’ actually listen to the community they’re studying… and the community acts as a full partner in and beneficiary of the research.  In other words, research isn’t done just to advance the career of an academic.  It’s done in conjunction with priorities identified by the community.

The UNC researchers seem to have taken that seriously by trying to provide some of the best quality care they can. They are certainly not taking short cuts and self-justifying it by saying, “Well, these people are getting something… it’s more than what they’d get otherwise.”

Bwaila head nurse, Gertrude Mwale

Bwaila head nurse, Gertrude Mwale

Nope. No thinking like that here.

But taking the research approach is also a brilliant move. It means that instead of constantly begging charitable donors for money, most of the patient care is paid for as part of research dollars. And in Malawi, those dollars buy more bang for the buck… a LOT more bang for the buck.

I’ll talk about these numbers later next week in a little more detail, but according to the project director, Francis Martinson, UNC Project spends about $8 million annually to care for patients – that money comes from research grants. And here are some of the numbers:

Patients being followed at the Lighthouse: 8000/ year
Women being followed at the prenatal clinic: 32,000/ year
Patients being seen at the STI clinic: 12,000/ year

For someone who knows the health care system in the US, to be able to see all these patients for so little boggles the mind. AND on top of that, UPC Project provides opportunities for faculty and students to do research and learn.

UNC isn’t the only US university functioning in this fashion in Africa. Researchers from Harvard, Johns Hopkins, Duke and many others have established similar relationships all over Africa. But the UNC Project is large, produces consistently good research and provides care for tens of thousands of people. And that’s saying something.

Bwaila Clinic

One of the more uplifting places I’ve visited during this whole trip is the clinic at Bwaila. There, they see pregnant women – 2000 of them a month! Every time I write that number, I have to look up the transcript of the interview again, to be sure I’ve gotten the number correct. Along with another satellite clinic, UNC Project workers see more than 3000 women monthly.

Women wait to be seen at Bwaila Clinic. An outreach workers hands out medical record booklets to the expectant mothers.

Women wait to be seen at Bwaila Clinic. An outreach workers hands out medical record booklets to the expectant mothers.

Keep in mind, in a country such as Malawi, most women only go for prenatal care once, twice, maybe three times. So the antenatal clinic is providing the prenatal care for many thousands of babies. Perhaps that’s why prevalence of HIV has begun to drop in Lilongwe and the Central Province of Malawi. For women attending this clinic, the rate of babies being born with HIV has dropped to below 10 percent. It used to be more than 30 percent.

In this first video, the women sing before the clinic opens in the morning:

In this second video, mothers bring their babies to get weighed. I’ve never seen anyone as efficient as getting a baby on and off of the spring scale. I still have a spring scale at home from my days as a home health nurse! They’re a great, low-tech instrument!

Comments? Send them to ncvoices@wunc.org

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