Friday, 8 January 2016

Venturing into moonlight clinics

The first time Emma was told to go and offer services in some of the biggest slum in Kampala, he was scared. TASO was rolling out a project to offer services to people living and working in HIV high risk areas. This service was named the Moonlight Clinics. 

During the Moonlight clinics, TASO staff had to go and offer services to Long Distance Truck Drivers, Sex workers and their clients, Men who have sex with Men and any other group that was easy to target at night under the moon light. These are groups of people who are hardly seen during the day due to the nature and stigma attached to their work and lives. The services offered included psychosocial support, HIV Testing and Counseling, referral to Public Health Facilities for further care and the medical team treated Opportunistic Infestions and Sexually Transmitted Infections.

Emma is just one of the many staff who went to Wandegeya, Katanga, Kalerwe, Nakulabye, Kibuye, Kabalagala, Nakawa and Gaba. He shared his story with me and now I share it with you. 

One of his first assignments was to find and talk to the group leaders to seek for permission to let TASO come in and offer free services. The leaders were very excited because they finally had someone to help their people. Emma says that as a Christian, he felt uncomfortable, but as an HIVcounselor, it was upon him to reach out to the Most at Risk Populations with HIV prevention messages and services. However, with time, he learned to distinguish between providing a service and what his potential clients did for a living. He says that he came to appreciate that as service providers, we have to treat those who require services regardless of their work.

On his very first walk through a lodge in Wandegeya, he nearly had all his clothes torn off him by the sex workers thinking that he was customer. He soon found out that that was not all. Many of his clients would be drunk or high on drugs and many times  paid only half attention to what he said, unless of course you gave them HIV positive results. Somehow HIV positive results sobered up a person  long enough to start paying attention.  

As a group of counselors, they had decided to print their phone numbers, first name and the word TASO Counselor on a piece of paper which they left in the care kit left with the client  so that when they are ready to seek help, they can contact Emma or one of the others for clarification or further help. 

In his words Emma says; 
"Many times we kept talking to them in the hope that at one point they will be sober enough to remember that someone talked to them about being tested for HIV and to seek for further support regardless of the test results."

TASO has since closed down the Moonlight clinic project, however, the clients enrolled during this programme were supported to form a group and start up other Income Generating Activities. Some still engage with the counselors they contacted and are still receiving ongoing support from TASO as long as they accepted to be registered as clients.

Emma's final words to his fellow counselors whether in or out of TASO is that;
"Distinguish between what clients in the Most At Risk Populations are and what they need. TASO encourages all staff to treat clients with dignity. These clients need good counseling, medical care and some one to give them hope for a different life. Several have started up other trades such as growing agricultural produce or hair saloon and are doing very well."

Thank you to Emma for sharing his experience.

Spending less hours in the field while improving our service delivery.

During another of my field trips, I went on a field visit with Molly and Ali to one of the TASO Mulago Community Drug Distribution Points in Kasangati. It was a 20 minute drive to the place and I had another learning session while we traveled there and back.

A Community Drug Distribution Point (CDDP), is a central place chosen by a group of registered TASO clients from where they can pick up their drug refills from TASO staff. This is part of the TASO Community ART model in which client satisfaction is met by reducing their costs and distance of travel to the Center and also giving a chance to TASO to provide them its services within the clients' environment. 

Kasangati is one of many such points served by TASO Mulago. The clients at this CDDP, and like in all other TASO CDDPs, are stable on their antiretroviral treatment, are above 18 years (in other words not children) and they have been assessed by both the Counseling and Medical team and have been found suitable to receive their drug refills this way. 

Molly is a Counselor while Ali is a clinician. On this day, they had gone to take ARV refills, assess clients in need of any psychosocial or medical support and also to further sensitize the community about HIV prevention as well as a new programme being rolled out that will require clients to take lead in their own drug distribution.

TASO has learned from its many years of service but especially through sharing experiences with partner or similar organisations and has therefore improved the community ART programme. It continuously morphs to suit the environment and also to improve on service delivery. This means that where it used to spend 8 hours to offer services at a CDDP, now it takes 2 hours to perform all the duties at the same CDDP. 

The minute we arrive, Molly and Ali greet the clients gathered, hold a health talk to address general health issues including a Question and Answer session. They then ask them to split into their groups for drug distribution by thire client leaders while Molly assesses those not yet in a group for counseling and Ali handles the clinical matters. With practice, the teams now work efficiently, the clients feel more involved and are taking on more responsibility for their health and the bulk of the work is not left to the TASO staff alone.

Speaking to a group of clients, I found that when they come together, they form a support group through which they help each other even beyond the mere picking of drugs. They also appreciate this new approach because when they are done at the CDDP, they can easily gone back and catch up on their work for the rest of the day. They also feel that Molly and Ali (and other TASO staff) work better when they do not have a very long line of clients to serve. A CDDP has fewer clients than the Center or unit.

Thank you to Molly and Ali for letting me tag along and ask questions. 

Dr. Christine Nabiryo hands over to Dr. Michael Etukoit

Yesterday, 13 October 2014, a team of Directors witnessed the handover ceremony for the new TASO Executive Director. Mr. Emmy Ngabirano - the Board Vice Chairperson, appreciated the outgoing Executive Director for her efforts in leading TASO for the past two years. Mr Ngabirano went on to welcome Dr. Etukoit , who he said was not new to TASO, and pledged on behalf of the Board to work closely with him. He assured him that the Board was aware of his capabilities and was looking forward to Dr. Etukoit steering the TASO team to even greater heights.

12 years now and we are still alive thanks to Bono.

The year was 2002 when Bono visited TASO Mulago unit. He was greatly impressed by the work being done by TASO staff but especially by the Peer Support Group, of 25 HIV positive clients, which was using music, dance and drama to sensitize their communities. Bono was moved by the fact that while the group members had courageously given a human face to HIV in Uganda, they were weak and needed more help. He asked what he could do to help TASO. 

Thinking that they had very little time left to live, members of the group thought that it would be better for them to receive financial support so that they could each buy a piece of land and possibly build houses for their respective families. The then Executive Director - Dr. Alex Coutinho -suggested that rather than receive financial aid, Bono could donate life prolonging drugs to the group. This was because TASO had not yet rolled out the ART programme within its units. This would enable the members to live long enough to build their dream houses, support their families and watch their children grow.

Refresher training for expert clients in basic HIV counseling

Counselor Brenda facilitating during the session on STIs
 TASO has always used communities to implement its programmes. It is one of the earliest lessons learned and  is one of the reasons why TASO has been successful in both programme and project implementation. 
TASO Mulago is the oldest branch of TASO. Being in the Capital city, it bears the weight of having to serve in the most populated part of the country. It serves a cross section of clients living in the urban and Peri-urban areas. Within these areas  are communities and each community has TASO clients living within it. Over the years TASO has trained those clients who are willing to come out about their HIV status, live as community models, volunteer as peer support members, are able to read and write and are willing to train their fellow clients within the communities in which they live. They are therefore seen as better informed and able to act as a link between TASO and the communities. These clients are called expert clients.

Is the work we do and effort we put in to perfect our services worth it?

Nulu Tabizanga (at forefront with a cup of  break tea)
Nulu Tabizanga is a client registered with TASO Jinja even though she lives around 56km away from the Center. Because of this distance, Nulu is a beneficiary of the Community Drug Distribution Point services offered by TASO in  Kitayunjwa sub country  in Kamuli district.

Nulu can not read or write and does not know how old she is. She says that she never suspected that she was HIV positive until after her husband died of a mysterious death. A neighbor suggested to her that she go to TASO for an HIV test. Nulu did and unfortunately the results came out positive. She did not give up but rather decided to look at it as a new chance at life. She was started on ARVs, taught how to take care of her dietary needs and asked to bring any other members of her family for HIV testing and counseling. According her, she has never missed a day without taking her drugs.

TASO towards its Golden Jubilee

Sustainability and continued contribution to leadership in quality community based health services delivery plus elimination of HIV and AIDS, August 2014

The AIDS Support Organisation (TASO) is a household name in Uganda. The Brand has been developed over the last 26 years out of the organisation's efforts to serve individuals, families and communities of people living with HIV and AIDS from the time when stigma and discrimination were still very high in the country.

TASO is an indigenous non profit organisation with 11 branches spread across Uganda, in Entebbe, Gulu, Jinja, Kampala, Masaka, Masindi, Mbale, Mbarara, Rukungiri, Soroti and Tororo. To date, TASO has touched lives of over 500,000 PLHIV in Uganda and countless others across the world. TASO's approach has been through the use of peer and community based approaches to service delivery.