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.

Commemorating the 2015 Candlelight memorial - Kaunda Grounds Gulu District

TASO staff and clients marching towards Kaunda Grounds
This year the Candlelight Memorial was held in Gulu at the Kaunda Grounds. The Function began with a march through the town by representatives of various stakeholders in the HIV and AIDS fight in Uganda. 

The commemoration theme was a continuation of the one used last year for the World AIDS Day campaign which was Getting to Zero: my responsibility. 

Hon. Rev. Fr. Lokodo at the TASO stall
In his speech the Guest of Honor, Hon. Rev. Fr. Simon Lokodo urged service providers to put emphasis on prevention especially through abstinence. He remarked that with a prevalence of 7.1% in Gulu, there should be measures to ensure that it came down. He pointed out that having an average of 400 people getting infected in Uganda every day is alarming. Rev. Fr. Lokodo urged the youth to be vigilant and take responsibility for their lives since they were the future leaders. He went on to say that promiscuity and pornography are making sex cheap and yet it was meant for only those who are married and are faithful to each other. He concluded his speech by encouraging all AIDS Service providers and Development Partners to work with Government rather than expect parallel services for its people.

Also present were members of the Parliamentary committee on HIV and AIDS, the Chairman Uganda AIDS Commisssion - Prof. Vinand Nantulya, the representative of the Inter Religious Council of Uganda - Msgr. Odong as well as representatives from various stakeholder organisations working both in Gulu and elsewhere in Uganda. 

TASO staff and clients participated during the march through town, the drama group presented several items and staff had an exhibition stall at the grounds. An estimated 200 people visited the TASO stall asking about services and especially where they can go to be tested for HIV.
Guests at the TASO stall
TASO team in Gulu





Partnering with Government to improve service delivery in Public Health Facilities - Health Systems Strengthening

The Center for Disease Control and Prevention (CDC) partnered with the Government of Uganda to improve services within the Public Health Facilities. This is done to create union between efforts of the Central Government and the Local Government in the various districts by making use of the AIDS Service Organisations already serving within those districts. Through this partnership, funding is from the CDC, service delivery is by a Government facility with supervision and technical support from an AIDS Service Organisation.

TASO is offering supervision and technical support to the 54 Public Health Facilities within the Districts of Jinja, Tororo and Manafwa. This support includes; signing Memorandum of Understanding with these districts to clearly state each partner's role, mentorship and technical support in the areas of medical and psychosocial services. It also includes infrastructure improvement, building capacity of human resources, monitoring and evaluation, enhancement of information technology for communication and advocacy.

Over the past 4 years, TASO has seen these public health facilities improve and in some cases come up with innovations that can be replicated elsewhere. One such example is at Merikit Health Centre in Tororo district. This health Center is leading in male involvement in health related matters. It began with encouraging all pregnant women to come with their spouses during the first antenatal check up. With time the culture caught on and now they report a high number of couples coming for health services together. This has enabled more men take interest in their wives health as well as seek for medical services such as HIV testing and child immunisation. A few years ago this was unheard of within the area. Mr. Raymond Ecoru informed the mentoring team that,
Mr. Raymond Ecoru (in white shirt - Merikit Health Center) interacting with the TASO team lead by Dr. Mugagga (in stripped shirt)  the Manager for Health Systems Strengthening in TASO

“During one of the ANC Health education sessions for those come for the first time, one of the women got so excited after she found out that discordance is possible. She immediately went home and came back with her spouse for HIV Testing.” 


Most Public health facilities have benefited from improvement in infrastructure especially in the laboratories and theatres. Their staff have also had skills training, and in some cases more staff have been recruited to support the districts. The districts are also able to report better and have their statistics reported directly into the national electronic Health System database. This is in addition to being supported to implement quality improvement projects within their facilities.

Dr. David Okumu - District Health Officer for Tororo District
When this partnership first began, there was a bit of skepticism on both sides on how well they will be able to achieve the project objectives. However, according to the District Health Officer for Tororo Dr. David Okumu, this kind of partnership reduces on duplication of services offered by Government and Non-Governmental Organisations. He says the District has benefited from technical assistant, financial assistance, training in logistics and Data management and can now get weekly reports from the Public health facilities he supervises. He is also quick to point out that through this partnership TASO is also able to learn from the health workers within the facilities. This way both parties are always up to date with the current trends in HIV and AIDS. Dr. Okumu commends TASO for the great partnership especially through the Center Manager and District Health Systems Strengthening focal person and goes on to thank CDC and the Government for initiating such a programme. 

As we track progress in getting to zero, all stakeholders should be on the same page. TASO is committed to working with these districts to ensure that they contribute to better HIV service delivery within their communities.

TASO partnering with Aidshilfe für Afrika to improve lives of those living with HIV in Soroti District

This partnership began with an exchange programme between the Catholic Church of Soroti and Osnabrück club in Germany. During this programme, part of the delegation was made up of staff from TASO Soroti who talked about their organisation. Among those listening was a member of the Rotary Club of Osnabrück. After hearing about the great work being done by TASO, the TASO Staff together with Christine Kaiping of Aidshilfe für Afrika (AfA) initiated the partnership in 2005 with support from the Rotary Club of Osnabrück. AfA is an organisation which was founded in November 2005 to contribute to the fight against AIDS in Africa, supports the TASO unit in Soroti. 


Through this partnerhsip, TASO Soroti has received the following support;
  1. Provision of ART services and general drugs for 200 clients (out of the 7,504 active clients registered at TASO Soroti) to enable them live a better and healthier life. 
  2. Automated Laboratory equipment worth 40,000 Euros including a machine to count CD4 cells (FACSCalibur machine) ,Chemistry analyzer machine, air conditioning for the Lab and data rooms. Funds are also spent on replacing lab reagents.
  3. Furnishing of the Child Care Centre
  4. Sustainable Livelihood programmes for clients such as giving households fruit trees, goats and sheep.
  5. Facilitation to the implementation of Prevention of Mother to Child Transmission of HIV, through nutritional supplementation to both mothers and babies, procurement of delivery kits for expectant mothers. This was initiated in 2010.
In 2011, Prof. Wolfgang Lenzen from AfA led a national bicycle rally to raise funds for TASO involving all the TASO Centers. It was also used as an event for HIV Counseling and Testing, community sensitization and mobilization, in that people along the highways of the bicycle rally route in over 20 districts received information on HIV and AIDS as well as condoms for both HIV prevention and Family Planning. A total of 5,769 Euros was raised and the cheque was handed over to TASO Management in February 2013 in Kampala. 
 
To date TASO has received a total of 288,000 Euros which has greatly supported the PLHIVs in TASO Soroti to live better and more healthy lives. 

TASO is very grateful to AfA and the Rotary club of Osnabrück for this great partnership and especially for all the financial and material support given to its clients.


 



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TASO in the Karamoja region

Following the successful implementation of the first SCALAP - K project (2012 - 2014) in the Karamoja region, Irish Aid announced a one year project extension starting May 2015 and ending April 2016. This is still a tripartite contract arrangement between TASO, AMICAALL and the Uganda Local Government Association (ULGA).

This time in addition to the initial 5 districts of Moroto, Nakapiripirit, Napak, Kotido and Abim, SCALAP - K is now operational in Amudat and  Kaabong.

Details about the SCALAP - K project can be found in an earlier post written in June 2014.

Elimination of Mother to Child Transmission Campaign launch held in Teso sub region

The EMTCT Campaign was launched in the Teso sub region on Friday 31st July 2015 under the sub theme: Keeping families in Care. The Guest of Honor was the Champion herself , the First Lady, Mrs. Janet K. Museveni. During her speech, she thanked the campaign organizing team which had been with her  throughout the campaign in the other sub regions, for making this yet another successful function. 


Mrs. Museveni interacting with the HIV positive parents who have successfully given birth to HIV negative babies through the EMTCT programme

Mrs. Museveni said that this campaign is aimed at making people angry enough to commit themselves to being part of having an HIV free generation through total elimination of Mother to Child transmission of HIV. She reminded the fathers that they have a duty to their wives, children and entire families to be responsible and keep them safe. In addition to this, she said that it was beautiful to listen to then children who are born HIV negative say in their own words that their mothers were their heroes for protecting them. She ended her speech by encouraging both development and implementing partners to keep fighting until the campaign has yielded recommendable results. 

Also present at the function were the Emorimor and his wife, Minister of State for Primary Health - Hon Sarah Opendi, Minister of State for Teso Affairs - Hon Christine Amongin Aporu, Deputy Director of CDC, Country Director UNFPA, Country Representative UNAIDS, Representative of the UN Resident Coordinator, Hon. Chairperson of LC V Chairpersons in Teso Sub region, RDC Soroti, Chairman Uganda AIDS Commission, Director General Uganda AIDS Commission and the Director General for Health Services.

The Director General for Health services said that the campaign still has two regions left before it ends. These would be held in Masaka and Kiruhura districts. She also said that the Ministry of Health was preparing to carry out another HIV impact assessment to measure the progress made with the existing HIV prevention interventions.

The Emorimor (cultural leader) thanked the development and implementing partners for taking services to the people in Teso. He advised his people to get tested so that they could make informed decision about their health.

Dr. Flora Banage from the CDC said that if the developed countries have been able to almost wipe out Mother to Child HIV transmission, then the developing countries have hope of doing the same. 

TASO Soroti Drama Group performing during the function
According to Dr. Bungudu from UNAIDS, Uganda still has 67% of its children born with HIV and not yet on treatment. He requested that the populace be explained to clearly and in their languages what interventions such as Safe Male Circumcision mean. 

TASO had an exhibition stall, a group of mothers and their children who were born HIV negative as well as the TASO Soroti Drama Group which received a rousing applause for having the most relevant item of entertainment for the community.
TASO Soroti mothers with their children born under the EMTCT programme




Involving PLHIV in service delivery

As I take photographs during a clinic day in TASO Tororo, a lady's voice behind me laughingly says, 

"That was not a very good one. They are all looking at you instead of paying attention to the health talk facilitator"

It turns out that the voice belongs to Judith Apai, a Community ART Support Agent (CASA) at one of the TASO Tororo Community Drug Distribution Points (CDDP). She has come to the Center for cervical cancer screening but she also has pain down her right side. She tells me about how women her age (she is 52 years old) and older feel that they should not go for cervical cancer screening because they are not sexually active. Yet Judith knows that the health workers told them that the HPV virus can remain alive in the cervix for a while before the cancer manifests. So she feels that after some years, she should come back for another check up and so should others. 

After telling me why she has come to the Center, she then tells me about her life. Judith lost her husband in 1999. She was bedridden and yet at the same time she was expecting. She thought that the stress of expecting plus loosing her husband had affected her because she lost a lot of weight and she had a rash in addition to having no appetite. When her baby was born, he too got a rash. One of her sisters who had gone to see the baby, suggested that both Judith and her baby go for an HIV test. Judith's results were positive and so she tried to sneak into TASO while covering herself so that she could not be identified. 

With counseling and continuous treatment, the rash got cured and Judith became more confident. She was now able to walk into TASO without hiding. Luckily, her son was HIV negative (this was even before the PMTCT programme was rolled out in TASO Tororo). 

Today, Judith is a CASA in TASO Tororo at a CDDP with 75 clients under her care. She also carries out continuous client education in her community. When I told her that some clients in TASO Tororo are reported to have their CD4 count go down, she was ready to find out more about the causes and to encourage them to ensure that they take good care of themselves. 

Judith says she is so much happier now that she is open about her sero status and is able to help other people in the community regardless of their HIV status.

Thanks to Judith for sharing her story and for the work she does in the community.


Can you donate a wheelchair to Nubuat - a client TASO Jinja?

Two years ago(2013), Nubuat was taken to TASO Jinja in critical condition and had to be enrolled immediately into care. She later got Tuberculosis and narrowly survived death. She became blind and also lost the use of her legs. Because she was unable to continue working, Nubuat lost her job at one of the Nursing schools. Right now she is living with her parents in the village. 

She has to use crutches to walk, but unfortunately the ones she has are not for her height. It would be so much better if she could get a wheel chair to enable her get around. Do you know of any places or organisations that can donate to Nubuat a wheelchair while TASO continues to monitor her health? 

Please contact TASO (U) Ltd on mail@tasouganda.org or post on our Facebook/Twitter pages. 

Thank you.