Health Programme

HIV~Aids
In rural areas health services are less able to offer access HIV screening and treatment, because of lack of medical staff and facilities.  It is estimated that the Mbashe area has 16,000 adults who are HIV positive. Our partnership approach with the Mbashe~Madwaleni HIV Programme is a comprehensive, integrated programme and starts before anti-retroviral drug treatment for those with a low CD4 count, with a Wellness campaign across the most vulnerable groups through an extension of HIV services from Madwaleni Hospital to eight clinics. The programme’s main asset is its eight Support Groups at each of the clinics, run by volunteers.  People walk long distances – sometimes all day – to be seen or attend the support group meetings every week. To date, the programme has screened over 15,000 people and is providing ARV treatment to over 1,300 people, with thousands more on the Wellness Programme. This year, the programme is set to expand to become the largest rural integrated HIV programme in South Africa.

TB and HIV
One third of people on the planet are infected with TB. In the Mbashe region, HIV cases are rapidly increasing and in some district hospital wards, as many as 80% are presenting with concurrent tuberculosis. Treatment failure of TB is rising and many are presenting with TB for the second, third or even fourth time. Predisposing factors include increasing HIV affecting the immune system, the difficulties of implementing a successful DOTS programme in an under-resourced setting, and the increasing incidence of multi drug-resistant tuberculosis. For children there are inadequate services for those presenting with chronic illnesses and chronic respiratory conditions, as well as long-term malnutrition and poverty among children. So far, the Foundation has improved diagnosis by funding an ultrasonic nebuliser and a fluorescein microscope, as well as building three TB screening rooms at Hobeni, Nkanya and Melitafa clinics. Five more are planned for 2009.

Home-Based Care, decentralisation and roll-out of services
A key component in a difficult geographic area with no transport infrastructure and dirt roads, is to roll out services to be offered as close to people’s villages as possible. This has happened firstly from Madwaleni Hospital to the seven outreach clinics at Nkanya, Soga, Mqhele, Xhora, Melitafa, Hobeni and Bomvana where  the Foundation has so far built seven HIV clinics, which double up for TB screening and OVC screening and support services. In addition we train Community Health Workers in both health promotion and care for people in their homes, to limit the need to travel to obtain medicines or the help they need where this can be offered in the home. This decentralisation of services is an important component in the effectiveness of all the Foundation’s health components and service delivery in the region so that people can access what they need as quickly as possible. Integrating with schools is part of this strategy.

Orphans and Vulnerable Children
Of an estimated 50,000 vulnerable children in the area, we aim to screen and reach 20,000 orphans and vulnerable children and treat at least half of the 3,200 who are estimated to be HIV positive, over a four year period. Components of the programme include applications for identity documents leading to social grants, fostering and family support including food gardens. We work to ensure every child aged 7+ is in school, and has all the basic health checks and follow up treatment they need. For families affected by HIV, the paediatric clinics see families together and ensure children at risk are assessed. The programme supports effective screening, care and / or drug treatment, nutrition, crèche facilities, support groups, trained OVC Care Workers and partnerships between schools, outreach clinics and the Departments of Health and Social Development.

Maternal Health
Current statistics show that married and child-bearing women have a much higher risk of HIV in South Africa so early screening is vital to tackling and preventing life-threatening complications arising.  Prevention of mother-to-child transmission (PMTCT) is part of the overall programme. The immediate challenge is to strongly encourage women to screen early and deliver at Madwalweni Hospital or Xhora clinic, rather than at home, which is the tradition. Information, awareness and empowerment for this kind of decision-making are major challenges. Good ante-natal care requires staff to have the chance for professional development and training. In addition we need to find funds for patient emergency transport, which is non-existent at the moment and would yield the biggest single impact on the goals to ensure no mother or child goes without medical intervention during birth and lives can be saved.

Palliative Care
Palliative care includes holistic management of all life-threatening illnesses, emphasising the need for early access to these services in the management of these conditions. Palliative care services for children are non-existent in this deep rural setting. This programme is developing an innovative and creative approach to cope with rural needs, including a cross referral for specialist care where this is needed, or a rehabilitation programme where possible. The programme is proactive in that it provides an intensive-care, short-term stay unit to both treat immediate needs while ensuring that comprehensive home care is provided once the patient is discharged. When appropriate, terminal care is provided at home or in the hospital according to the patient’s needs.

Training and Professional Development
Essential to being able to ensure quality health services in the area in the future, is the need to upgrade the training and development opportunities so as to ensure a quality of life, skills empowerment, development for both the individual and the professional capacity in which they operate.  As part of the Department of Health’s ‘Revitalization programme’ at the Hospital, the Foundation assists with high quality recruitment for training and professional development, including specializations in the areas of  HIV, TB, maternal health, eye health, paediatrics, palliative and home-based care. A critical part of this strategy is a well equipped training centre for doctors, senior nurses, senior management and programme specialists, so that multi-disciplinary training can become the norm, as well as different on-line training be used to overcome distances and cost of centralized training.

Eye Health / Sight Restoration / Blindness Prevention
In the Eastern Cape alone, there are 30 000 avoidably blind people, due to cataract, a condition of ageing. Most of these live in rural areas. This process can be reversed through quick diagnosis, transportation to an eye health centre, and a 20-minute operation where the cloudy cataract is removed, and a perspex intra-ocular lens is inserted in its place. Bandages are removed 24 hours later, and sight is restored. The knock-on effects in the community include the carer - usually a school student - being allowed to return to school or participate in an active and productive working life (and the local economy), and the patient can now return to a productive working life and participate more constructively in the local community. The Donald Woods Foundation’s role in this process is to facilitate capacity-building, training, outreach and access for patients.

Food Security and Nutrition
Essential to the success of the Wellness and OVC programmes is access to nutritional food at an affordable cost. In this area there are severe logistical difficulties such as uneven terrain, lack of roads, little ground and rainwater harvesting – all of which are a major challenge to family health. Training will also be needed such as balanced crop planting, timing, maintenance and harvesting. The plan is to incorporate this training into the clinic and school activities to support OVC and TB programmes, but also for these systems to be replicated by individuals in their homes. In schools, the aim is for each child to ‘own’ his or her own 1m x 3m plot and the subsequent produce. Small-scale income generation will also be linked to the programme to provide food for the crèches and support group activities.