Leveraging HIV Treatment to Strengthen Primary Healthcare and Other Rights

November 19, 2007

Some have critiqued HIV treatment programs for being narrowly designed – even directing a disproportionate amount of “limited resources” towards one disease at the expense of others. As Paul Farmer has argued (see Foreign Affairs), this is only the case if treatment programs are not designed effectively.

With the aim of promoting equity, Tiyatien Health seeks to leverage “marvelous momentum” for AIDS care to strengthen primary healthcare in general. We have found that even modest interventions can help result in healthcare for all. For instance, all of Tiyatien’s accompaniers are asked to bear responsibility for tending to any sick individual in the communities where their AIDS patients live. Following this principle, 17 accompaniers found nearly 150 sick individuals in communities around Zwedru, during home visits to AIDS patients. All were referred to clinic and some of these people were found to have and treated for life-threatening illnesses like tuberculosis, severe anemia and malaria. Some may have otherwise have had delays in diagnoses, possibly leading to death.

In addition to visiting three AIDS patients on Sunday morning, Dweh and I were able to facilitate uptake of primary healthcare for four other sick individuals with a range of conditions including quadriplegia, respiratory infections and malaria. We also found “Papa Joseph”, a man with liver failure, who had been unable to attend a follow-up visit (due to cost of transportation to the hospital) after being discharged from the hospital last month. He was in a critical condition. His failed liver had led fluid to slowly reaccumulate in his abdomen – causing it to distend as tense as a soccer ball. We found him in his home, lying on a mat on a dirt floor, unresponsive. We called for an ambulance and he is now at Tubman hospital receiving acute management.

Home visits with our accompaniers remind of the importance of Tiyatien’s work in rural Liberia, where AIDS isn’t the only disease afflicting the poor.

Some have asked whether Tiyatien’s accompaniers get tired as some walk for long distances on a daily basis to reach their patients’ homes. When I think of accompaniers and their patients, I am reminded of Mahatma Gandhi’s wisdom, who after leading long marches to promote freedom and justice during India’s revolution, said: “My feet may be tired, but my soul is rested.”

Tiyatien’s accompaniers are carrying on the march towards justice in Liberia.