Reflections on Home Visits with Accompaniers

November 18, 2007


Accompaniers form the backbone of Tiyatien Health and the HIV Equity Initiative here in Zwedru. Accompaniers, selected by neighbors or loved ones with HIV, are trained by Tiyatien and MoH staff to provide “accompaniment” to AIDS patients and their families through: daily delivery of life-saving antiretroviral medications; moral and psychosocial support; delivery of food packages; direct links to the health center in cases of illness, side effects or toxicity; education on HIV/AIDS. They also serve as a link for any sick individuals living in communities they serve.

This morning, I joined one of Tiyatien’s accompaniers, Plugbe Dweh, on his daily home visits to deliver life-saving antiretroviral medicines to AIDS patients. Most care for the destitute sick, of course, occurs in the home rather than the hospital. So, home visits are enlightening. They teach about patients, their families, their life histories, their hardships, as well as their hopes. Dweh and my visits this morning were no different.


Home visits to Nancy, Susy and Victoria

I left my hospital-based lodge at daybreak and met Dweh at 7:00am in the center of town. By 7:15am, we reached Nancy’s home. She lives in a white, tin-roofed hut with walls embedded by multiple bullet holes – stark reminders that Liberia’s brutal civil wars were all too recent. Dweh called for Nancy’s mother, who escorted us through the brown curtain overlaying the entrance to Nancy’s room. The sunlight piercing through the room’s single window hardly brightened the dark, murky interior.

Lying in her bed, Nancy stared up at us with a smile. She is a frail young woman, only a few inches above 5 feet in height and weighing only 60lbs. Her thin, tan-colored skin drapes tightly around the contour of her ribs and clavicles. She did appear a bit stronger than when I admitted her to Tubman Hospital, six weeks earlier, for severe anemia and a fungal infection in her mouth. Now, she was barely able to rise out of her bed on her own.

Nancy’s life has been plagued by tragedy. Born in Liberia’s capital, Monrovia, Nancy was displaced with her family into camps at the start of Liberia’s civil war in 1990. Although theirs was a large family – Nancy was one of eight children – a vicious cycle of disease, violence and poverty had claimed the lives of many loved ones. Her father was ill when war first hit. With fighting in the streets abound, food quickly became scarce. In the middle of it all, Nancy’s mother said, her husband starved to death.

Illness and war had other terrible effects. Four of Nancy’s seven siblings had died. Measles and diarrhea had killed two of them in infancy. One died at the age of eight when shrapnel from a rocket became embedded in his abdomen. The other died soon after a complicated birth.

As AIDS began to claim Nancy’s life, her mother made the decision to move to Zwedru, home of Tubman Hospital, which provided services free-of-charge thanks to support from the Ministry of Health and Merlin, a British relief agency. She is relieved that the correct diagnosis has finally been made. And treatment is providing hope, with Dweh standing by her in solidarity. He delivered her HIV medications to her during our visit, as he does everyday. This week he also delivered a food package filled with oil, corn soya-blend, bulghar wheat, and salt. We scheduled an appointment for her in two days and left with her some money to pay for transportation to attend clinic.

We left Nancy’s place at nearly 8:30am and walked about four miles to see two more of Dweh’s patients. We stopped to deliver medicines to Susy at 8:53am and to Victoria at 9:20am. Fortunately, having been on antiretroviral medicines and cared for by Dweh for many weeks, they were now both relatively well.
Dweh’s solidarity with his patients can only serve to inspire. He and his fellow accompaniers are providing life-saving care here in southeastern Liberia, the country’s poorest region.

Accompaniers are on the frontlines of a movement that seeks to prove high-quality care for complex diseases can be delivered even in the world’s most impoverished regions.