Tiyatien Health & HIV Equity Initiative: Performing a Needs Assessment in Fish Town

On March 17-18, Weafus, Tiyatien Health’s Project Coordinator, and I traveled 80 km from Zwedru to Fish Town, the capital of River Gee County. River Gee shares the southern border of Grand Gedeh County. Tiyatien Health visited Fish Town in November 2008 to perform an initial needs assessment for possible expansion of our HIV/AIDS services to this area. This was our follow up visit to determine whether any improvements had been made to the health care system and to further define the role Tiyatien Health could play in this community. Our visit was facilitated in large part by the UN Military (UN MIL), who play a significant role in most towns and communities in Liberia post-civil war.

Weafus and I visited the Fish Town Health Center and the still unfinished Fish Town Hospital. The Hospital continues to stand without proper completion of construction. It was to hold about 30-40 beds, an operating theatre, a pharmacy, laboratory, and stock rooms. Currently, the rooms are largely empty except for a delivery room and 1 room for antenatal care. Otherwise, since the Hospital is not operating, the inpatient wards have been moved into the Fish Town Health Center.

The Health Center holds 6 inpatient beds: 3 female, 1 male, and 3 pediatric beds. The Health Center sees approximately 700-1,000 patients a month with a staff of 1 Nigerian physician (who is the only physician serving in all of River Gee County), 1 Physician Assistant, 2 certified nurse midwives, 3 registered nurses, 1 lab technician, and 1 lab assistant.

As Tiyatien is considering expanding its services to all of southeastern Liberia, we found that Fish Town is completely lacking HIV/AIDS services. While HIV testing and counseling are performed, the clinic has no access to anti-retrovirals and cannot provide any treatment for patients with new diagnosis. Because of this, community members do not see a reason to get tested for HIV/AIDS as there is no further step after diagnosis for them. Instead, if a patient is diagnosed, they are referred to Martha Tubman Memorial Hospital, which is a 3 hour drive from Fish Town. Unfortunately, most patients are then lost to follow-up. Alarmingly, last year, Fish Town Health Center had 28 new diagnoses of HIV in pregnant patients. If you perform the math, this means that 28 women have HIV, 28 infants and at least 28 male partners have been exposed to HIV. This totals 84 people who are likely affected by HIV/AIDS in 1 year and are lost to treatment and care! It is a shame that anti-retrovirals exist, but so many patients do not have access to these live-saving medications due to poor infrastructure and poor health care systems.

Weafus and I also visited with all of the non-governmental organizations doing work in Fish Town, including German Agro Action, Medical Mondiale, and Dakonie/Community Union for Sustainable Development. Our aim was to share our mission with these local NGOs as well as to identify possible areas of partnership with them. For example, Dakonie/CUSD has a public health program that trains community members to educate others on basic hygiene practices and treatment of diarrhea in the villages. Tiyatien has a similar program in our accompaniers who are focused on HIV/AIDS treatment. If Tiyatien is to work in Fish Town, it seems that a collaboration between Dakonie/CUSD’s community health workers and our accompaniers would be fruitful in that both can train the other on their areas of expertise to provide a more effective and educated community health worker and accompanier.

Weafus and I will be writing a report on our visit and will make recommendations for Tiyatien’s possible foray into River Gee County. Overall, our visit to Fish Town was very productive, and it left us with the intense feeling that Fish Town could very much benefit from an HIV/AIDS organization like Tiyatien.