Tiyatien Staff Preparing for the Day
Cultural Dance Show
HIV/AIDS Photo Exhibit
A Captive Audience
Educational SkitsSaturday, March 21, 2009
HIV Awareness Programme
Today, Tiyatien Health and UNHCR co-sponsored an HIV Awareness Programme in Zwedru. The day long programme started with a march to City Hall with the community. At City Hall, educational skits were presented. A cultural dance show was performed. Key HIV/AIDS leaders spoke, and a photo exhibit was shown. This afternoon, two local high schools will battle in a football (i.e. soccer) match. Below are some photos by Gia:
Cultural Dance Show
HIV/AIDS Photo Exhibit
A Captive Audience
Educational Skits
Cultural Dance Show HIV/AIDS Photo Exhibit A Captive Audience Educational Skits
Friday, March 20, 2009
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.
Medical Records at Fish Town Health Center
Inpatient and Outpatient Pharmacy
Pediatrics Ward (3 beds)
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.
Fish Town Hospital
Fish Town Health Center
Medical Records at Fish Town Health Center
Inpatient and Outpatient Pharmacy
Pediatrics Ward (3 beds)Thursday, March 19, 2009
Celebratory Palm "Wine"
Today, Gia and I went to the hospital to say goodbye to our wonderful nurses, nurse aides, and staff that have been so gracious to us. Our male ward nurse, Sangai, arranged for a bottle of palm wine to be delivered to the hospital via a local palm wine “chief.” Palm wine is tapped from the tree, and it is only found in the villages and not in Monrovia. We couldn't figure out if there is any alcohol content since they call it "wine," but it tastes slightly sour and fizzy. Liberians tell us that Palm Wine makes you strong. Gia and I were so excited that we were able to share our first taste of this special drink with Sangai and our nursing staff.
Palm Wine
Nurse Aide, Lindsay & Sangai
Sangai drinking Palm Wine
Nurse Aide, Sangai, and Gia
Palm Wine
Nurse Aide, Lindsay & Sangai
Sangai drinking Palm Wine
Nurse Aide, Sangai, and GiaNew Midwifery School in Zwedru
Gia and I visited the new MacBain-sponsored/Merlin Midwifery School today.
The school has enrolled its first class that consists of 45 students, including 8 males (only the second time that they have allowed males into midwifery school!), with a range of ages from 18 to 43 years. Students are recruited through an extensive process, including submission of high school diploma, transcript, taking an entrance exam, and completing an interview. Once accepted, they do not pay for tuition or fees, and they are provided a dormitory and monthly stipend for food and incidentals (80 USD per month).
The program is 2 years. The students are in class from 8 AM to 4 PM Monday through Friday. During their first semester, they study anatomy, physiology, introduction to nursing, psychology, English, and math. During their second semester, they study pharmacology and start doing practical experiences at the hospital. They then get placed at local hospitals or clinics for practicum. After they graduate, they are required to stay in the Southeastern Liberia region for 3 years in return for their education. Their expected salary upon graduation is about $80 USD/month, but hopefully, this may increase to $110 USD/month. This system is very similar to the National Health Service Corps in the US.
The midwifery school shares facilities with a local high school located in Kudah Bye Pass, while they await construction of their own school on Monrovia Highway next year. They have a well-stocked library with nursing and medical texts. They also have a skills lab with models of the women reproductive system as well as a model arm to practice blood draws on. There are two main instructors who both hold bachelor's degrees in nursing.
Overall, this program will hopefully encourage midwives to stay in southeastern Liberia where there are so few trained midwives It would be awesome if this could be replicated with Physician Assistants, RNs, and Physicians in SE Liberia to improve the medical education system and the retention of medical personnel.
Model Venipuncture Arm
Female Reproductive System Models
Midwifery Students
Curriculum
The school has enrolled its first class that consists of 45 students, including 8 males (only the second time that they have allowed males into midwifery school!), with a range of ages from 18 to 43 years. Students are recruited through an extensive process, including submission of high school diploma, transcript, taking an entrance exam, and completing an interview. Once accepted, they do not pay for tuition or fees, and they are provided a dormitory and monthly stipend for food and incidentals (80 USD per month).
The program is 2 years. The students are in class from 8 AM to 4 PM Monday through Friday. During their first semester, they study anatomy, physiology, introduction to nursing, psychology, English, and math. During their second semester, they study pharmacology and start doing practical experiences at the hospital. They then get placed at local hospitals or clinics for practicum. After they graduate, they are required to stay in the Southeastern Liberia region for 3 years in return for their education. Their expected salary upon graduation is about $80 USD/month, but hopefully, this may increase to $110 USD/month. This system is very similar to the National Health Service Corps in the US.
The midwifery school shares facilities with a local high school located in Kudah Bye Pass, while they await construction of their own school on Monrovia Highway next year. They have a well-stocked library with nursing and medical texts. They also have a skills lab with models of the women reproductive system as well as a model arm to practice blood draws on. There are two main instructors who both hold bachelor's degrees in nursing.
Overall, this program will hopefully encourage midwives to stay in southeastern Liberia where there are so few trained midwives It would be awesome if this could be replicated with Physician Assistants, RNs, and Physicians in SE Liberia to improve the medical education system and the retention of medical personnel.
Model Venipuncture Arm
Female Reproductive System Models
Midwifery Students
CurriculumWednesday, March 18, 2009
Thank You to Our Liberia Staff
Gia and I are in the midst of preparing for our impending departure from Zwedru. We have been so thankful to work with our dedicated, passionate Liberia Team, and we expressed our appreciation with a celebratory dinner at the UN Logistics Base. Here are some photos from that night:
Amos and Alphonso
Neewray
Amos and Alphonso
NeewraySunday, March 15, 2009
Saturday, March 14, 2009
Translating Office Visits to Data Collection
The HIV Equity Initiative (HEI) Clinic has enrolled almost 300 patients since 2007. With each visit, a plethora of information is collected, including weight, WHO Clinical Status, medication information, adherence, and more. Currently, the clinic used paper charts, and this has been working remarkably well given the infrastructure limitations. However, Tiyatien Health is moving towards an electronic database that will collect this information so that statistical information and data can be at our fingertips.
While Gia and I have been here in Zwedru, our colleague, Dr. David Kraemer at Kansas Wesleyan University has been working countless hours to make and refine a database for our HEI Clinic. With this database, each clinic visit will be recorded, accurate (no more messy handwriting!), and stored on a computer for easy access and retrieval. The database will also make it easy to provide summary statistics to our partners, including the Ministry of Health and the Liberian National AIDS Control Program, as well as help identify gaps and strengths in our program. It will allow us to perform research for dissemination and show the international community the success a local NGO like Tiyatien Health can do in a short time.
Gia, Dr. Kraemer and I have been in close contact during the last few weeks, spending hours on Skype and exchanging many emails, about making this database user-friendly, applicable to our clinic, and sustainable. We hope to recruit research assistants this summer to help us implement the database so that our Liberian Team has this powerful tool to help further our ability to care for our patients in the best way possible. Tiyatien is growing leaps and bounds, and we are excited to be a part of this very important process.
While Gia and I have been here in Zwedru, our colleague, Dr. David Kraemer at Kansas Wesleyan University has been working countless hours to make and refine a database for our HEI Clinic. With this database, each clinic visit will be recorded, accurate (no more messy handwriting!), and stored on a computer for easy access and retrieval. The database will also make it easy to provide summary statistics to our partners, including the Ministry of Health and the Liberian National AIDS Control Program, as well as help identify gaps and strengths in our program. It will allow us to perform research for dissemination and show the international community the success a local NGO like Tiyatien Health can do in a short time.
Gia, Dr. Kraemer and I have been in close contact during the last few weeks, spending hours on Skype and exchanging many emails, about making this database user-friendly, applicable to our clinic, and sustainable. We hope to recruit research assistants this summer to help us implement the database so that our Liberian Team has this powerful tool to help further our ability to care for our patients in the best way possible. Tiyatien is growing leaps and bounds, and we are excited to be a part of this very important process.
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