Tessa14: New Adherence Project and Hlane Park

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Now that the new volunteers have taken over most of the WFP duties, I’ve been free to work on the new adherence project with Tina. Some background info about outreach… Baylor sends doctors to Good Shepherd roll-out clinics. These are clinics that are located in rural villages and treat mild ailments. But once a month, Good Shepherd (the hospital in the Lobamba region of
Swaziland) sends nurses to distribute to the HIV patients there. The Baylor doctors accompany them to see the patients, assess their health, and assess their drug regimen.

Good Shepherd uses a certain form to record the adherence of each patient. It basically has a place for counting the pills and then a place for a general assessment, but the adherence percentage is never calculated. Also, no recommendations concerning the adherence level are made. Tina gave me a new form to edit and test out in the field. This form makes it easy to calculate the adherence percent and make an appropriate recommendation (ie: continue ART, see an adherence councilor, refer to doctor, put in “high risk adherence failure” group, etc.)

Before I went to the outreach clinics, I edited the sheet to incorporate the system they use now and to make it visually resemble the form they use now. I figured the fewer changes they had to make, the more likely they would be to change. The first day we tried it out was Tuesday. Tina explained to the Good Shepherd adherence councilors what I was doing. One of them I’d met before and was happy to help me out, but the other one was initially very resistant. So I spent the first day filling the sheets out myself along side of them as they filled out their sheet. This gave me a chance to get to know the new councilor better. Also at the end of the day, they looked at it with me and gave me input about what they thought worked well and what needed to be changed.

Today, only one of the councilors was there. She was much more receptive and friendly today, and she actually had to use the forms for the last 10 or so patients since she ran out of her own forms. That gave her a chance to actually use and see what she thought about the new adherence sheet. Once she got the percentage calculations down, she seemed very pleased and asked for extra copies to take back with her to the hospital.

One other change, which I think will be much more difficult to make, is to get her to ask the patients why they took so few or so many extra pills. Sometimes—depending on her mood and on the patient—she just filled out the form and said nothing to the patient, even if their adherence was horrible. Thus, the patient had no idea that he/she is doing anything wrong. Having said that, she was also much better at counseling (more like scolding) them than the other councilor I met at the Vuvulane clinic.

Anyway, it’s turned out to be a very interesting project, and I’ve gotten to see much more of
Swaziland during the drives to and from the clinics. This past weekend was pretty fun as well. I went with David (not Dave Dallas but another visiting scholar) to
Hlane
Game
Park. It turned out to be quite the adventure when our cab driver took the wrong turn and we ended up driving on a bumpy dirt road through a huge sugarcane plantation, by an ominous looking factory, around the entire game park, and eventually reaching the entrance from the other direction. Luckily the sunset safari was running late, and we made it just in time. Our luck increased exponentially over the next two hours as we saw almost every animal they have in the park (we didn’t see cheetahs or leopards) which included some giraffes, elephants, rhinos, and lots of lions.

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