Nsambya Home Care - Activities

Activities

Nsambya Home Care offers services like;

• HIV testing and CD4 count
• Antiretroviral drugs and treatment of opportunistic infections
• Outreach programmes to patients and to schools and communities
• After care services to patients and provision of necessities like food every week.
• Behavioral change programmes especially in schools
• Training volunteers and counsellors to take care of patients
• Controlling stigmatization:

Children sick with HIV/AIDS are ostracized by family members, communities, schools and playmates who fear contracting the disease. They are denied play, stopped from going to school, used by own parents to ascertain own sero-status. Those who opt to take them up demand for blood check ups against the children's will. Children are always told lies about the kind of check up, counselling for Pre-test is always given to care-givers and not the real children, the sero-status is always discussed and known by relatives or care-givers and medical workers but not the children themselves.

The whole situation of counselling and testing children defy the issue of making an "informed decision" for the HIV test and the professional ethics regarding confidentiality. The patient's own consent on whatever is to be done on him or her is broken since the child's care-giver handles the counselling and caring that involves the child. The children's own stories about their feeling and problems they meet regarding HIV/AIDS are tested and counselling shared. The importance of disclosure to the child, confidentiality and information sharing concerning the child's sero-status are analyzed.

"Nsambya Home Care informs people about the spread of HIV/AIDS. Dr. Maria Nannyonga said that AIDS is spread mainly through having unprotected sex with an infected person. Secondly, she said the HIV virus is spread through blood transfusion. This still a big problem because some of the blood donated could contain the AIDS virus, but because it is still in its early stages (the window period), the blood still tests negative and then transfused into a patient.

The virus can also be transmitted from mother to child. This can be before, during or after childbirth. The virus can only be transmitted to an unborn child if there is a damage to the placenta otherwise an infected mother can give birth to a healthy baby. A baby on the other hand can get infected through breast feeding. The infected mother is thus expected to only bottle feed the baby since the breast milk contains HIV. AIDS can also be further spread through un-sterilized instruments like needles, razors, knives. This mainly affects traditionalists who are exposed to such objects especially during circumcision.

There is a general belief that one can be infected during the act of deep kissing. However, according to the doctor at the center, this is only possible if the uninfected person has a sore in the mouth or if that person swallows twenty liters of saliva of the infected person. Normal kissing usually does not carry those risks.

NHC teaches about the signs and symptoms of HIV/AIDS. There are major and minor symptoms. It also teaches about various ways of reducing the transmission of the HIV infection. Dr Erika Vlieghe a physician who previously worked at NHC writes *

"Monday morning, a rural district hospital in Uganda. A ward round through Female Ward. A 40-year-old woman has been brought in with diabetic coma. She is actually recovering while receiving insulin, but how to continue the treatment at the village? Two women in their fifties are recovering from another exacerbation of cardiac failure. For one, it is already her third admission since last summer. They complain of painful ascites and their failure to perform the household tasks. In the same room, three women aged between 25 and 45 are admitted with extensive and very painful breast tumours. They are very embarrassed about the deformities and the smell. The nearest place offering specialist care for cancer patients and radiotherapy is 400 kilometres (250 mi) away, through a war-ridden area.

In the next bed, an emaciated old lady has hardly been eating or drinking for the last 6 weeks because of an oesophageal tumour. In the afternoon, a 45-year-old women is found to have a locally spread tumour of the cervix. She thinks she cannot afford to go for radiotherapy, although the smelling vaginal discharge and the pain are really disturbing her. A young man is very uncomfortable with his legs swollen and knobbly because of Kaposi's sarcoma. He does not know he has AIDS. He hopes he can go back to the kraal soon. In the evening, an old man arrives from a place 100 kilometres (62 mi) away because of a painful hard swelling in his upper abdomen: a gross liver tumour.

Unfortunately, the needs of those chronically ill are not met by far in most existing health care services. If the illness has a treatable or stabilisable cause (e.g. diabetes, or some types and stages of cancer), often the treatment is not available, not maintained for a long period or not given in an adequate way. Thereby, little or no attention is given to the broader needs in chronic illness: follow-up, counselling, information and education, involvement of the relatives, social or material support, rehabilitation. It seems that in general, chronic illness does not fit in most of the existing services, as they are designed for acute and communicable diseases and for standardisable, short episode illnesses. In most programs and reports on health needs in sub Saharan Africa, chronic illness is not given adequate attention or the priority it deserves. There are several reasons for this lack of priority. Some are true, and difficult to resolve, but many arguments originate from misconceptions, myths and a reluctance to face changing health patterns in developing countries."