Community and Home Based Care

Home Based Carers

Our community-based care-givers are often called heroes and they are an inspiration. Many patients live kilometres from the nearest dirt road and so our care-givers walk up to 20km a day to reach them. Before the project began many patients had poor access to medical care as those in advanced stages of AIDS often cannot reach even a local clinic.

Recruited from the communities they serve and getting around by foot and bicycle, our care-givers are well-known and typically are approached for help by neighbours, community health workers or family when someone in their area becomes sick. Around 80% of our patients are HIV+ while others have cancer, severe stokes or other life-limiting illnesses. Our caregivers visit the family and give advice on how to care for the sick person, subsequently visiting regularly when required, and providing basic medical attention.

Ingwavuma Orphan Care has 42 trained community-based care-givers, covering 1500 square km. They are supported by five senior caregivers, three nurses, a doctor and a chaplain.

The care-givers visit around 1500 patients each month and provide crucial, dignity-building health care at an enormously difficult time for them and their family. Being trained AIDS counselors and ARV adherence trainers, their presence has lead to a markedly greater uptake of HIV testing as well as the numbers of people accessing ARVs. The caregivers are also trained in TB recognition and treatment support, First Aid and basic nursing care.

Palliative Care - Hospice Philosophy

Our nursing sisters, who are trained in palliative care, devote themselves to seeing the sickest of our patients. They follow the hospice philosophy of providing quality of life until death, dignity in death and support in bereavement. Patients are visited weekly by the nurses and medication given for pain control and other symptoms. We also provide incontinence pads, wound dressings and other nursing supplies.

Once a week we visit the local government hospital (Mosvold Hospital). The doctors and nurses refer patients to us who have been given the best medical treatment that is available, but are not responding to treatment. In cases like this, it is better for patients to be at home with their families in familiar surroundings rather than lying in hospital at risk of catching infections off other patients in the vain hope they will recover. We help assess their home circumstances and prepare the patient and their family for their discharge from hospital. If they are too sick to travel on public transport, we also take them home. We then visit the families regularly and give them support.

HIV Support Groups

As more of our clients have been restored to health through antiretroviral treatment, we have seen a greater demand for support groups. The groups have several purposes; a place where people living with HIV can meet and share together; they can gain greater understanding of their disease through watching the Beat-It treatment literacy course on DVD; some groups are starting up income generating projects and vegetable gardens in order to support themselves; the facilitators provide basic non-prescription medicines such as vitamins and paracetomol and also screen the clients for TB.

There are currently 21 adult groups and 6 children's groups for people living with HIV meeting monthly. The groups are facilitated by ex-home caregivers who have been promoted to this post. The children's group follow a purpose written curriculum which explains HIV and treatment in child-friendly ways through games, art and singing.

TB work

In 2008, we started to work more closely with people on TB treatment. 25 people, including some with multi-drug resistant TB (MDR) and one with extremely drug-resistent TB (XDR) met for a 3 day workshop where they learnt about TB and also shared experiences of diagnosis and accessing treatment. The group named themselves "TB pioneers" and decided to work to help their communities fight TB. Some have formed support groups for people on TB treatment, others go door to door educating their neighbours and checking if anyone in the homestead has symptoms. They also offered to assist in the hospital with collecting TB sputum and making sure that the results reach the clients promptly. However, to date the local hospital has not taken them up on this offer.

To protect our staff from TB, we train them about cough hygiene and good ventilation of homes and meeting places. We also offer them a course of Ioniazid to protect those who are HIV positive from TB. Staff are also given protective masks (N95 masks)to protect them. However these masks are quite uncomfortable to wear and clients may find it difficult to hear what the caregivers are saying.

Once every 3 months, we hold a TB awareness day in the community. We educate people about the symptoms of TB and teach them about the importance of taking their treatment for the full course (which is 6 months or more).