Patient adherence to HIV treatment and prevention in the Centre de Santé Communautaire de Sikoro, Bamako, Mali
TOUNKARA Karamoko, KONE Youssouf, KOTY Zoumana, ABOUBACAR Ben, WERWIE Timothy, DE GROOT Anne S.
Blog
The data speaks for itself
Binny Chokshi’s TB Bolo Update
Protocol:
We submitted the protocol to Dr. Flabou last wednesday. He emailed back with comments early this week, the most important being that we needed a signature from the Chef de Vilage of Sikoro and the Mayor. Once we fixed it up and got the signatures, Dr. Flabou told us to bring the protocol directly to the Faculty of Medicine (at Point G) which we did today. We met with the guy who seemed to be in charge of the Commite de Etique submissions, and he told us many things that we had not heard before. The two most important being 1.) We need to submit the protocol by Tuesday, in order for it to be seen that Saturday. This means that we will not go to the Committee until next Saturday July 26th. 2.) The cost of submission to the committee (as i think karamoko has written) is $500+. (S#e^%*Fge&^bK)!!!!!
Peer Educators:
We met with them last week, as I had emailed. It was a great productive discussion, that resulted in the decision to have a salary increase for the two month pilot period. We are meeting with them again tomorrow with a few goals in mind: 1.) To let them know that the budget was a go, and salary increase approved. 2.) To go over the curriculum with all 11 educators in French/Bambara, 3.) To go over the logistics of the TB BOLO project (specifically those that make it different from here Bolo, i.e cough questionaire, active screening for at risk patient) 4.) Introduce them to Salimata, from the clinic, who handles all the TB cases in Sikoro. We have asked Salimata to explain to the peer educators the process of a Tb patient in Sikoro, where to get tested, where to get meds, who administers meds, etc.
Binny Chokshi’s Week Two Report
Hello—
Last Monday I went to Point G and “shadowed” Dr. Diallo (so handsome! Haha.) I sat with him in his office as he saw patients for the morning. He’s definitely got a mix of visits. The next day I went back and rounded on the TB floor with the medical students and Dr. Patrice. He’s wonderful, does research (Ousmane is his ultimate boss) on HIV and TB and is looking at cytokine levels at different time points. His English is great, and he was very nice to make sure to explain the important points of each patient to me. In fact, if I was ever out of sight all of a sudden I would hear “Where’s Bin-Tu?” He heads the TB rounds to keep up with clinical medicine. I think he’s a great person to have be connected with GAIA, because he’s a little less busy than the big wigs, he’s much more accessible and willing to help. He spent over two hours with me a few days later looking over the TB curriculum suggesting small but helpful changes (i.e people in Mali don’t know what stress is, therefore they won’t really understand that its connected to active TB, haha.)
Binny Chokshi’s Week One Report
Most of the past few days was spent shaping up the TB curriculum and with a lot of sophies help we translated it into French. We decided to lessen the emphasis on co-infection in light of stigmatizing hiv and/or tb patients.
Sophie did a great job of presenting the curriculum to the Peer Educators yesterday. We met with them for approximately an hour (they gather the last friday of every month at the gaia house to get their pay etc.) We had printed out copies for them to share. Sophie engaged one of the peer educators to read the curriculum aloud (& translate into bambara) which was very helpful. Some were more receptive than others, asking questions etc, but everybody seems to have an interest. Karamoko chimed in often to clarify some medical terms (such as resistance, bacteria, etc.) A major question that came up was how kissing individuals with Tb can be allowed. I’m going to do some more research so that we can present this information more clearly. Most took a copy home with them and are going to read it over and prepare any questions that they have, which we will discuss when we meet with them next Friday.
Hope Center Clinic Ribbon Cutting Ceremony
Just a few days ago, we participated in the official opening of the Hope Center Clinic. This long awaited event represents the culmination of much effort by the GAIA Mali team (Karamoko Tounkara in particular) and the ASACO (led by Mr. Guidé Diarra), who deserve our congratulations for the work accomplished. The clinic also represents action made tangible: since we believe that putting HIV medication at the reach of a patient’s hand, in their own village, and that the only way to put an end to AIDS is to do that everywhere that AIDS exists, world wide, we can say that we have put our thoughts and beliefs into action and we have accomplished our goal.
It was a glorious occasion. There were speeches, there were certificates provided to the women and men who helped found the clinic, and Sophie and I received Chiwaras (antelope sculptures), a sign of the highest recognition in Mali.
Today in Sikoro–or Any Place on Earth
For pictures
http://web.mac.com/dr.annie.degroot/iWeb/Site/Bamako%20June%2015.html
But start with the words – the simple words of a doctor speaking to a patient, a very thin woman in a yellow headscarf, who is 28 years old and who waited for over two hours to have her turn in his office today. A small child sits quietly in her lap. The doctor asks her some questions. She speaks softly, coughing as she is answering. A medical student looks at her lab results. She has 20 T cells. He asks her if she had ever been given medication before, and she says yes, but it was a long time ago, and the medicine had run out. The doctor pauses, considering what to do. Her life is in danger, but she has no money to pay for emergency treatment, and the hospital is far away.
Words for World AIDS, December 30 2007
On that Day, I will remember, I will not forget.
I will remember, and you will too, the sound of mothers crying over a lost child. I will remember, and you will too, the quiet look of desperation in the young girl who now knows that she is HIV-positive. You and I, we will not, we cannot forget the children left abandoned by the death of their parents. We cannot forget the children left in the care of the grandmothers. We can not forget the grandmothers who were the last ones standing. I will remember, and you will too, the lines of patients at the clinic, and our long talks with them, and the slow handfuls of pills that kept them alive, day by day, day by day. We will not forget, we will, we providers, all remember how few of our patients had medicine, how many could not get the test, or the x ray, or the pills.
Donkeys in the Courtyard
There was a donkey in the courtyard that night. The donkey stood, calmly chewing its cud, in the corner. I could see him behind the chief, out of the corner of my eye, behind the two counselors sitting with the chief on his purple plastic prayer mat. I sat listening to what they had to say, listening to the back and forth of French and Bambara. The donkey chewed quietly. The sky was full of dust. The courtyard was full of straw and dirt. The children were clustered at the chief’s feet, listening to us speak. There was a French to Bambara, Bambara to French rhythm that sounded like prayers.
We were talking about what Brown University students found when they came to work in the clinic in Sikoro, this summer. Besides the women who were too poor to pay the five dollars to deliver their babies in the clinic, besides the children taking care of children, and besides the lack of clean water and food, the students found that the women of Sikoroni wanted desperately to learn. To know more. To find out about HIV. To talk about it. And they made songs that they sang and the students captured those songs on film. They sang about the children begging on the sidewalks, about the poverty bringing HIV to Sikoroni. One of the women named Bintou made a song about what she learned. She sang about the girls ‘walking alongside the road” and the HIV that they bring home. That’s the song that I played to the chief from my shiny metal laptop with the large screen. I played Bintou’s song.
Heros
I am sitting on the outbound from Bamako to Charles de Gaulle and thinking about what might have been the most amazing event that happened anywhere in the world today – the fact that Mark at Labtracker received an email from Maggie who was sitting in GAIA’s Hope Center clinic in Sikoro, Mali, working on the “donated” computer. The internet worked! Maggie asked Mark gently, politely for help from a place as far away from Ground Zero as one could possibly be. You are my heros today. You are.
If I give you the visual picture (or you can see it yourself using google earth at the northeast corner of Bamako, Mali) perhaps you will see why I am so amazed and thrilled and ecstatic – look and you would see mud, and dogs underfoot, and the rocks in the stream bed that we call the road in front of the clinic, and abandoned stuff, and happy kids (picture attached), and the worn desk that the even more worn computer sits on, and the patients patiently waiting
Postcard from Dr. Annie DeGroot
There’s much that can be said in a sidelong smile. That’s what I had from Fanta Siby Diallo, the head of the DRS (Direction Regionale de la Sante) today at the end of our meeting, where we finally were given the OK to proceed with building our clinic. As she said, she’s really not the building expert, and she advised us to consult some, but she didn’t see why we couldn’t just get started! Words sweeter than honey, if you ask me! Of course, we agreed that the DRS would also get involved in doing a “survey” of Sikoro sometime in the future, and that Tounkara, our director, would come in and work on the survey with the team at DRS, and I told them we’d have to put it in the budget, but don’t hold your breath – what’s important is that we have a green light to proceed. Success! The groundwork laid by Sophie, and the hard work of Tounkara – when you think that we were at the bottom of a deep dark hole just in April (only 17 patients, no formal paperwork, a director that was to be fired, and Mme Diallo at the end of her rope). Thank you Sophie, thank Tounkara, thank you board for your patience as we worked this through. We have the “paper” we have the “green light” we’re going to meet with Guide and the Mayor of Commune 1 before I go, and if all goes as planned, we’ll be starting to build the Hope Center clinic on September 1. Hence the smile, and the comment by our most wonderful Diallo who has been our guardian angel over the past months – “we women need to stick together”. A sidelong smile, and a hug. We’re blessed. As Sophie would say “Champagne!”. or was it “Chapeau!”. I say BOTH!
Meanwhile we’ll be working on a Plan D’Action that will need to be approved by the DRS and the CSLS about the HIV care we’re providing, and we’ll work with the PNLTB on our plan to do cough monitoring. Data is getting entered slowly – Maggie has surmounted massive computer problems and downloaded a new version of Labtracker across that electronic smear that is the internet stretching between a very wet Bamako and Ground Zero right in the Haight. What possibly could be more perfect than that? I can see the bits and bytes streaming right out of the great big glass windows of Dan and Mark’s office overlooking the epicenter of AIDS in San Francisco (from years past, having shifted to this side of the globe, since then), circling once, before they take off towards the East, flying over a Providence that is shutting down for the day, and the wind whipped ocean, and the storm crossed Sahel, and around our mango tree, and into our garden, and into the blue plastic linksys box that Matt bought for us . . . Labtracker is here, Maggie has the data, and as I sit here (next to the dog, who is quietly ecstatic to be lying next to me on the couch) I can see her across the room typing furiously. . . Thank you Labtracker, and Mark and Dan – if all goes well, and the red rivers of mud do not keep us trapped in our garden, we’ll sally forth tomorrow to feed data into the computer and tell you all about the results.