Importance of Staging HIV

When it comes to HIV, the aim of the game is to beat the virus by identifying it, attacking it, containing it and stopping it from progressing to the next stage by prescribing the right ARVs. Whilst only a small percentage of our kiddos at TTL are HIV+, we need to be on the lookout for tell-tale signs that their ARV meds are not working and thus that their HIV is progressing to the next stage.

Baylor Clinic at Mokhotlong Hospital

TTL staff in the Baylor waiting room
for the lecture to begin!

This is where the wonderful Dr Divin and his staff at Baylor Clinic at Mokhotlong Hospital come in. Dr Divin regularly holds lectures for TTL staff to keep us up to date on the latest treatments and research on HIV/AIDS and TB. We went to one of these special events on Tuesday 19th August and here is what we learned:

So, in a very small nutshell, HIV attacks proteins in our body called CD4 and this makes the body incredibly susceptible to infection. If we are able to identify the virus at an early stage we could save our clients a lot of pain, hassle and extensive treatment. So, what are these different stages and what do we need to look out for?:


STAGE I  This is a tough one to catch as there are hardly any symptoms. But if you have a constant cold
                  or swollen lumps on the face and groin then get the kid to a doc to get checked out!

STAGE II  A tad easier to notice. It normally affects the upper respiratory system and skin. So you need to
                   look out for sinus issues, easy bleeding, abnormal skin rashes or pox and big old swellings
                   on the face and groin. We've posted some pics of common HIV Stage II-related skin
                   problems.WARNING- They ain't pretty!

   

PPE- one of the Stage II skin infections.

STAGE III- This is where the virus starts to attack the poor lungs. We're talking Pulmonary TB, unexplained anaemia, moderate malnutrition, bacterial pneumonia and oral candidiasis. Don't know what oral candidiasis is? Look below for a lovely photo of how it affects the body..you're welcome.

Oral Candidiasis- Stage III symptoms

STAGE IV- We don't want to see this stage of the virus as it only means bad news. Bad news for the lungs, skin, eyes, blood. Bad news all over. Full blown TB, Meningitis, blindness in the eye, sores all over the body. You name it, this stage brings it.

This is why staging is so important. Like us against the virus in a game, we we want to stop it from getting to the final stage. If we can do that we can save ourselves a whole lot of hassle and time in a hospital.

Now, we are by no means clinicians. We would never presume to know how to diagnose a kid with HIV. However, if we notice these signs in any of our clients we now know to get them to a doctor as soon as possible.

We want to thank Dr Divin and his colleagues for their engaging and interactive lecture and we look forward to the next!

The Brit arrives in Mokhotlong!

Greetings from the gorgeously sunny Mokhotlong!

This is just a quick blog to introduce myself as TTLF’s newest fellow here in Lesotho. My name is Harriet Doughty and I’m an International Relations graduate from the UK. I studied in London for my BA but moved to The Hague, NL, to do my Master’s where I was predictably pulled into a world of international politics, food security and international aid.

The Brit touches down on TTL Campus!

I kept myself busy during my studies by working on a few projects. One was to help organise events, lectures and conferences hosted by Dutch Foreign Office, the UN, European External Action Services and Hague-based NGOs. I learned a lot from this experience and I look forward to applying that knowledge to supporting TTLF this year. The second project was to continue building and developing a Non-Profit I had helped to start in 2008 in a Peruvian prison. I was only 18 when we started the project so, as you can imagine, I met a lot of seemingly insurmountable challenges in attempting to start her up. It required a lot of (hastily-learned) skill in project management, communications, fundraising and income generating. But with a bit of time, help from good ol' Google and help from friends we got Maki International up and running and we now support almost 200 prisoners and their families through sustainable education and rehabilitation programmes. I'm excited to use this work experience to boost TTL’s online presence and to develop their income generating prospects.

First day in the Safe Home

I'm really looking forward to this year and I'm so chuffed that everybody here is so friendly and generous!

Hope to hear from you all as the year goes on!

Warmest wishes,

Harriet

It takes a village

VHWs at the Manemaneng Clinic greet TTL staff with song and dance.

An important role for any NGO is to strengthen their collaborations with local partners. TTL maintains partnerships with several different community groups, including hospital and clinic staff, local government officials, and other NGO staff. One of our most important partnerships is with the Village Health Workers (VHWs) who serve their home communities in rural and hard-to-reach areas across Lesotho.

VHWs act as the first points of contact for those whose access to health services can be challenged by remote locations and costs associated with transportation. In an effort to provide rural children and families with frontline health service, the Government of Lesotho has recruited a dedicated group of volunteers to provide health information and service recommendations for rural communities. VHWs are trained to recognize signs and symptoms of various common medical conditions, to counsel mothers on options to maximize healthy and safe pregnancies and deliveries, to monitor the health status of adult and child community members and to provide health service recommendations, based on level of severity, including urgent or non-urgent referrals to the local hospital or clinic. These Basotho men and women recognize the fundamental right of every person to access health care and health education, and they provide this service without compensation.

TTL supports the enormous efforts of the VHWs by providing monthly training sessions in alternating clinic catchment areas around Mokhotlong and Thaba-Tseka districts. By sharing critical health knowledge with the VHWs, TTL encourages them to react confidently and appropriately when consulted on child health situations in their communities. With an expanded knowledge base, VHWs can provide an enhanced level of care and identify health complications before they become acutely problematic.

                    

TTL Outreach worker M'e Mamosa introduces the training topics to the VHWs.

In July, a TTL-run VHW training took one TTL Outreach staff member, the TTL Managing Director, and a TTLF Fellow out to Manemaneng Health Clinic, about 2 hours away from the TTL campus. A group of almost 50 VHWs walked from areas near and far to attend and welcomed TTL with song. They then turned their attention to ‘M’e Mamosa, who explained in detail how to recognize the signs and symptoms of acute malnutrition in children under five. This training expanded on the one held in June for identifying acute childhood malnutrition by assessing anthropometric measurements using tools such as weighing scales, length boards, and MUAC tapes to measure Mid Upper Arm Circumference. The attendees were engaged participants and glad to part with improved knowledge and skill for taking on the task of preventing and monitoring acute malnutrition. Supporting the health of an individual child is not a job for the family alone - it really does take a village.

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TTL Managing Director 'M'e Nthabeleng Lephoto welcomes the crowd.

Champions of Change

In this update blog, Gargi pulls from her final project report to explain many of the new alterations to the Safe Home and Outreach programs. You can read about some of the initial developments in her first guest post.

The past month at TTL was all about changes. Target, Train, Track, Test - the 4 T's and public health mantra for implementing change - helped guide the recent programmatic developments. Of course, changes are not always welcome, but the case is different for TTL where staff welcome changes in the best interest of the children they serve.  If public health experts have their 4 Ts, then TTL has its 4 Cs: Care, Connect, Change, Champion. We witnessed all of these in recent weeks.

Improving nutrition in the Safe Home

Often the only sign of severe acute malnutrition (SAM) in children is appetite loss or reduction. Their shrinking bodies experience a disruption in metabolism that interferes with their appetite, which may lead to further starvation and death.

Fortunately, appetite loss is easy to identify. All it takes is a spoonful of peanut butter and a little patience. 

Using this basic appetite test, if the child eats a ‘good’ amount of peanut butter he or she passes the test and can be fed normally in the Safe Home. A failed appetite test indicates a need for more intensive medical therapy before 'food therapy,' and the child goes to the District Hospital with convincing evidence of metabolic distress. There he or she can receive appropriate medical support before returning to the Safe Home for round-the-clock care.

The Safe Home Supervisor implemented this appetite last month and now uses it diligently for all incoming clients.

Focusing on growth and development

As TTL staff had already received nutrition training, we determined which areas needed strengthening based on a role-specific assessment. From their responses, Outreach staff were trained on using aids to counsel caregivers on child growth and development, and the Safe Home staff were introduced to an enhanced monitoring and evaluation (M&E) system for recording food intake and health danger signs.

In the Outreach training we emphasized educating caregivers on the developmental milestones of child growth. With the help of counseling cards, Outreach staff learned to help caregivers assess whether their child’s development was on track and to provide examples of activities that support age-specific development. 

Similarly, for tracking Outreach client growth we introduced growth monitoring charts to plot the child's weight each month. The charts show the client's trajectory of growth over time and allow comparison against a normal growth curve. One Outreach worker also suggested pinning the growth charts on the walls of each client’s house so that caregivers could compare ‘how their child is growing’ to ‘how their child should grow.’

Everyone agreed that instead of discussing weights in arbitrary numbers, a visual aid (with spikes, plateaus, and dips in the child's weight) would aid discussion to identify episodes of illness or other reasons for the lack of weight gain. TTL staff could then tailor their counseling to address specific issues - whether diarrhea management, using TTL food parcels for optimum child feeding, or the importance of hygiene & sanitation. Eager to use the growth charts, some Outreach staff have started plotting weights of children in the Safe Home and are practicing their counseling skills on the Safe Home caregivers!

For the Safe Home training we took a slightly different approach. With the help of two Sesotho-speaking interns, we conducted a quick survey among the 13 caregivers to understand the difficulty and amount of time spent on record-keeping during day and night shifts. Overall, we found that Safe Home caregivers understood the importance of record-keeping and did not find it burdensome. They all reported that maintaining daily records, whether it was detailed observations of a client's behavior or noting every time a diaper was changed, was easy. The only time-consuming or difficult activities were feeding fussy eaters or attending the doctor’s questions during health check-ups. (Of course the favorite activity was playing with the kids!) Encouraged by the survey results, we then piloted new M&E forms to monitor individual food intake and health danger signs.

In their monthly meeting, the caregivers discussed activities that some of them found difficult: for example, strategies to feed fussy eaters and time management tips to avoid wasteful activities. During this peer learning exercise, we oriented them to the new forms, which contain additional monitoring steps to provide more expert support to the Safe Home clients. The caregivers have already started charting individual food intake and health parameters flawlessly! They even reported that they now feel as knowledgeable as the hospital nurses. And should any problems arise, they know they can just ask each other for help.

Guest post by Gargi Wable, Nutrition Consultant for TTLF, who recently finished up work for a TTL grant from UNICEF.