Pediatric HIV Group Reflection

Academic:

The Pediatric HIV group (Toni, Anastasia, and Victoria) have had much exposure to HIV/AIDS in the classroom, but the opportunity to observe and interact with those closely working with the disease was indispensable in expanding their knowledge. When first going out to explore HIV/AIDS in Uganda, we were all thrilled to have the opportunity to study the disease in a place with such a high prevalence; however, we didn’t realize the similarities we could draw, despite our cultural differences. From talking to health professionals to researchers, we were not only able to learn more about this widespread disease in Uganda, but were also able to create parallels within our own country. As related to Baltimore, the quality of care is directly related to your income as well as your place of residence, specifically comparing rural and urban areas.

Pediatric HIV Group exploring Kampala

               When beginning to learn about HIV/AIDS, we realized that the disease is highly stigmatized in Southern Uganda because the social implications for having such a disease are associated with promiscuity and immorality to mention but a few. This social stigma has put major health access restraints on children who have inherited the disease. In Uganda, Pediatric HIV is predominantly transmitted from a pregnant mother who is HIV positive during birth or through breastfeeding. The overall health of HIV positive children is highly influenced by the disease; it weakens their immune systems and makes them increasingly more vulnerable to common diseases such as malaria, diarrhea and pneumonia. Because social stigma is such a concern, women sometimes hide their child’s status, not disclosing it to teachers, doctors or even fathers due to fear of discrimination, which directly affects a child’s ability to get the proper care. This was evident when we visited the pediatric ward at Kalisizo Hospital in Rakai. Rakai is a rural district of Uganda, which has had a high prevalence of HIV/AIDS. We were astonished to learn that although every child was required to be tested for HIV before treatment, some mothers would deny their status or even leave the hospital to seek traditional medicine. There was also a lack of drugs and a shortage of staff throughout the hospital. This hospital was unlike any we had ever seen:  the undivided beds in the wards and healthy children playing amongst those in critical condition were disheartening. It was an overwhelming day after seeing the major advancements and research being done by the U.S. donor-run Rakai Health Sciences Program (RHSP) a few blocks away. Since the creation of the RHSP in 1988, it has had major strides in managing the HIV/AIDS epidemic. We were astonished to see how this program’s research and involvement in the community has been wildly beneficial in more ways than providing proper health care. Through our visits with our homestay families, we were able to see the respect and value the Rakai residents had for the RHSP. Some of our host families were employed by the program for 20 years, and others were grateful for the free and easily accessible treatment their families received. Through our independent study, we found out that the key aspects of managing such a debilitating disease include education that this disease can happen to anyone, proper treatment through administering drugs and offering counseling, and encouraging prevention through contraception use. By looking at such a rural area’s advancements in HIV/AIDS treatment and prevention, we were able to see the progress that can be done. This however, is not indicative of all rural areas of Uganda. A rural village called Toruwu, which we visited earlier in our trip, was a better representation of the discrepancy of care between rural and urban settings. From brief visits with the families that lived there, we found out that the nearest health facility was in Mulago, which is 15 km away. Many children with HIV are usually unable to get the proper medical care because many are either orphaned or abandoning them with grandparents who are physically unable to walk these distances. Despite the lacking care in the rural areas, there are increasing advancements in the city, which shows how far this country has come in decreasing the prevalence of HIV/AIDS.

After visiting Kalisizo hospital, we got a chance to experience pediatric health care at Mulago hospital situated in Kampala district, an urban center. Mulago hospital is one of the national referral hospitals in Uganda, it receives patients from different parts of the country that come for treatment for various kinds of diseases. At Mulago hospital, we visited a foundation created by Makerere University and Johns Hopkins University entitled MU-JHU that was set up to improve the health status of families living with HIV or affected by it. This foundation has carried out research concerning HIV/AIDS which has provided information on how best to prevent the HIV epidemic especially in the area of mother to child transmission; it has also set up a community based approach in controlling and handling HIV so that HIV no longer becomes an individual issue but a community issue. This has been done by encouraging HIV positive individuals to come with their partners for testing and counseling and by providing treatment and health care for all HIV positive individuals in a family. The information from the research carried by the foundation was instrumental regarding treatment options for prevention of mother to child transmission of HIV/AIDS.

Poster at Kalisizo Hospital

Reflection:

                Earlier that day before our reflection session, the group returned to the Ndere Cultural Center from our safari adventure at Lake Mburu National Park. That afternoon, Dr. Fred Ssengoba, a faculty member from Makere University School of Public Health came to speak to us about his work with health systems. He introduced the six building blocks of a health system: governance, finance, service delivery, workforce, medical products, and information systems. Based on the findings from an assessment he conducted in 2010, he pointed out the variety of issues associated with each building block, but despite the resource constraints in Uganda, the overall service delivery is performing reasonably well. The problem with service delivery is that it is heavily affected by the failures from the other five building blocks. While there are numerous issues in the Ugandan health system, Dr. Ssengoba left us with a positive outlook by reflecting on how many micro changes have occurred over the past eighty years, which resulted in improved health, such as mandated immunization in children.

                We began our reflection session with an activity to gage the group’s knowledge on HIV/AIDS. We read aloud ten HIV/AIDS related statements and asked the group to clarify whether they were myth or fact. Overall, the group was able to correctly determine which statements were true and vice versa. We then asked the group to reflect on their reaction if an immediate family member were suddenly diagnosed with HIV. A few members of the group shared personal experiences of dealing with close family members and friends who were diagnosed with the HIV. It was inspiring to hear their stories, which helped place the group into the personal aspect of the disease. After our reflection question, we shared with the group the development of our research through the site visits and interviews. We ended our session with a light hearted bonding activity, where we each picked a random question out of a hat and had to answer it. Would you eat a bucket of live crickets for $40,000?