The main bulk of my time here has been helping KCCC start a program for the prevention of mother-to-child transmission of HIV, or PMTCT. If PMTCT works properly, it can be 99% successful and babies can be born to HIV-positive women and themselves be HIV-negative. The basic steps are different than they would be in the US where we would do a cesarean section and tell the mom not to breast feed, as those are 2 ways to avoid transmitting the virus. Per the WHO in a developing country where most women deliver at home or in a random cli
The program at KCCC was supposed to have started several months ago and was limping along with no direction, no clear understanding of what they were doing, no records or tracking and no buy-in from the staff when we got there in November. It was not until January that I had any clear sense of what to do, how I could help. Up to now I have written a budget and designed numerous work plans for the year. The organization is required to compile masses of reports for their donors on a monthly basis and everything is supposed to be accounted for, down to any notebook purchased. The bureaucracy is such that everything happens REALLY slowly (as those of you who know me, you understand that this is hard for me!) and there is often triple work to make all the reports. The donors dictate everything they want PMTCT programs to be achieving at all their funded sites, regardless of whether the activities are relevant for the community or the particular clinic. Most of what we are doing at KCCC is mobilizing in the community, spreading the word that we can prevent mothers from passing HIV along to their children during pregnancy, and making sure that our clients who are HIV-positive are on the proper HIV medications and that the babies get the drugs once they are born and that breastfeeding is done safely. It is actually a huge task and many things fall through the cracks, but here it is more about the general direction a program is taking, rather than details--which is, again, hard for me.
On a daily basis, this means that I am sometimes doing something as simple as making labels and cutting them and sticking them into a book that is used to record the names and information about our pregnant clients and babies. (Everything is recorded in these massive books and using an Excel sheet on the computer is a totally foreign and impossible concept, so information is missing or re-recorded and it makes it challenging to know what you are really doing.) Other times I am seeing clients with the doctor who is the head of the project, counseling mothers about medication and breastfeeding or the importance of delivering their babies in a medical facility as opposed to at home or in a
Three times I have been told that the funding for the project would be cut and I have visited the local offices of our donors to see that the money can be secured. The budget for the entire year is only $2500 (not including the drugs that we provide for clients) but the expectations of what we are supposed to do with that little money are pretty large. My low point was when the doctor who I am helping (or some might say pushing into doing this work) told me that he was relieved when they thought that the funding might not come through. I realized that maybe I want this program to work more than they do. The staff who were assigned to work on the project are already busy and a bit difficult to motivate. But the truth is that this place has gotten over 2000 people on HIV drugs and now these clients want to have babies and one of the best ways we can be effective in preventing new infections is through this project and I think that when we leave, even if they only hold onto a few things that we have started, maybe, just maybe, we will prevent some.