Positive Living

This week we had our first (HIV) Positive Women’s support group. We had 5 beautiful women show up, 2 who have already delivered and 3 pregnant women. Unfortunately there must have been a miscommunication on the time as 3 of them showed up first thing in the morning, even though the meeting wasn’t to start until 1pm! They said “no problem”… that they would wait. And so patiently they sat amongst the other ANC mothers as the usual routine of palpation, injections and health education went on around them.

An hour before the meeting was to start Helen, one of the midwives, asked if MSF was providing refreshments? I had said we had not planned it but we could make a proposal for next time? She thought about this briefly and then piped up “we are a humanitarian organization. How can we call these women together and not provide them with anything?! Let’s pool our money together and buy some mineral and biscuits”(soda and cookies). So between the 3 of us we came up with the $5 for refreshments. I was really proud of Helen for taking ownership of the group and taking action!

Because we decided to start a bit earlier finding a space to meet became an issue. Thankfully there were currently no women admitted in the 6 bed maternity ward and so we met in the empty space, which as it turns out was the perfect setting. All the moms got comfortable on the beds, putting their feet up and lying their babies down beside them. This started the meeting off with a very comfortable vibe, as opposed to sitting on the uncomfortable wooden benches (which have been known to break under the weight of 5 pregnant women!).

After Anna, our counselor had gone over some ground rules (confidentiality being her main point) and discussing some of the possibilities of the group, she asked the women to introduce themselves. She asked one of the younger ones to start, but she was so shy that she just kept looking down, so Anna moved on to the next. Slowly we went around the circle, as we came to the end, the shy young one blurted out “Shinaka” (the name of her village), “I’m from Shinaka and my name is Amina”…she was not about to be missed in the end! (this was all communicated in Hausa language) I could see the confidence grow just in this short time.

As I looked around at each woman I couldn’t help but be overwhelmed by the beauty and courage of each one. They are each taking their health and the health of their babies seriously and are doing what they can to ensure this. My hope is that this will be fostered even more through the support of each other in our little women’s group.

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Contextually Appropriate

After a bit of a blogging hiatus (can it really be called a hiatus after only 3 entries?!) I feel like I’m back to the task of sharing with you the life and times of women here in Goronyo!

There’s been lots highs and lows in the last couple months, and many stories as a result.  Today Anna, our counselor, was explaining to me how she has made the description of a positive woman’s CD4 count easier to understand for our newly diagnosed women.  Besides using the standard, ‘your CD4 cells are like soldiers which fight infection’ she uses a very contextually and agriculturally appropriate analogy of how having a low CD4 is similar to leaving the door open to your hut (your body), where the goats and chickens (germs, opportunistic infections) just wander in and take whatever they food they like, leaving you empty handed (sick).  Apparently this usually gets quite a few giggles from the crowd!

It was also fantastic to hear of another woman who approached Anna at the end of her pretest counseling session to specifically thank her for sharing about HIV.  This woman’s sister is positive, and has been shunned by the family for fear of transmitting to the rest of them.  No one will enter her hut, or share dishes with her.  She was so thankful to Anna for spreading the news that it’s okay to have contact with her and she was going to go home to educate other family members.  Anna came away beaming, knowing that she personally just helped ease the burden of stigma for a positive woman.  It was such a cool experience to be a witness to.

I am still continually amazed at how young some of our mothers are…“babies having babies” is how our one midwife put it.  I don’t know if it’s a result of this , but the midwives have been more motivated to encourage family planning lately and nothing is more hilarious than to see one of the community health workers come sailing in with a hand carved generously endowed wooden dildo tucked under her head scarf and proceed to instruct on how to use a condom.  But the talk of using condoms in family planning in such a lighthearted, unintimidating way is so helpful in decreasing the stigma of using condoms in the prevention of other sexually transmitted infections (including HIV).  I am so proud of these health educators!

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Frustrated. So frustrated!

Apparently this is the common emotion amongst us MSFers.  It’s what motivates us to move.  To complain.  To advocate!

How can we run a PMTCT program without HIV tests?  We ran out mid-November and apparently it’s not as simple as just calling the next town to borrow some.

When they were planning on starting the program it really was uncertain as to what the uptake would be (woman are given a choice to opt out of the testing).  But the acceptance has been beyond all expectations and when we are seeing more than 300 women in ANC/week, and have more than a 98% uptake, we flew through the supplies we had in the first couple months.

So now we are waiting.  Waiting for an urgent air cargo shipment of HIV tests to come through.  If only I had known I would have stuffed my bag full of them when I came!

That’s what I had written last week.  But today, thankfully today all activities have resumed!  It was really exciting to be able to tell Anna that the test kits were in and delivered to the lab.  And even more exciting that all 25 women we tested today were negative.  During the group pre test counseling that Anna gave, the women seemed really engaged in her health talk.  At the end of the morning she translated for me what was going on (my Hausa is yet to be as fluent as I had hoped!).  They were busy asking her about modes of transmission.  One woman said that her son had found 100 Naira ($0.66 Cdn) on the ground, but she was worried that HIV might be on it, so she made him burn it!  Anna was oh so happy to help correct some of the misconceptions around transmission.

And so we’re now back on track.  As I was watching the session I couldn’t help but compare what this would look like back home and how drastically different the scenes are.  We generally have 80+ women sitting in front of us on benches, under a shade screen with Anna on the veranda of the building directing the ladies.  Many of the women have a child wrapped on their back (yet to see a “Baby Bjorn” here!) and have come from a few minutes to few hours trek away.  And then there are the goats…wandering in between the women’s legs as they stand up and walk to the end of the row to stand on a scale to be weighed.  Fortunately it’s guava season and so the fragrant fruit smell is now permeating the waiting area.

On a few side notes…I got to meet the quadruplets last week!  They have definitely achieved celebrity status here at the clinic…there’s an immediate buzz on the grounds when they arrive.  Jean, the midwife, called me over to introduce me to them.  2 girls and 2 boys…delivered at home by the mother herself, now 4 months old and looking quite beautiful.  What are the chances of that? I’ll have to google…

We’ve all been really enjoying watching the change in apparel as we move into harmattan season here (where the Saharan winds blow a fine layer of dust over everything and bring in some “cooler” weather).  Apparently it’s winter (at a crisp daytime temp 30C with low of 20C at night) and so the staff are found donning their furry hats and winter jackets!  It’s useless to try and describe a prairie winter night at this point.  And unfortunately I’ve become really Hausa as I have found myself wearing a jacket in the early morning as well!

Frustrated. So frustrated. Apparently this is the common emotion amongst us MSFers. It’s what motivates us to move. To complain. To advocate!

How can we run a PMTCT program without HIV tests? We ran out mid-November and apparently it’s not as simple as just calling the next town to borrow some.

When they were planning on starting the program it really was uncertain as to what the uptake would be (woman are given a choice to opt out of the testing). But the acceptance has been beyond all expectations and when we are seeing more than 300 women in ANC/week, and have more than a 98% uptake, we flew through the supplies we had in the first couple months.

So now we are waiting. Waiting for an urgent air cargo shipment of HIV tests to come through. If only I had known I would have stuffed my bag full of them when I came!

That’s what I had written last week. But today, thankfully today all activities have resumed! It was really exciting to be able to tell Anna that the test kits were in and delivered to the lab. And even more exciting that all 25 women we tested today were negative. During the group pre test counseling that Anna gave, the women seemed really engaged in her health talk. At the end of the morning she translated for me what was going on (my Hausa is yet to be as fluent as I had hoped!). They were busy asking her about modes of transmission. One woman said that her son had found 100 Naira ($0.66 Cdn) on the ground, but she was worried that HIV might be on it, so she made him burn it! Anna was oh so happy to help correct some of the misconceptions around transmission.

And so we’re now back on track. As I was watching the session I couldn’t help but compare what this would look like back home and how drastically different the scenes are. We generally have 80+ women sitting in front of us on benches, under a shade screen with Anna on the veranda of the building directing the ladies. Many of the women have a child wrapped on their back (yet to see a “Baby Bjorn” here!) and have come from a few minutes to few hours trek away. And then there are the goats…wandering in between the women’s legs as they stand up and walk to the end of the row to stand on a scale to be weighed. Fortunately it’s guava season and so the fragrant fruit smell is now permeating the waiting area.

On a few side notes…I got to meet the quadruplets last week! They have definitely achieved celebrity status here at the clinic…there’s an immediate buzz on the grounds when they arrive. Jean, the midwife, called me over to introduce me to them. 2 girls a

Frustrated. So frustrated.  Apparently this is the common emotion amongst us MSFers.  It’s what motivates us to move.  To complain.  To advocate!

How can we run a PMTCT program without HIV tests?  We ran out mid-November and apparently it’s not as simple as just calling the next town to borrow some.

When they were planning on starting the program it really was uncertain as to what the uptake would be (woman are given a choice to opt out of the testing).  But the acceptance has been beyond all expectations and when we are seeing more than 300 women in ANC/week, and have more than a 98% uptake, we flew through the supplies we had in the first couple months.

So now we are waiting.  Waiting for an urgent air cargo shipment of HIV tests to come through.  If only I had known I would have stuffed my bag full of them when I came!

That’s what I had written last week.  But today, thankfully today all activities have resumed!  It was really exciting to be able to tell Anna that the test kits were in and delivered to the lab.  And even more exciting that all 25 women we tested today were negative.  During the group pre test counseling that Anna gave, the women seemed really engaged in her health talk.  At the end of the morning she translated for me what was going on (my Hausa is yet to be as fluent as I had hoped!).  They were busy asking her about modes of transmission.  One woman said that her son had found 100 Naira ($0.66 Cdn) on the ground, but she was worried that HIV might be on it, so she made him burn it!  Anna was oh so happy to help correct some of the misconceptions around transmission.

And so we’re now back on track.  As I was watching the session I couldn’t help but compare what this would look like back home and how drastically different the scenes are.  We generally have 80+ women sitting in front of us on benches, under a shade screen with Anna on the veranda of the building directing the ladies.  Many of the women have a child wrapped on their back (yet to see a “Baby Bjorn” here!) and have come from a few minutes to few hours trek away.  And then there are the goats…wandering in between the women’s legs as they stand up and walk to the end of the row to stand on a scale to be weighed.  Fortunately it’s guava season and so the fragrant fruit smell is now permeating the waiting area.

On a few side notes…I got to meet the quadruplets last week!  They have definitely achieved celebrity status here at the clinic…there’s an immediate buzz on the grounds when they arrive.  Jean, the midwife, called me over to introduce me to them.  2 girls and 2 boys…delivered at home by the mother herself, now 4 months old and looking quite beautiful.  What are the chances of that? I’ll have to google…

We’ve all been really enjoying watching the change in apparel as we move into harmattan season here (where the Saharan winds blow a fine layer of dust over everything and bring in some “cooler” weather).  Apparently it’s winter (at a crisp daytime temp 30C with low of 20C at night) and so the staff are found donning their furry hats and winter jackets!  It’s useless to try and describe a prairie winter night at this point.  And unfortunately I’ve become really Hausa as I have found myself wearing a jacket in the early morning as well.

nd 2 boys…delivered at home by the mother herself, now 4 months old and looking quite beautiful. What are the chances of that? I’ll have to google…

We’ve all been really enjoying watching the change in apparel as we move into harmattan season here (where the Saharan winds blow a fine layer of dust over everything and bring in some “cooler” weather). Apparently it’s winter (at a crisp daytime temp 30C with low of 20C at night) and so the staff are found donning their furry hats and winter jackets! It’s useless to try and describe a prairie winter night at this point. And unfortunately I’ve become really Hausa as I have found myself wearing a jacket in the early morning as well!

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PMTCT

The letters just roll off the tongue now.  We aim to prevent the transmission of HIV from Mother to child in pregnancy, labour and delivery and breastfeeding.  In the West this is done under the close guidance of highly specialized physicians, monitoring closely lab values and providing highly specialized services.  In the rest of the world it actually becomes a fairly simple and yet effective program run by locally trained midwives and nurses so that women living in the far corners of the earth can know that there is something being done to stop the transmission of HIV to their babe.

What that means in Goronyo is that when a woman comes to the health clinic for her first prenatal check up, along with checking her for the standard pregnancy blood work, we offer her an HIV test.  If this comes back positive, Anna our counselor will bring her into a private room and begin to explain what the implications are.

I am sure, the world over, women’s reactions are unique to them but share similar themes: what does this mean, what will my partner say, should I even tell my partner, what does this do to my baby, am I going to die?

Already in my short time here I’ve been witness to a variety of situations, none of which prove simple, all of which raise so many issues.

One woman was barely allowed the time enough to receive the result…her husband pressuring her to leave the clinic as he had thought she had spent enough time there and he had other things he had to do.  Even with counseling she was unable to come to terms with the diagnosis and fled the clinic.

Another woman had accepted Anna’s offer to accompany her back home to her village to offer support to her as she told her husband.  Anna relayed the story back to me.  She told her husband and he responded “umhmm”.  Anna clarified, “she’s telling you she has HIV”. “and so?” he responded.  He then disclosed that he himself is positive and has been receiving care in the neighboring city.  He had basically just been waiting for either her to become positive or deliver and then move the family to the city.

What a crazy twist of feelings we all had about this.  On one hand, how evil you think of the man who is just waiting for his wife to be infected with a preventable illness, but on the flip side, we now know she will have access to care for herself, and assume her husband will support her in coming to the clinic for their child.  The complexities of these issues are only the beginning.

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Two weeks into the new normal

It’s amazing how quickly routine sets in.  The new norm is now a wake up call at around 5am from the neighboring mosque followed by a half-conscious tracking of the lizards/vermin activity in the ceiling above my bed.  I check my personal email from the comfort of bed and wait for the generator to roll to life.  After a cold bucket bath (the cool water is still a welcome, even though we are in winter) I greet a smattering of the 11 collective expats on our compound for toast and Nutella/peanut butter/or whatever other condiment has managed to find its way into our cupboards.  Coffee is a treat we’ve had consistently but has to be brought in from the capital (a 1 hour flight and 1 hour drive away); fortunately with the recent turnover of expats there has been an uninterrupted supply.  The early risers start the 10 min walk over to the Primary Health Centre (PHC) while the rest of us pile into a car to drive over.  Early mornings and late days are the best times to walk… choosing to walk back and forth from the MSF base and PHC in the scorching midday sun is an amateur move I only needed to make once.

After a brief meeting of all PHC staff we head to our posts.  I head over to the ANC area where up to 80 pregnant women gather daily to be weighed, palpated (which means to have you stomach squished and prodded by the midwives until they can estimate the size of the fetus, and how far along in the pregnancy you are), and as of the end of September, tested for HIV.

Antenatal Care (ANC) has been growing and now averaging around 1000 women/month here at the PHC.  The PMTCT program started up at the end of August to great acceptance.  Thanks to huge efforts of previous MSF expats and national staff working in the community to spread the message and purpose of HIV testing in pregnant women, HIV testing uptake has been beyond expectations.  HIV prevalence in Nigeria has been documented to be around 3% according to UNAIDS 2008 data, and therefore including a PMTCT (Prevention of Mother To Child Transmission) package in any ANC program has been strongly advocated for.

The program has now been running for about 2 months and there’s close to 100% uptake from the women.  The midwives and nurses keep commenting that the women in the community really do want to know their status.

Anna is my partner in crime…she’s our PMTCT counselor and national staff, who is constantly going above and beyond her role to support the positive women in the community.  She has such a gentle spirit about her as she counsels the women through the potentially tough road ahead.  And I’m just beginning to have a glimpse into what that entails.

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