SOUTH AFRICA: Sihle Motha, "You have this person's life in your hands"
Sihle Motha, a nurse at Malvern Clinic, in Johannesburg, is among the first to have been trained in the management and initiation of patients on antiretroviral (ARV) treatment. She will soon be joined by thousands more as the government rolls out nurse-initiated ARV treatment at primary healthcare clinics across South Africa.
She talked to IRIN/PlusNews about some of the challenges she faces, particularly since the clinic's only doctor left and has not been replaced.
"Sometimes I have emergencies and you can’t just say, ‘No, there is nothing I can do for you’"
"I had some background in HIV/AIDS so Dr [Natasha] Davies [her trainer] just filled in the gaps. She did theory with me for three weeks, then she could leave me with a patient and I would assess the patient and initiate them according to my own understanding, then she would assess.
"After three to four weeks she could leave me with the patients, but it was so much easier then because I still had the doctor [at the clinic] to consult so I kept going to her whenever I had a problem. Now there is nobody, but I have their numbers and I use my own phone to call them whenever I have a problem I can’t solve.
"But otherwise, being left alone in the clinic, it sharpened me, I think. Sometimes I have emergencies and you can’t just say, ‘No, there is nothing I can do for you’. Now I phone Dr Davies once every two weeks; before it was twice or thrice a day.
"I refer [to a doctor] when I suspect the patient is having a bad reaction to the drugs or if they have different types of TB or if the drugs are too much for the liver.
"I think it’s good [that nurses are initiating] but I think we need a doctor to be here at all times. The training is too short. There’s quite a lot [to learn] about each and every one of those drugs – the side-effects, how to deal with them and how to prevent [them]. And our patients are psychologically consuming... you need to always reassure them, so counselling is not just done by the counsellors.
"Our patients think if they’ve taken ARVs for one month and then go to a traditional healer, they’ll be healed. Most challenging is those patients who come in, go through their adherence and you initiate and then the following week they want a transfer-out letter because they were not staying here, they just came for the ARVs and then they go home.
"There are a lot of people; I think they’re calling each other saying, 'Now at Malvern you can get ARVs - come, come, come'. I see 50 to 60 patients a day, but I initiate only three per day.
"When we had our doctor, I used to initiate up to five or six, but now... I can manage only three. Because you have this person’s life in your hands, one mistake and then you fail that person and not just that person, the whole [health] department because you end up having a lot of side-effects that cost us quite a lot in time and finances."
Source: Plus News
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