Quinet's Ugandan adventure

As an African born and raised in Nigeria, and living in the UK for the past 12 years I wanted to gain some work experience in Africa but at the same time give back to my people. Hence I chose to volunteer.

I was also interested in exploring the similarities and differences in HIV care in UK compared to Africa and in exploring the differences/similarities in the perceptions and attitudes towards sexual health of Africans living in the UK to those of Africans living in Africa.

Whilst I was in Uganda, I worked at a large government Health Centre providing a wide range of care to the community. I worked across two HIV services: the HAART clinic and the PMTCT clinic.

At the HAART clinic, they had over 1000 patients on their books and, according to the staff, this was too many patients, considering the supply of ARVs. The patients got decent care despite being treated in the open; they had to sit on the grass under the scorching sun and came into a portacabin to see the doctor and get their medication.

They were given general counselling in the open grounds of the health centre, although I offered one to one and private counselling to those that could understand English. It was a case of making the best use of limited resources but at the same time I wanted to demonstrate to staff that more could be done to better improve patient's confidentiality.

I engaged in other tasks such as registration of new clients, working with doctors around taking medical history, drug adherence and management of side effects, and general medical and health advice.

The staff at the HAART clinic were definitely under a lot of pressure. Every Friday there were over 80 clients with and without appointments turning up from various villages to access care.

People travelled from far villages because of fear of being exposed as having HIV within their own villages. Some missed appointments because they were too ill travel or could not afford the transport fare.

A lot of the time ARVs were out of stock and people were given a different regime or asked to come back in a few weeks. Some patients report that they have to share or borrow medication from other family members or friends.

Drugs made available to patients at this clinic included, in different combinations: efavirenz, neviripine, AZT, 3TC and d4T.

However when people got diagnosed they were immediately put on septrin to fight infections and many remained on septrin for a long time, without ARVs and there could be a delay of several months before their CD4 is checked.

Despite this being a free government health centre, patients had to pay for certain things such as medical card or they had to go out of clinic to buy their own gloves because the laboratory was out of stock.

The clinic used paper patient records and of course mistakes were bound to happen. One example of this was a client turning up to clinic and searching endlessly for his file only to find it marked as "dead" in the pile of deceased files.

Citing all of these issues is not to condemn the system but to highlight the challenges the people and the healthcare service face. A lot of effort has gone into improving the service and educating the people to live better with HIV but a lot more can still be done.

The staff appreciated my time and help as an "extra pair of hands" which helped ease the burden of their workload. They also appreciated hearing how HIV is managed in the UK and how they could work to advocate and improve the care they offer their patients.