Health Visiting African Style

Rhona -
Most of my time and energy has been focused on increasing Reach Out’s research capacity and capability.
For the last few weeks of my placement I am concentrating on helping to develop better care of our babies born to HIV women. Although Reach Out seems to provide, in African terms, a Rolls Royce service to their clients, there is little monitoring of the babies in the Prevention of Mother to Child Transmission (PMTCT) programme, into which mothers are enrolled during pregnancy. 

Babies are discharged at 18 months of age if they test negative at that stage. If positive they are enrolled as clients in their own right. Babies and their mothers are given drugs to reduce the risk of transmission during pregnancy, birth and breastfeeding, which is the best option for HIV exposed babies here, given the costs and risks of infections associated with replacement feeding in an urban slum area. Almost half of children under the age of five in Uganda are malnourished, which given the fertility of the land is difficult to understand in rural areas. In Kampala, people with no jobs depend on trying to earn very small amounts of money by selling cooked food, or fruit such as mangoes and pineapples and it is common for families to have no money for food . Many families only eat once a day, which is not enough for babies, so many become malnourished between six and 18 months, when breastfeeding is not enough for them. However, there is no routine monitoring of children and some children present with moderate and severe malnutrition.

Up until now the babies have not really been clients in their own right, but now  they are being given their own file and their growth will be monitored and charted, so that faltering can be identified before they develop moderate or severe malnutrition. So before this happens, I am doing a baseline nutrition survey of all the children aged between 0 and 24 months, and then the nutritionist, the PMTCT staff and the mother-to-mother community health workers can make decisions about whether they need to increase health education or increase access to food support for some families. Fortunately there is free software available form WHO’s website which makes the survey fairly straightforward.

I have been out doing home visits with the clinicians and the community health workers, especially the mother-to-mother supporters (including Saban, who features in the photos) who look after women in the prevention of mother to child transmission programme. The M2Ms are all clients themselves, who have been trained to support women during pregnancy and until the child is 18 months of age.

While everyone is aware of the poverty and desperate conditions most children in the world live in, and living in Africa makes it all more real, actually coming face to face with the reality of living in a Kampala slum and even more, assessing it from a professional perspective, puts it into 3D. Most of the women have come from villages up-country but they do not want to return because they will face a lifetime of hard physical work, digging fields to grow their own food and trying to sell any surplus they have. The reality of life with no safety net is very stark.

However, while it was the differences that struck me most at first, I now see the same problems I see in health visiting practice in Edinburgh  - fathers who do not take responsibility for their children, domestic violence and some mental health problems, though post-natal depression is not recognised. I also see great similarities in the way parents really care about their children, they are very interested in seeing how their children are growing and respond very positively to being told that they are doing a really good job.