Care and Treatment Centre (CTC)

Rupert works in the CTC looking after those people who are HIV positive. Kagera was the first place in Tanzania to recognise AIDS in 1982 but treatment with antiretrovirals has only been available since 2004. It has slowly been extended from Bukoba to outlying hospitals and Kagondo started in February this year.
We have an active counselling and testing centre mainly run by a superb nun Sister Renate. They have done about 2000 tests this year and the positive rate is about 12-15%. This is mainly among the worried or those with symptoms. The background rate is about 3% in antenatal mothers and posssibly 4 % in the adult population. It is higher in the towns and Bukoba runs at about 8%. What no one has adequately explained to me is why the prevalence rate has dropped from 15% in the 1990s. The rate in South Tanzania is rising from 7% to 14%.
The CTC has about 300 patients on their books with about half on antiretrovivals (ART). Adherence to drug taking is amazingly good and most people are very insistant on taking their tabs. The response is often dramatic, with appetite returning weight going up 6 or 7 kg in 3 months and going back to working in the garden. It is difficult to predict what the future will hold but if one views it like chemotherapy for cancer, it gives people a year or two or three or more to teach, be a mother, work in the garden or whatever.
Unfortunately many people are prsenting late and die within a few weeks of starting treatment. There is still stigma but the women are much better at coming, adhering to treatment and be willing to talk about things and show other people how life can continue on ART. Again it is similar to the attitude prevalent in the UK in the sixties about cancer before effective treatment became available when one just did not talk about cancer.
Rupert works with Sister Immaculata who is very determined and works without a break till all the patients are seen. Fortunately this is by 12 or 1 pm. Godi, our nurse works very hard and is good at councelling and encouraging the patients. After the clinic I wander round maternity and womans ward but that is not arduous with only 4 - 10 patients on womans ward. Later I am spending my time sorting out the registrer and planning where I can be most useful over the next 9 months.