The Care and Treatment Centre

The outpatient clinic for HIV positive patients, the CTC continues to develop. We are registering about 20-35 new patients a month and now have about 400 on our books. A clinical assessment is made and we check their CD4 cell count. If this is low or they are clinically very unwell they will start Anti Retroviral Treatment (ART). They need to pick a treatment supporter, ie someone who is willing to come to the clinic to get their drugs if they are unwell and who will encourage them to stay on treatment. Both the treatment supporter and the patient need to attend on three different days for adherence counselling before starting ART.
There are about 190 people who have started ART (about 15000 in the Kagera region alone) and they have to attend every month. The default rate is remarkably low and is less than 5%. This is lower than many CTCs in USA, since many HIV positive patients in the West are drug addicts and have chaotic lifestyles. The response is usually rapid with 5 – 10 kg weight increases in the first 6-10 weeks. Certainly most of these patients would have died without ART. Some have been taking them for 4 years and are leading normal lives.
I (Rupert) often do joint consultations with Sister Immaculata, which helps us to learn from each other and speeds up the process. However if she is busy or away I do joint consultations with Godeliva, the hard working CTC nurse. The aim is to train her up to do routine assessments of monthly attendances herself.


The work is enjoyable with a deal of humour over my inability to speak reasonable Kiswahili. We have two good peer educators, Adventina and Gosberth who help to encourage the patients and do the register. We work almost non-stop till about 2.30pm then home for lunch and rest and admin work.
I (Annie) am spending more time in CTC helping out as we get busier, as well as linking in with the mothers and babies. We run a mini dispensary and I dispense all the ARTs and prescribed drugs, explaining how they should be taken. I try to help keep the registers up to date. All ARTs have to be signed for by the patient and some of the regimes can be very complicated, especially for new patients and small children. We are pressing for another nurse to be appointed to CTC to be to trained take up the work I am doing… “..we hope for one next month..” I have managed to learn a (very) few KiHaya words, which delights all the patients and sends them into peals of thigh-slapping laughter, giving them something to discuss for ages. Must be my accent!
We have our occasional heartbreaks of course, mainly involving children. Last week a sick 16yr old came in on her own and whispered to Rupert and the nurse that what was the point of taking her medicine when she was going to die from hunger, not having eaten for 2 days? She’d spent her last pennies to get here. We quietly all clubbed together to get her some food and chai and were able to refer her to an excellent NGO who helps orphans such as her.
But generally we have a lot of laughs amid the hard work and we feel the patients genuinely appreciate our efforts to help and thank us often.

Winifreda and Annie discussing