So many of you have shared good ideas about working with TB and AIDS education. Here is a collection of them. We hope that some at least will be helpful to you.
Why do so many not return for their HIV test results even after pre-test counselling? Yet others return every week for advice or medication. Very difficult to understand. Here are some ideas…
- Be private and confidential.
- Mix AIDS clinics with general clinics so there is no fear of recognition.
- Be patient.
- Give lots of support and encouragement to counsellors. It can be very lonely. We meet and pray together regularly.
TB and Children
The traditional ways of diagnosing TB are not very helpful for young children. They cannot produce sputum for testing. Look for the following…
- contact with people with chronic coughs
- cough, fever or diarrhoea for more than one month
- weight record – unexplained weight loss may mean TB
- enlarged neck glands
- fits or neck stiffness (may show TB meningitis).
If the fever continues after checking every other possible cause – having given a trial of antimalarials and antibiotics – try giving thiacetazone/isoniazid tablets. (Warning: thiacetazone can give very bad side effects if the patient has AIDS.) Only TB bacilli will respond to these two drugs. If the fever disappears within two weeks, put the patient on full TB treatment.
Wrong TB treatment is worse than no treatment at all because the patient may become drug resistant. The patient may then die but will first pass on drug resistant TB to others. Don’t start TB treatment unless you are sure you have enough drugs to finish the treatment and can follow them up.
It is better for all the family members to know if someone is HIV-infected. At least the head members should know. A lot of money will be needed for care and this will give the family time to prepare. Sometimes people move to town to hide away from their families. But this means that they soon use up all their money – there is none left to care for their children or to look after them when they become really sick. It is better for people to stay with their families and tell them.
The gap in the story
Use the idea of a story with a gap, to encourage discussion. Show two pictures – one showing the problem, one showing the scene afterwards. Encourage the group to describe both pictures and describe what might have happened in between. In other words, the group ‘fills the gap’.
Cutting the cost of dying
Death is very costly. People with AIDS often sell their property and land before they die, to pay for treatment. In Zimbabwe papier-mâché coffins are being produced. There have been so many deaths from AIDS that some pastors spend nearly their whole time burying people. The demand for coffins is so great that timber supplies are running out. The papier-mâché coffins are also much cheaper.
Just me, the Bishop – and God
When I first arrived in Dodoma, I asked our Lord what he wanted me to do. He showed me very clearly that I should join the Diocesan AIDS scheme. However, I discovered there was no AIDS scheme – just me and a Bishop with a large vision for his community! I had to rely totally on God to show me what he wanted me to do and listen to the advice of the Bishop and the medical personnel around me. The vision has developed until now we have a team of Health Educators. We are training volunteers from selected villages to help them care for their sick – especially those with AIDS. We have a series of clinics and have produced two leaflets and a cassette about AIDS. We know our Lord has more in store.
We use a drama with ‘AIDS tunics’. Here it is known as UKIMWI. We tell the story of John, who got AIDS (he puts on a tunic). He sleeps with his girlfriend and she gets AIDS (she puts on a tunic). She marries someone else who gets AIDS (he puts on a tunic). They have a baby who gets AIDS, etc. It’s very amusing for the audience as their own people act it out. It teaches…
- how easily AIDS is spread
- that over half the people who get AIDS are not promiscuous – AIDS is not a matter of shame
- the time delay involved. Someone may be a Christian now but may have picked up HIV infection in their past. AIDS does not mean you are going to hell!
Songs can break up a teaching period and can reinforce a message. Write songs to the local tunes. Teach the audience a song to sing as they go home.
Information for health workers
The HIV virus can pass from body fluids – blood, semen, vaginal fluid – into broken skin on hands. When caring for patients and handling body fluids, we use plastic bags to cover our hands. We find gloves are either unobtainable or too expensive.
The following chemicals can kill the HIV virus…
- Glutaraldehyde 2% or VIRKON powder
- Polyvidone iodine 2%
- Chlorine solution 0.5%
- Rubbing alcohol 70%
- Surgical spirit 70%
- Hydrogen peroxide 6%
- Lysol 3%
Savlon and Dettol are not strong enough to kill the HIV virus. Boiling instruments in water for 20 minutes will also kill the HIV virus. Lysol does not kill hepatitis viruses, (also carried in body fluids) so it is not always recommended – this has caused some confusion.
With particular thanks to Ruth Chorley (Tanzania) and Jenny Gibson (Sierra Leone) for their contributions on these pages.
EDITOR: We apologise that in earlier issues of Footsteps we said that Lysol, sometimes the cheapest chemical, did not kill the HIV virus. Recent information has confirmed that it does.
“Any community will react to the AIDS situation with a gradual process – beginning first with denial. Only when the community reaches the final stage is real change possible.”
DENIAL - there is no problem - there is a problem, but it’s not ours - we have a problem - we have to change - ACCEPTANCE
In Beijing, China, the ‘barefoot doctors’ are paid about $1 for each TB case they find. For each TB patient who completes a full course of TB treatment, the ‘barefoot doctors’ are paid a $10 bonus. These incentives have helped to increase by four times the numbers of TB patients discovered and treated. Now this scheme is being extended to other parts of China.
“AIDS is depressing. Make sure you have some variety in your work. Do enjoyable things as well as sad things.”
“Patients in a TB ward are usually very poor and have lots of spare time on their hands. Basket-making, sewing, soapmaking, mattress-making and gardening can help them to earn enough money to improve their diet. They will be useful skills for the future, too."
“I strongly believe that you cannot just ‘do’ a job. You must be ‘with’ the community, join in their meals and relax with them. Spend time with them ‘outside the job’.”
“Start small and see if God blesses the work. Only then will it grow.