Monday, November 26, 2012

Paediatrician making a difference for Cambodian children with HIV

Refrerral Hospital has increased the uptake of paediatric and HIV care.
© UNICEF Cambodia/2012/Julie Masis
When asked about his HIV patients, Dr. Chea Pov, the director of the pediatric ward at Battambang’s Referral Hospital, remembers a 9-year-old boy named Luos Tola, whom he met five years ago. Dr Pov recalls that the child was so weak that he could not walk or speak, “He looked like he was already dead.” However, after a month at the hospital, thanks to antiretroviral treatment that stops HIV from destroying the immune system, as well as antibiotics to fight tuberculosis, Tola started walking again.

“Now Tola is 13 years old and he can come to the hospital from far away on his own. He doesn’t need his parents to bring him” says Dr. Pov.

Tola is one of about 400 children with HIV that Dr. Pov is happy to have treated and cared for. These children come to the hospital for monthly check-ups, and some of them have become adults and have found jobs.

“Before, there was some discrimination against patients with HIV. We were not sure that we should treat HIV patients because we didn’t even know if the treatment would help them, and we were afraid of catching this disease ourselves,” Dr. Pov admits. “But after we started to understand HIV, we learned that HIV is not something you can get from touching, treating patients or from eating.”
It was in 2005 that, with UNICEF support, Dr. Pov visited Bangkok as part of a group study tour to learn from the Thai experience in treating HIV/AIDS in children and preventing mother to child transmission.  He returned and became one of several senior trainers of physicians countrywide on how to deliver HIV treatment services to children.

Dr. Pov also attended follow-up training sessions about breastfeeding practices for HIV positive mothers and the management of opportunistic infections for children with HIV.

Hospital renovations encouraged attendance

Where children are concerned, treatment is only part of the solution. Getting parents to bring their children to the hospitals can be a challenge if the facility is dilapidated and unappealing.  Dr Pov addressed this issue too. With UNICEF support and funding from the French Committee for UNICEF, the Battambang Hospital was refurbished to provide an environment that encourages children to look forward to their monthly check-ups.

Parents bring their children to the Referral Hospital for antiretroviral treatment.
© UNICEF Cambodia/2012/Julie Masis
It has a colourful playroom with toys and picture books, and two hospital staff members have been trained to manage the hospital library to meet the needs of attending children. To assist those parents and children who have to travel long distances to reach the hospital, the French Committee for UNICEF also supports the provision of a transportation allowance and food for them at the hospital.
Before the renovations, the ward was in poor shape – the plumbing leaked, the beds were without mattresses; floors and walls had holes in them. Starting in 2006, the walls were repainted with murals, and ceiling fans and 30 new beds were put in.

In 2012, the hospital refurbished its emergency room – installing new windows, floor tiles, glass doors, and air-conditioning. Before, it had windows that were always left open.

“Air conditioning is not only making the emergency room more comfortable, it’s also an improvement with regard to infection control,” Dr. Pov says. “Before there was no glass in the windows, the mosquitoes could come in.”

Before the overhaul, Dr. Pov estimates that only 40 children came to his hospital every month. The hospital improvements have helped not only children with HIV, but all sick children. Today, he says that the number of patients has increased more than five times – to 200 or even 300 per month during dengue season. Mortality rates at the hospital decreased also after the staff were informed about the best way to care for malnourished children, Dr. Pov adds.

Reducing child mortality

Under Dr. Pov’s leadership, the children’s ward of Battambang’s hospital began holding staff meetings to address each mortality case – “to discuss why it happened and, if some practice was not correct, to not make the same mistake again.”                                       

These changes encouraged more parents to begin bringing their children here. Malnutrition is one of the major complications of HIV/AIDS infection but Dr Pov says mortality rates at the hospital decreased after the staff were informed about the best way to care for malnourished children.

According to Dr. Pov, “Before, malnourished children were [only] treated with IV solution… Before 2009, we didn’t have the proper guidelines on treating malnourished children.”

UNICEF therefore worked with the government to include in the Cambodia Ministry of Health National Nutrition Strategy, the treatment for child wasting and to ensure that national guidelines and training materials were available for all hospitals, health centres, and communities.

Funding from the French Committee for UNICEF has contributed to the establishment of a better system for staff training and supervision and as a result, strengthened the screening and treatment of severely malnourished children; expanded the quality of opportunistic treatment and antiretroviral therapy; and contributed to the earlier initiation of treatment for infected children, including care for severely malnourished children.

Now, with supplies provided by UNICEF, children admitted with severe malnutrition receive specialized treatment with therapeutic food, which has been shown to significantly reduce mortality. A kitchen recently built at the Battambang hospital for the preparation of therapeutic food is also used to teach the parents of malnourished children how to make nutritious meals at home to sustain their children’s recovery following discharge from hospital and help prevent relapse.

As Dr. Pov stopped to visit 6-year-old patient Heng Sophorn, the girl’s grandfather Prom Sat said today’s hospital is much different from the way he remembers it ten years ago. “Before, there were no beds, no electricity, no ceiling fans, and no running water,” he said, adding that, “Before, the patients had to buy medicine from outside, but now there is enough here.”

By Julie Masis and Denise Shepherd-Johnson

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