Monday, April 22, 2013

Friends helping friends affected by HIV

Mondul Mith Chouy Mith helps to improve the quality of paediatric care.
Mrs Seang Kunthea (named changed) on the right, reads a story to a riveted audience.
©UNICEF Cambodia/2013/Shepherd-Johnson
The exterior of Svay Rieng Provincial Hospital looks much like any other health facility in rural Cambodia. Enter the two storey sand coloured building and on some of its long narrow corridors there are patients lined up waiting to be seen, some holding IV bottles and others on gurneys. But step onto the second floor in the paediatric ward and you step into a different environment where illness is not apparent. Instead, there’s a large brightly coloured playroom with a mural on very wall featuring animals from around the world. A blue and red see-saw and bright yellow rocking horse signal that there’s fun to be had here. Lines of origami shapes in pink and yellow are draped from the ceiling and underneath, more than 30 children sit wide-eyed on a large blue mat riveted by a story being told by a volunteer.

A child-friendly safe environment
The children are all HIV positive and they are attending the monthly forum of Mondul Mith Chouy Mith (friends helping friends) known as ‘mmm.’ The forum was initiated in 2005 by Cambodia’s Ministry of Health with UNICEF support as part of its paediatric care service. Transport and meals are provided as an incentive for children and their caregivers to attend.

The child-friendly welcoming environment is designed to encourage HIV infected children aged 18 months to 15 years to follow their treatment regimen and get regular health check-ups, while providing a safe space to relax, play and receive support without stigma or discrimination.

Mondul Mith Chouy Mith forums are held in 35 locations across Cambodia. Twenty-two forums (nine of them with playrooms) are supported by UNICEF and made possible with contributions from the German Committee for UNICEF, the Linsenhoff Foundation, the French Committee for UNICEF and the HIV thematic fund from the Korean National Committee.

From 8 a.m. to 11 a.m. at Svay Rieng Provincial Hospital the children are taking part in a variety of activities while their caregivers are watching a cooking demonstration and learning ways to keep the children healthy through nutrition and hygiene education as well as how to respond to opportunistic infections when they arise. 

Today, the volunteer reading to the children is also HIV positive. Mrs Seang Kunthea,* aged 45, learned her status in 2007. When she came to collect her medication at the hospital, she was invited to join mmm sessions with her 12 year old daughter who was also positive.

Ra became a volunteer in 2010. “One day [the staff] asked us who can read and write,” She says, “I had completed high school to Grade 12 and told them about my education, then sent a CV. I was so happy when I was selected it was my opportunity to learn more. I went to Phnom Penh to get training and then came back to work here.”

Describing her training, Kunthea says, “I learned how to hold the book when story-telling, how to select books based on the age of the children, how to make origami animals and flowers, and how to lead a drawing and painting session. I also know how to prepare monthly reports on the sessions.”

“I get the most joy from reading stories to the children,” says Kunthea “I’ve discovered stories about Cambodia that I didn’t know, so when I read for them I’m learning too!”
Following a discussion, the teens at Mondel Mith Chay Mith (known as ‘mmm’) read together in the playroom.
©UNICEF Cambodia/2013/Shepherd-Johnson
The mmm was also life-changing for Kunthea’s daughter. Her mother says, “She felt safe with friends and there was no discrimination in this environment. The doctors and nurses were helpful and showed me how to deal with side effects of the medication. We saw people living positively. Even though they are not infected, I was also able to bring my younger children here too and the hospital staff also brought their children.” With the confidence instilled by attending mmm sessions Seang Kunthea’s daughter, now 17, has a full-time job and is engaged to be married. Her mother is very proud.

A release from fear, stigma and discrimination
Whilst the younger children listen to stories, a group of teens are exchanging information about living with HIV. Thirteen year old Vichet* lives with his grandparents and says he wants to be a singer on TV when he grows up. His best friend at the mmm, 15 year-old Phaktra* is cared for by his grandmother. He would like to teach English language and computer skills. They both enjoy coming to the playroom to meet up sing, read and have lunch together. Socheata* and Makara* are 13 year old girls who first met at the mmm and then discovered that they attend the same school. They say this is one of the few places where they can be honest about their status and do not have to hide.  Says Socheata, “At school I talk about my studies and lessons but here I can also talk about how to take my medicine.”

At Mondul Mith Chouy Mith the children receive information about nutrition, food preparation, hygiene and sanitation, along with the warning signs and risks of opportunistic infections like diarrhoea and fever. They also get the chance to forget about their status and just ‘be kids’ by enjoying the playroom library and taking part in activities like singing, story-telling, paper-folding, drawing and games.

Sothavy’s* parents died in 2000 and he was diagnosed with HIV in 2003. He now lives with his aunt and uncle. The 13 year old looks younger than his age, but like the others in the group he already has a wealth of knowledge about HIV thanks to the mmm. “I know the difference between treatments for opportunistic infections and antiretroviral therapy: one is for light illness but the other is for when I’m sick - to prolong my life,” he says. Phaktra shares that through the mmm, “I also learned to take my medication regularly because it helps my health.” And Sok Heng adds, “I have learnt about good hygiene like I have to wash my hands before eating.” It is no coincidence that several of the teens say they want to work in the medical profession in future. For most of them the goal is to be able to take care of the health themselves and their families.

In the safety of the mmm, the children feel confident to talk about the discrimination they have faced. Thirteen year old Theany says, “Once at school someone said ‘Don’t stand close to her because she has HIV.’ I told them not to look down on me because some people don’t have it but they might still die before me.”  Vichet also shared how he responded to bullies. “They used to call me ‘HIV boy’ and tease me and say ‘You don’t have a father.’ It’s better now, some still say things behind my back but I say, ‘Don’t look down on me because you don’t know what will happen in the next life.  With treatment I can live just like you.’ ” Sothavy relates that in recent times he has seen an improvement in people’s attitudes, “Some friends I knew used to discriminate against me. They didn’t allow me to enter their homes and didn’t play with me, but it’s different now.”

Dr. An Sophat, Deputy Director at Svay Rieng Provincial Health Department has been working with Mondul Mith Chouy Mith since it began in 2005. He says “I’m impressed with the mmm and can see the benefits in the regular follow-up as the children come for treatment. Through observation and learning the children know how to take their medication, and do so properly. In my experience it has contributed to a reduction in death rates. This is a special forum for the children. They can relieve their tension, they meet other children living with HIV and they are released from fear and stigma.”


*Names changed to protect identities.

By Denise Shepherd-Johnson

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