Interview with Dr Refanus Kooper, Chief, ART Clinic, Katutura State Hospital

Katutura State Hospital, Windhoek, Namibia

17 June 2009 | Dispatch from Namibia

Q: When did your clinic start providing antiretroviral treatment (ART) to patients?

A: This clinic is affiliated with Katutura State Hospital, and it's called the Katutura ART clinic. We started providing ART to patients in the hospital premises in 2003. When we first started, there were no doctors who were trained in ART management. We began training doctors using WHO guidelines, then standardizing and adapting them to our country settings.

Q: How many patients are receiving ART?

A: Our patient population has really grown since 2003; we now have about 5000 adults and 1100 children receiving ART on a regular basis at the clinic, and we start about 80 to 120 new patients every month. To start a patient (on ART), it takes about two or three weeks. Depending on the patient's social background, it might take a little bit longer because we may have to deal with social issues.

Q: How do patients hear about the free treatment provided at the clinic?

A: Nurses from our clinic go to schools in the Katutura vicinity where they talk about HIV. They tell young people that we have an ART service available, and that they can come to the clinic to be tested. We also do community awareness using the VCT (voluntary HIV testing and counselling) sites in Katutura. Patients hear about us through word of mouth and the media as well.

Q: What services do you provide at the clinic?

A: Our clinic is divided into sections. We have a paediatric site and an adult site. We have a pharmacy, where patients collect their medication. We also provide pap-smear services, family planning, and so on, in collaboration with CDC (the Centers for Disease Control and Prevention). We see PMTCT patients here, and we have TB screening services. We offer counselling services, specifically for alcohol and psychological problems. And we try to offer food security, referring patients to NGOs. So we really offer a full range of ART services.

Q: Are patients in rural areas receiving treatment at this clinic, or just those living in Katutura?

A: This clinic focuses mainly on patients in the Katutura vicinity. The Katutura Health Centre, not affiliated with our clinic, is servicing outreach centres; they send out doctors and nurses to these centres rather than bringing patients to Katutura Hospital. Occasionally, we send our own doctors to these outreach centres as well, if help is needed.

Human resources are a big problem. We need to employ more nurses and more doctors for both these outreach centres and our own clinic, but it's very difficult. Looking at the human resource set-up in the country's HIV sector, you'll see that there are 300 doctors, but only two are Namibian. You'll also find that most doctors don't like going to rural areas. Most Namibian doctors will just work for the state for one year, and then they'll work as private doctors because they want more money. We need to encourage more Namibian doctors to show patriotism by staying in the state health system - a culture of loving your country, helping your own people. And we need to look at incentives to encourage doctors to work in rural areas, perhaps rural allowances. The Ministry of Health is working to think of ways to keep Namibian doctors in the state health system. It's a great problem.

Q: Is there one patient's story that stands out in your mind?

A: Yes, there is one story that really stands out—the story of a 17-year-old teenager who was diagnosed with HIV about three years ago. The patient was initially on treatment with a private doctor. Her mother was then diagnosed with HIV, and died. When the patient arrived at our clinic about three months ago, her treatment was failing—she was having difficulty with HIV drug adherence due to problems at home. After her mother had died, she lived with her stepmother and father, and the relationship with the stepmother was terrible. When the patient came to our clinic, she had already had two suicide attempts. While at our clinic, she was also diagnosed with TB. We started counselling her, took her from the family and put her in a children's home. Now, clinically and psychologically, she's doing really well. Her mood has changed and she has regained hope. For me, it's a success story of someone who was drowning but now, with ART and support, looks beautiful and sees that there is hope.

Q: Any final thoughts?

A: I'm just grateful that we started this programme, and that we could base our start on WHO guidelines. Working from the guidelines, we are able to help patients and give them quality care. Our motto: "Excellence is our belief, but to see a smile on a patient's face is our pride."

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