[This document was prepared for students at MIT to instruct them on “Continuum of Care” in the Matero community.] Continuum of Care: Lessons from the Matero Compound template for community-based healthcare On October 3, 2005, the University of Zambia and Ridgeway Medical students visited the Matero Compound to learn first-hand how the community-based health network operates. The goal of the day in Matero was to give students a complete picture of the “continuum of care” within one urban community in Zambia. Students spoke in small groups with representatives from the community pediatric hospice and home-based care program. The day also included songs/performances by local orphans and vulnerable children and programs by community peer educators, both focusing on HIV/AIDS. The children first welcomed us with a song in Bimba, recited poems about HIV/AIDS and the effects on their family, and performed a skit about the abuse of a school girl who was forced to find a “sugar daddy” when her parents died from HIV/AIDS. Peer education in Matero is done through a series of performances in local bars, schools, and homes on subtopics that include VCT, PMTCT, STIs, and abuse. We saw performances about VCT and PMTCT. Through this program, the students had an in-depth look at not only community health workers in Matero, but also the people affected by HIV/AIDS and what is being done within the community, by the community to promote awareness and education. Below is a compilation of the student interviews with health workers from each step along the community continuum of care. Christina DeFilippo Kathie Dionisio Pete Mack Subtopic: Hospice Katebe Sakala, Mike Tongo Because of the escalating levels of HIV positive people and those who are sick with full blown AIDS, there has been a rise in the need for these people to be cared for in an environment of cleanliness, care and love. It is comforting to see that a number of hospices are being set up to provide a place where these sick people can die peacefully. One such initiative is the Matero pediatric hospice which is currently under construction. Hospices have been seen to be very important because they provide specific healthcare. To help us get an in-depth knowledge of what a hospice is all about and its other operations, we talked to John, a clinical officer at the Matero hospice. Part of John’s work involves training community-based heath workers. A hospice caters for everyone in a community and beyond, and when a patient is referred to a hospice from a district clinic, tests are done. Care and counseling are provided but not the administration of ARVs. John trains CBHW to identify people with diseases such as TB and also train them as how to monitor patients. These trainings are done through seminars or personal talks. Health workers are trained to go into the community to bring those who are very sick. At a hospice HIV test is done on all patients to determine their status. Sometimes when the patient is not in a critical condition this test is done without the patient’s consent, but the patient is talked to after the test. A hospice receives patients from home based care, Clinics etc. Families usually are the ones who decide to send their sick to a hospice. The hospice does not only rely on patients referred by district clinics. The problem is that the government does not really offer any support, hence the cost of drugs are quite expensive. ARVs are given by clinics but monitoring is done by community health workers. [Note: this has recently changed, and now ARVs are provided free of charge to patients. Before June 2005, ARVs cost each patient 40,000 Kwacha per month (~9USD)]. Access to healthcare is being improved throughout the teaching of community health workers, teaching people preventative measures and how to monitor patients on ART. Since some people have negative attitudes towards a hospice, the health workers have to make sure that people are getting better for others to get encouragement.One of the greatest challenges in caring for the sick are that for some people, a hospice is a scary place – it is a place of death. The challenges of money, manpower, materials, medicine and equipment cannot be overlooked. An emotional challenge that health practitioners face is the limit of how far they can go to help out also the challenges of telling the patient’s family of the plight pf the patient. Seeing people die after caring for them is an emotional strain. There is a need to motivate health workers to be committed to the sick. The number of people with HIV AIDS has increased; hence there are long lines of people waiting to be given ARVs. The good thing is that nowadays, people have confidence in ART, in spite of their side effects. A hospice normally keeps people until they are stable, recover or die. Some people decide to be discharged on their own free will; they choose to die at home. At district hospitals, follow-ups of the patients on ARVs are not done properly, only the hemoglobin test is done when the patient goes for review. A general check on the patient’s condition is not done. In contrast, a hospice’s follow-ups are done through training of family members; hence there is always a link between the patient and the hospice. Some patients are referred to the University Teaching Hospital if their condition cannot improve. In conclusion, some of the above raised issues require serious attention for us to ensure that the needs of the patients are met. Subtopic: Community Nurse (CN) Kateula Sichalwe The community nurse (CN), Christopher, has been working in the various zones of Matero and nearby places. The church has been very actively involved in the fight against HIV/AIDS. Records are collected on paper and kept under lock and key. Christopher feels that government clinics have respect for the referrals made by the CN and community nursing assistants (CNAs). The major challenge is to have people talk. Subtopic: Community Nursing Assistants (CNAs) via the community nurse Chishimba The Matero home-based care program focused on pediatric care called “Arms Reach Care”. 30 community nursing assistants (CNAs) have been training for 7 weeks for arms reach care. The program aims to reach the homes of 150 pediatric patients, all of which will be monitored by the community nurse, thus allowing a greater number of patients to be effectively monitored and treated. Many of the patients