Home Visits

As I’ve previously said, I am assigned to an organization called ICAP. ICAP provides HIV treatment and psychosocial support. To implement these services, there’s a group of HIV+ women at the hospitals known as activistas, that make home visits to those on HIV treatment, and give educational lectures twice a morning about one of many health topics, and they also facilitate a support group once a month. There is a counselor at the hospital specifically there to counsel people before taking an HIV test and also to educate patients who are starting or are already on HIV treatment. The counselors are provided by ICAP, who works as a partner with the Ministry of Health in Mozambique. The counselor at my hospital is known as my “counterpart”, a term that Peace Corps uses to describe a local national that you work with everyday to train them to build sustainability, not dependency. My counterpart is a counselor at the hospital where I work and her name is Madina.

We provide two types of home visits to maintain healthy treatment adherence. The first is called visits of support, where activistas go to patient’s houses and counsel them about any troubles or concerns the patient may be facing. They reiterate the importance of taking treatment correctly and maintaining a healthy lifestyle- practicing safe sex, eating a balanced diet, abstaining from alcohol/smoking/drugs, and coming to the hospital when needed.

The other type of home visit is practically a search for patients who haven’t been showing up for appointments, mostly to pick up HIV treatment. It’s really serious because this usually means that the patient has not taken their meds in a certain period of time, which is bad because when that happens, the person will develop resistance to HIV treatment, which would ultimately lead to death.

2 pairs of 2 activistas go into the community everyday to make home visits. I go with them at least 3-4 days a week. ICAP supplies us with home visit cards which have a list of information about the patient and we are to fill out the card after the visit about how the patient was. The cards also describe if the visit is a visit of support or search for the patient. So, sounds good, right? You may be thinking that doesn’t sound all that hard and maybe you wouldn’t mind helping out with that for 2 years. Well, let me tell you about the iceburg of complications under our surface of seemingly wonderful home visits.

First of all, there are SO many patients. One in 4 people is infected with HIV. Hundreds of people receive treatment at our hospital. Keep in mind that our hospital is not the only hospital in Xai Xai that provides HIV treatment. In our hospital, all patient information and appointment summaries are recorded in paper files. We don’t have a computer. I think a computer may solve some of the issues we face but I also see that it may create new problems as well.

While I was in the States in my last semester of college I was a social work intern with an organization that provides services for people living with HIV/AIDS. I would make home visits for our clients. Ohhhh how I now see how good I had it! Each client had an organized file on a computerized database and on paper as well. To go on home visits, the organization had a company car with working air condition and specific directions to the client’s house. What a wonderful system we have back home, absolutely wonderful.

Back to reality. Ok so home visits here can be difficult because of the topography of our area. Sand and hills make up Xai Xai. Sand, hills, and heat are three of my absolute favorite things in life. Especially walking through all 3 of them for hours at the same time, now that’s what I call fun. We walk very far distances to make home visits, too. My point is to say that physically, it’s not easy. “Neighborhoods” here aren’t organized like they are in the States. There are no organized streets that have names nor are there maps or directions of any sort. Everyone’s just kind of scattered about. There are points of reference, however. So, the heat, terrain, and lack of specific addresses are the main sources of our difficulties.

When we go on visits in search of patients, most of the time we don’t find the person we’re looking for. The most common reasons for not finding patients are mostly because: the patient has moved, the patient has traveled (many people migrate to find work or live with family members in times of need), the patient has died, or no one knows the patient because they gave the wrong address. Unfortunately, people often give us the wrong address, sometimes wrong name, when they open a file at the hospital. That alone is the cause of a few issues. People fear that confidentiality isn’t really legit and they think that people in the community will discover their status if people from the hospital keep coming to their house. Their fears of discrimination/stigma are pretty valid because confidentiality here isn’t like what it is to Americans. We’re working on improving that. My activistas used to go into the community and show the home visit cards (which have information that identifies the HIV+ patient) to people in the community to try to find who we’re looking for. They don’t do that anymore, thank goodness. Occasionally, we find patients that we’re looking for. Some reasons they give us for not coming to the hospital: they forgot the date, they are too sick to go, they don’t have transportation, they went to the hospital but the hospital didn’t attend them well, or they say they’re getting treatment from another hospital.

It's complicated but it's coming along.