due time: tb/hiv

I woke up this morning to a much anticipated phone call from Greg, before putting on my towel and bringing my green basin outside to prepare my bath. The meeting was supposed to start at 9:00AM, and I planned to catch a boda around 8:15AM, with my expected arrival at HAU somewhere around 8:30AM. It was 7:30AM when I stepped out to say an “icho mabe” to Janet, only to find that David was just now boiling water for his morning bath. After he finished, I began to alternate between pouring cold and hot water into my basin, adjusting the temperature until I was satisfied. The instant I placed the kettle back on the charcoal, one of the new university students bypassed me in his towel with basin in hand, making a hurried beeline towards the shower-place. (Two university guys arrived just last night to rent out Edgar and Achola’s room.) After all the delay, I was ready to leave at 8:15AM, but was guilted into breakfast by Beatrice’s nudging smile: Fried eggs with green pepper, and Mukwono Tea sweetened with raw sugar. It was 8:30AM when I started walking down the road, hoping to flag down a boda. The rain was fierce last night in a refreshing sense, and the conditions of the road provided unquestionable evidence of the torrential downpour. I hop-scotched and zig-zagged my way down to avoid the puddles and slippery patches. On two occasions, I miscalculated my steps and found my Ecco sandals sliding beneath the quick-sand mud. Around 9AM, a car labeled “Terra Renaissance” stopped alongside me, asking me if I wanted a lift. I obliged, and jumped in the back seat with my toes dripping. The woman driving was the Director of Terra Renaissance, a Japan-based organization working with child mothers in Gulu, providing them with counseling and avenues for microfinance opportunities. I arrived at HAU around 9:15, sending apologies all around until I figured out that Dr. Edson, the TB Focal Person at NUMAT, had not yet arrived. While dialing his number on the office phone, I breathed a sigh of relief and was happy to be running on, as Tabo calls it, “African time”.

WORK:
Dr. Edson arrived in an oversized maroon van at 9:30AM with a surprise guest, Mr. Opwonya, the TB/Leprosy focal person for the District of Health in Gulu. We walked to the back together, finding 8 CVC’s and 3 staff members sitting in a circle underneath the tarp. Francis, HAU’s Director, came out to say a quick hello before rushing back inside to finish preparing his presentation for Save the Children. I introduced the two visitors, and facilitated the meeting. The reception from the CVC’s was more than I could ever have hoped for. While Dr. Edson was introducing TB in terms of its relevance to HIV/AIDS, I scanned the faces of the CVC’s, seeing with great gratification that they were all nodding in agreement, furrowing their brows in concern every so often at what they were being told. Yes, they had heard about TB before, and had even suffered from it themselves in the past, but Dr. Edson provided a macroscopic approach to TB/HIV which sparked a renewed interest. He explored the statistics – TB is the cause of death in close to a third of all those with HIV/AIDS, TB causes 2 million deaths/year, Uganda is among the 22 countries that contribute to more than 80% of the world’s TB burden, a little more than 50% of TB patients are HIV positive, etc. It was imperative that these CVC’s understood the importance of TB/HIV collaboration, and that the opportunistic infections, not HIV itself, is the cause of death in those who are HIV positive. Mr. Opwonya described HIV/AIDS as being a Masters of Ceremony, inviting everyone, aka the OI’s, to come and join in the festivities. They underlined the importance of treatment adherence, and gave an anecdote about a university student who had a severe case of XDR-TB in Gulu, just last year. All 5 of the different TB drugs available in Uganda could not combat the TB germ sample given by the patient. What’s worse is the fact that the boy’s XDR strain could have been transmitted already to who knows how many. Gulu is said to have the highest prevalence of HIV/AIDS in all of Uganda at an estimated 8.2 – 11%, compared to the national HIV/AIDS prevalence of 6.4%. TB cases are surely numerous in Gulu because it is dominated by IDP Camps and because of the escalated HIV/AIDS prevalence. According to Opwonya and Dr. Edson, there are no community-based organizations existing in Northern Uganda at the moment with an active TB CB-DOTS program in place. There are those who practice CB-DOTS in theory, and so it must be emphasized that Health Alert – Uganda would quite possibly be the first to implement TB into its HIV/AIDS programs within Gulu, and perhaps, within all of Northern Uganda.

The CVC’s asked so many insightful questions, and there are plans being made to arrange an all-day training for the 65 CVC’s of HAU on TB/HIV collaboration in the near future. Sadly, I may not be in Gulu when the trainings are to take place, but there is comfort in knowing that the District of Health, NUMAT, and Health Alert – Uganda have successfully joined hands in combating TB/HIV. Because Uganda’s Ministry of Health accepted WHO’s 2006 Interim Policy on Collaborative TB/HIV Activities, all hospitals and organizations are supposed to address HIV/TB together. Though it is a government mandate, the community still does not feel the effects or see results of the policy. Hopefully, Health Alert – Uganda can be a pioneer in TB/HIV collaborative activities, and spur other CBO’s to adopt the same approach.