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Shelley Wright is a nurse from Temuka, New Zealand,
and is currently on her first mission with Médecins
Sans Frontières (MSF) in northern Uganda. Here Shelley
writes about her first impressions working with MSF’s HIV/AIDS
programme in Arua, a town near the north-western Ugandan border with
the Democratic Republic of Congo.
I am now in my third week based in Arua in northern Uganda in a team
working with HIV patients.
It is my first mission with MSF but not my first time in Africa, a place
that I love. We live in a quiet; leafy compound in Arua. The rains have
started so the mosquitos are a bit more plentiful and because of malaria,
care has to be taken in the early mornings and evenings. But the mangos
and pineapples are ripe and very sweet.
The team is a mixture of French, Japanese, Malawian and British volunteers.
Arua is the main town in this the West Nile region of Uganda. There is
an AIDS clinic run at the District Hospital which is jointly run by Uganda’s
Ministry of Health and MSF.
It was decided to decentralise some of the care to smaller local clinics
and hospitals to make the service more accessible (most people rely on
public transport but the costs are out of reach to many). At present
four other clinics run with the input of MSF are located at Moyo, Nebbi,
Koboko and Adjumani.
I am on the road five days a week with my colleague, Dr.Julien Bonifas.
The journeys are between one and six hours to each clinic and only one
road is sealed!
Our objectives are twofold - Julien sits in on consultations to help
local clinicians improve their skills, particularly with the other opportunistic
infections that go hand in hand with HIV, such as Tuberculosis and Kaposi
sarcoma (a form of skin cancer); and my role is to try and improve the
flow of patients in the clinic; dealing with the standard of paperwork
and the collection of data; including numbers of men and women and children,
and recording those who default on their treatment and then mortality.
The work is often challenging with paperwork that needs streamlining,
problems in the transportation of medicines and generally working in
another culture with at least three languages going on simultaneously,
can be hard work sometimes. Additionally, MSF does not want to become
a substitute for local staff, rather impart our knowledge to enable a
better service; and at the same time appreciating that we all have different
standards and cultural needs.
At the moment we are only able to get to each clinic once a week .The
idea is that shortly, there will be two teams going out and we will split
the clinics between us so we can have an input to every clinic, everyday.
The highlight of the week for me is the drive to Adjumani which involves
a drive along a dirt track for at least four hours and then a ferry crossing
of the Nile which is so beautiful and ancient and the fisherman punt
by in boats made of hewn logs and cast small nets.
Some days are really hard though. We had a grandmother recently at Koboko,
who brought in her tiny scrap of a grand daughter after the mother had
died. Unfortunately the baby had a terrible infection and died before
our next visit. Today, an old man brought in his three young grandchildren
whose mother had died from AIDS - he brought them in to have them tested
too and they were all HIV positive. He had suspected they were and had
wanted to bring them in for a long time but their mother would not let
him, and now he is their guardian and he took this huge step for them
to get started on treatment, hopefully he has given them a real chance.
I salute him.
Would I be anywhere else right now?
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