By Owen Nyaka
SALIMA-(MaraviPost)-Quality and standards sometimes is being compromised in our health sector especially in circumstances where student health trainees who are on job-training operates with minimal or no adequate supervision by qualified medical personnel.
An investigation on the touching tale of a poorly HIV diagnosed toddler in a typical rural area within Salima district is just one exposed scenario of the negligence for unqualified medical personnel conducting blood samples test without no supervision.
Akweti Sani is a woman aged 39 with four children. She has given a written consent to this writer to tell the world her story.
She is daughter of traditional chief Sani in Salima district.
She tested HIV-positive on February 9, 2012.
Years later, she got pregnant while on ART but sadly Akweti was divorced when she was only four-months pregnant.
As per Malawi guidelines, she started life prolonging Anti-Retroviral Therapy (ART) and was put on Prevention-of-Mother-to-Child-Transmission (PMTCT) package as by then, she was lactating.
Her nearest facility where she gets treatment is Lifuwu Health Centre, which is about 15 kilometres away and from her home – Chigolo Trading Centre to the District Hospital is a distance of 60 kilometres one-way.
Moving forward, she gave birth to a healthy child on December 8, and Niverapin Syrup (NVP) was administered. She came to her near facility Lifuwu with the child on February 12, after two (2) months for DNA-Polymerase Chain Reaction (PCR) test, which is offered from infants under the age of two months.
However, on this day instead of collecting Dried Blood Samples (DBS), the student trainee at that time, without any supervision, she single handed collected rapid test and the obvious result was that of positive since HIV-exposed infants still have maternal antibodies at this age.
This rapid test positive result was the one which was given to the guardian on that day.
“I was told that my baby was HIV positive. I was heartbroken and accepted the result but no any further counselling was provided and I went back to my village,” Akweti said.
Three months since the HIV positive results for her baby was announced, Akweti on May 15, met Baylor Tingathe Children’s Foundation team which was on the ground at Sani Village, specifically at Chigolo Trading Centre.
At that time, the then Community Health Worker and Counsellor for the area, Dunken Phiri asked Akweti for the second DBS collection but she refused.
She responded in a deep sullen voice to the community worker, saying the child is already living with HIV and why should they keep on pricking her finger?
“God why putting the punishment on this innocent child, at least if you could just let it be on me and not on my child,” she said to herself at that time.
Phiri vividly remembers that as Akweti’s tears rolled down her face, the voice went slow and she seemed totally lost.
At this point, Phiri had to be tactical and immediately stopped talking about the issue of DBS and decided to hear her story.
While using her wrapper to wipe her tears, Akweti explained that she was told that her child was HIV positive on the same day she got a rapid test.
“I realised that something was amiss. I went through the HIV Testing and Counselling (HTC) register and discovered that the child was tested and given the final result of reactive. I asked her if we can talk for a few minutes, she accepted; I did outline procedures that are supposed to be followed on any exposed child with interventions alongside it. Later, she accepted to give the sample, but I could read her face that her mind was already made up that the child was infected,” Phiri said, adding that “it was pathetic while I was drawing the sample as her tears started again.”
The sample, number 243 was taken on May 15 and the results were received from the laboratory two months later on July 7.
The collect result of the same child was this time around being negative.
Immediately, authorities linked up with the Health Surveillance Assistance (HSA) from the area to advice Akweti to come to the clinic, but she never turned up.
Her heart was still broken because a month elapsed without coming to the clinic.
Permission from the then Baylor Tingathe Children’s Foundation coordinator was granted to make a home visit, together with Environmental Health Officer, Kennedy Nyirenda.
They travelled 15 kilometres away from Lifuwu and managed to locate her.
Phiri asked Akweti if it was proper to discuss issues of her child within her house and she gave a go ahead.
He asked her how she had been finding it in her heart about the issue to do with her child, but she clearly stated that she was still not happy with the outcome of the result.
“I went on to ask for consent to give her fresh results, she said yes and I disclosed to her that the DBS was negative, she could not believe it…she looked me into the eyes and said, Adokotala….you men my child is HIV free?” Phiri said.
This is how Akweti’s child escaped the manacles of being enrolled into paediatric HIV treatment.
As per the procedure, she was advised that the final test shall be after twenty-four months to determine if the virus has, at all, been passed during breast feeding period and she got the results-two-years later on February 15.
“God is good all the time. The qualified HIV provider certified after two years that my child is HIV negative. I am more than happy because my child is amongst the HIV free generation after tests were retaken correctly,” Akweti said.
Akweti is all smiles because of the change in fortunes for her child but one wonders how many other children might have been poorly diagnosed in the area by this student health trainee.
Health Rights Education Program, executive director Maziko Matemba said it is saddening to note that as a country we need to make sure that we put everything in a proper perspective more especially in the health sector.
Health sector is a very sensitive sector, and all people who are supposed to be handling patients are also supposed to be qualified, so qualification of people who are handling the sector in terms of health workers comes from where they are coming from, how they have been taught and mentored, also how they are given necessary tools for them to deliver services.
Matemba say as you are aware that the Ministry of Heath currently has strategic plan which is very clear, it is about quality of services, in fact the ministry of health has got a quality health department which looks at quality health care, and quality can only come when we have qualified, well mentored health workers who can deliver services as it is required.
“So the issue about quality in terms of medical students who are on the job training, if they are operating with minimal or inadequate supervision is a concern. We would ask at Medical Council of Malawi because they are mandated to do this as a regulator but also with our public health collages and institutions with a profession of universities and colleges in Malawi.
“There is a lot of work to be done in terms of ensuring that there is quality of students that are graduating so that it does not endanger the patients when they finalise or graduate, so supervision of such students is as critical as handling a patient itself,” says Matemba.
He adds, “We would want to make sure that our health workers are managed, but also all institutions that are mandated to regulate the training of health workers need to do their job properly, making sure that there is adequate supervision if there are issues of resources, make sure the resources are available because these are medical doctors, clinicians and nurses in waiting, who will be handling patients soon or later”.
He said this is critical, and if this is happening it is a concern and as a health rights activist, we would like to make sure that they are there and it is corrected if needed, it is happening amidst the environment we are living in, in Malawi.
Public Health Specialist and Women Activist, Dr. Bridget Malewezi says it is unfortunate that both the mother and the child had this experience.
It is challenging for them but then fortunately was picked up at the second DBS sample collection even though she went through the whole series until the 24 months test.
She said from human resource perspective, we have huge challenge of shortage in numbers of staff providing actual care and then looking at training and that person being able to also supervise another person that means other clients may not be being seen, served or attended.
This is one challenge that is in the clinical area when it comes to training and preceptorship of students for clinical care.
She, however, say it is very unfortunate this happened, not just as a woman activist but also as a health professional, it is sometimes that we have to make sure that it has been looked at in the clinical education about making sure that students who are in the clinical area have somebody to provide correct supervision and guidance for the training.
Dr. Bridget Malewezi said in that way they are going to practice the correct and right thing.
“It is unfortunate that this woman got the wrong test results, because of the wrong tests, but it is unfortunate that she was able to get back to the system, she did not lost the follow up, and sometimes we do have lost follow ups, especially when you are given a test that says you are positive.
“People just assume that the child is positive for sure but they don’t comeback, so it is somehow a success story that she was able to continue through the whole chain to make sure that the child got 24 months test,” says Dr. Bridget Malewezi adding, usually one of the challenges we are actually seeing in the HIV experience and the inability of women to get these follow up tests done, and that is a little bit retrogressing to our health system.
In 2011, the Malawi ministry of Health streamlined their prevention of mother-to-child transmission (PMTCT) programme by pioneering ‘Option B+,’ a universal test-and-treat strategy for HIV infected pregnant and breastfeeding women, resulting in dramatic increases in the uptake of antiretroviral treatment (ART) among HIV infected women.
