Namibia Ministry of Health and Social Services by Alex Kiesling

by tuftsigl
Jul 12

This summer I have been given the opportunity to work with Dr. Steven Hong from Tufts University School of Medicine in collaboration with the Namibia Ministry of Health and Social Services (MoHSS). Many resource-limited countries in sub-Saharan Africa such as Namibia have been severely impacted by the HIV/AIDS epidemic. AIDS is one of the drivers of poverty in Sub-Saharan Africa. People are too sick to work, die early, are unable to care for their families, and overwhelm the healthcare system with costs. To lift the affected countries out of poverty, we must figure out a way to reduce aids deaths. In parts of the west, AIDS is controlled with certain drugs and protocols, and we must figure out how to develop protocols that will work in Africa.

Although increasing efforts to provide antiretroviral therapy (ART) have made treatment available to millions of people, there has been an emergence of HIV drug resistance (HIVDR) due drug selection pressure. Many cases of HIVDR are preventable, so the World Health Organization designed a public health strategy for monitoring and preventing HIVDR in resource-limited settings. The foundation of the strategy includes Early Warning Indicators (EWIs) of HIVDR, which are ART site-level factor that create situations favorable for the emergence of HIVDR. Namibia is a resource-limited country in sub-Saharan Africa which as been severely affected by the HIV epidemic with up to 18% prevalence of HIV in pregnant women. Fortunately, ART scale-up in Namibia has been highly successful with over 80% of eligible patients on ART. The challenge for Namibia is to optimize continuing ART delivery especially in a country with people who are geographically separated by long distances. Namibia has successfully rolled out and scaled up EWIs to all ART sites in the country. Some important results include the identification of ART retention and adherence as one of the most prominent obstacles in the long-term success of the ART program. Identifying geographic areas where ART sites continue to be performing suboptimally will help the ART program to plan targeted public health interventions. This research has large implications for other resource-limited countries delivering ART with the public health model of care and will help define what works and what does not so that changes can be made to treatment protocols, which will in turn reduce sickness, death and the associated societal and economic costs.

I am currently analyzing EWI data collected under WHO methodology in the Namibia Ministry of Health and Social Services database from all ART sites in the country. Data has been abstracted from the Electronic Dispensing Tool (EDT), which is the national pharmacy dispensing tool. These data are currently being cleaned and validated using data from the electronic Patient Management System (ePMS). These data will then be used to calculate the appropriate EWIs for all sites. Geographic Information Systems (GIS) data of all ART sites will be made available by the Ministry of Health and Social Services (MoHSS). These data will then be linked to ART site EWI data. Then geographic factors can be assessed as risk factors for suboptimal performance for EWIs. The phase of data analysis that I am currently working on is sometimes quite tedious. Each patient receiving ART is given a Unique Number that identifies them in both EDT and ePMS, however, their Unique Numbers are not always entered properly. There are 12,000 patients who are currently missing their Unique Numbers in EDT and must be looked up individually in ePMS before the data can be validated. Even with two of us working on the project, it will take a couple weeks to get through all 12,000 patients. Since this is a public health project, we are focusing on the health of the population, rather than the individual. It is frustrating and I sometimes find myself complaining about how long it takes to look each number up individually, however, I think it is important not to forget that each number represents a person who is living with HIV, many of whom are struggling. There are a lot of reasons that the ART system can fail, including that the average person must travel 55 minutes to the ART clinics and does not always have the resources to get there regularly. Another reason is that one of the side effects of ART can be increased hunger. Some patients who do not have enough to eat refuse to take their medication because they do not want to be hungrier than they already are. When I think about the hardships that each of these people must go through in order to receive treatment, I realize I have absolutely nothing to complain about.

Although I have already been in Namibia for over one month, my real work has just begun. For the first couple weeks the EWI data was not available yet due to system inefficiencies completely out of my control so my coworker and I worked on some side projects for Dr. Hong. In many aspects of life here there is no rush to get things done, except when you’re on the road. I’ve been told that Namibia has the highest rate of traffic accidents per capita of any African country, and I can see why. Each morning I take a city taxi to the Ministry for work, which only costs 10 Namibian Dollars (less than 1 USD). City taxis are not like taxis in the United States. The drivers cram as many people as possible into them and are constantly honking at people walking to see if they want to get in. There are rarely seatbelts and the taxi drivers don’t always know where my destination is, so I had to quickly learn the route to work. There are also tourist taxis available, yet they cost N$70 so I only use them occasionally at night.

I live at the Chameleon Backpackers lodge right near the city center. I live in a safari-style tent that has a bed, nightstand, and lamp. When I tell my friends that I’m living in Africa this summer the first question that they usually ask is “is it really hot there?” I know that when people think of Africa they think of dry dessert and blazing sun, but Namibia is in the Southern Hemisphere so it is winter here and actually really cold, especially at night. Sometimes my tent is a little chilly. There are a lot of travelers coming through Chameleon including a fair amount of young people, which creates a fun atmosphere. There are also a few “long termers,” like me, who are here for an extended period of time, which forms a small community. There are a lot of fun activities that both the guests and some of the staff participate in regularly. For example, Friday night is Quiz & Braai night at Chameleon. Everyone who wants to participate is divided into teams of 4-5 people and there is a 4-round trivia challenge. The winning team receives a N$100 tab at the bar (my team won last time I played). For $70 you can purchase a braai pack that the staff will cook for you, which includes a piece of pork, a chicken skewer, a sausage, garlic bread, and salad. Tuesdays are also popular because the Warehouse bar, which is a local spot that is only a 3-minute walk from Chameleon, hosts a karaoke night. I have a terrible voice, but a few weeks ago it was my friend’s birthday so a few of us sang “My Humps,” which was quite funny. There is also the most fantastic Indian restaurant just down the road from Chameleon! On weekends when I am in Windhoek I usually watch a U-15 boys soccer team that Dr. Hong knows from his church youth group. The boys are physically smaller than the boys on other teams because they come from a poor informal settlement outside Windhoek, however, they are fast and aggressive players. They win a lot of their games so we call them the Bad News Bears, even though that is not their official team name.

During my time here I have also had the opportunity to travel to other parts of Namibia. I took a trip to Swakopmund and Walvis Bay on the coast for a few days with my co-worker, where we took a boat ride to see seals and dolphins, explored the dunes on a guided 4x4 trip, visited the Karakulia Weavers and leather factories, and ate delicious Namibian oysters. I also spent two weekends with my family when they came to visit. We traveled south to Sossusvlei, to climb the giant red sand dunes and go hot air ballooning at sunrise. We also went on safari in the North in Etosha National Park and Ongava game reserve. In the couple days that I was there we saw 20 lions and 11 rhinos (!) as well as a lot of other animals including: giraffes, elephants, antelope, zebras, etc.

Namibia is a beautiful country and has very friendly people. I am interested in the work that I am doing and have had some amazing experiences both living in Windhoek and traveling around different parts of the country. I am enjoying my time here tremendously and am happy to have another month left of this adventure.

 

Add new comment