SWAZILAND: Mobile clinics in cash crunch

Mbabane, 11 May 2010 (PlusNews) - Mobile clinics for HIV patients have been benefiting entire communities in rural Swaziland, but tight budgets have scuppered plans to expand the project, or even sustain a fleet of just two vehicles.

"Whatever financial problems we have are temporary, I am sure, because the people have responded so well to the mobile clinics," said Siphiwe Hlope, founder and director of Swaziland Positive Living (SWAPOL), an NGO that supports those living with HIV, especially in rural communities, which started the project.

In theory, mobile clinics are unnecessary because the health ministry's goal of having a medical clinic within seven kilometres of every dwelling has been achieved for about 95 percent of the population.

But in mountainous Swaziland, seven kilometres can mean travelling for several hours, and is "an infinity if you are ill and you can't walk" said Maphangisa Dlamini, a male nurse and mobile clinic driver. "Many people also cannot afford the bus fare."

According to the United Nations Development Programme, 80 percent of rural Swazis live in chronic poverty and on average it takes them two hours to reach a clinic.

"The idea for a mobile clinic actually came from our members," said Hlope. "We asked [them] what they needed to make their lives with HIV easier. Many had problems getting to clinics - the distance by foot, the transportation costs - and these accounted for 'ARV defaulters' [people who stop taking antiretroviral medication], and also not getting children the medical attention they needed."

A minibus donated two years ago by the Stephen Lewis Foundation, which funds HIV/AIDS projects in many African countries, was converted into Swaziland's first mobile clinic, but had to be retired this year along with its nurse/driver when operating costs could no longer be met.

A new mobile clinic was donated by the UN Children's Fund (UNICEF), which also pays its operating cost of R1.5 million (US$198,400) per annum, but additional sources of funding are needed to recommission the original mobile clinic and get two new vehicles on the road, so that remote locations in all four of Swaziland's regions can be reached.

"By now we were supposed to have two more nurses - one for the Manzini Region, in the middle of the country, and one for the Lubombo Region, in the east - I think it's just a matter of time before we meet our targets, because the people depend on the truck clinics now," Dlamini said.

Dlamini's mobile clinic stops at local government buildings and Neighbourhood Care Points, set up by UNICEF to assist orphans and vulnerable children left in the wake of Swaziland's devastating AIDS epidemic. These children now make up almost one-fifth of the 970,000 population, and meeting their medical needs is a national priority.

"We bought the second mobile clinic truck for SWAPOL as a way of treating the children," said Makhosini Mamba, Health and Nutrition Officer at UNICEF Swaziland. "SWAPOL has a network of support groups for people living with HIV and AIDS, and with this community network already in place, it was a good way for us to get to rural areas that are hard to reach."

In remote locations, where health services are otherwise only provided by traditional healers, the mobile clinics offer immunizations, micro-nutritional supplements, and treatment for minor ailments. "The entire community, as well as HIV-positive people, is served by the mobile clinics," Mamba said.

SWAPOL director Hlope said the clinics had also helped people rethink their prejudices about HIV. "Because we are a women's support group, our focus is on HIV-positive mothers and their HIV-positive children, but now all the people know our clinics ... they don't fear us. Instead, they come running when we arrive because they want our services."

Monitoring HIV-positive people to ensure they take government-supplied antiretroviral (ARV) drugs is high on Mamba's agenda, but he also provides HIV counselling and testing, a popular service that has increased SWAPOL's membership.

"I am busy, but I like my work," said Mamba while fixing a punctured tyre that had put the truck out of commission for a few hours. The clinic on wheels treated 5,600 patients in 2009, including 1,635 children. He tested and counselled 300 people for HIV and referred 328 to hospitals to begin tuberculosis and ARV treatment.

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Theme (s): Care/Treatment - PlusNews, Children, HIV/AIDS (PlusNews),

[This report does not necessarily reflect the views of the United Nations]