15 Sep, 10 | by BMJ Group
In 2004, when the South African antiretroviral programme to tackle the HIV pandemic finally began, the concern turned to the management of children – the group that is always left behind.
As with most good stories, this one began on a cold and stormy night in February, when a chance remark from a colleague, turned into what is today CHIVA Africa. A contact had suggested that those of us who had been looking after children with HIV might like to share our expertise with colleagues in South Africa, who were, for the first time, being given the drugs with which to treat them. The task was enormous: healthcare professionals who had never used antiretroviral drugs before, who were already overwhelmed with wards overflowing with dying children and vacant posts, were now expected to develop clinics, recognise, diagnose, and treat children – all new tasks and a huge increase in workload. Outpatient long-term clinics for children were a new concept in an environment where care was mostly acute and opportunistic. Hospitals are remote, and patients walk many miles or pay exorbitant sums for transport, in order to reach the nearest hospitals-the beautiful rolling hills hide enormous hardships and deprivation.
In the UK, we have been treating children with HIV for close to two decades; experience and practical skills that have been developed over time and the longitudinal perspective on management we have garnered was what was needed by our colleagues in SA – why learn from trial and error on such an enormous scale, when we could share our experience and help prevent the replication of our mistakes? In sharing our practical skills, we could help our colleagues move ahead fast.
And so CHIVA Africa was born – first under the auspices of CHIVA (the Children’s HIV association of the UK and Ireland) and now as a standalone charity. A bunch of highly experienced paediatric HIV healthcare professionals from across all disciplines who were complete amateurs at aid work (as opposed to AIDS work!) embarked on what I naively thought would be a short three to five year programme in KwaZulu Natal, the epicentre of the South African HIV epidemic, and our work would be done. Six years later, I am coming to terms with the fact that I am now heading up a large and growing aid organisation providing support and training for healthcare professionals across three South African provinces, with more to come, and no end in sight to the work that needs to be done. It has been a rollercoaster journey, heartbreaking, inspiring, frustrating, and exhilarating all at once, and it is nowhere near over.
We have few rules, but those we do have are cast in stone. The watch words are collegiality, respect, and the partnership of colleagues, who are equals with different skills that they are committed to sharing with each other. Our volunteers learn as much from their South African colleagues as they teach and return to the UK exhausted but inspired. All advice and teaching is strictly in line with South African guidelines. All volunteer expenses are paid, but they receive no salary, they donate their time to us-they spend short periods of time in SA, dependent on their UK commitments.
It’s amazing what a group of aid work amateurs can achieve with a good helping of common sense, respect for colleagues, and a large dollop of commitment.
Over the coming weeks and months (maybe years!), we will be bringing you stories from South Africa, from our volunteers here and our colleagues there. They will build a picture not only what we have been doing there, but also the scale of the HIV problem in South Africa, the hardships faced by both the people and the healthcare services, and the enormous strides that have been made in spite of these. I hope you will come on this journey with us, as we move forward with our adolescent programme (the children who were dying are now growing up) in KZN, our PMTCT training, and our core paediatric programme which we are taking elsewhere in South Africa and beyond. Join our rollercoaster – it’s an incredible ride! (The picture shows Karyn Moshal teaching in KwaZulu Natal.)
Karyn Moshal is the founder and London based executive director of CHIVA Africa.