Are OI clinics doing the job?

Catherine Murombedzi HIV Walk
Opportunistic Clinics (OI) are specialised clinics meant to offer health services to people living with HIV. With the advent of the HIV pandemic ,the health delivery system has been overwhelmed with patients who require specialised services.This prompted the Ministry of Health and Child Care to establish the OI clinics which are found in all hospitals and offer anti-retroviral therapy.

Due to a number of challenges in various provinces, one OI clinic is manned by trained personnel.

At other centres nurses who have not received any special training in OI are expected to provide services.

For centres with nurses not trained in OI services, patients encounter a number of challenges ranging from pure ignorance to unprofessional service.

Nurses in most hospitals and centres are not stationed in one department and are rotated as the matron deems necessary.

Thus the OI ends up with staff members not trained in that line hence the handling of patients varies from one centre to the other.

This was noted by the community monitoring team which paid visits to eight provinces out of the 10 in the country.

The team encountered some centres where the nurses did not even know what liver tests functions were nor did they take samples for CD4 counts because the service was not available.

The team spokesman Mr Stanley Takaona recommended that the OI being a specialised unit should be allowed to retain trained staff so as to offer valid service.

“Opportunistic clinics by their nature offer specialised service and there is no doubt that trained staff needs to be retained in the clinics.

“However, that is not the case on the ground. We find that nurses are moved to other departments. People living with HIV have encountered problems as they have had their dignity strapped.

“For example at Mutare General Hospital if one does not have US$8 consultation fee then he or she has to wait for special clearance which is done in a manner that is rather humiliating.

“The clerk just orders those without the fee to stand on one side and wait to see the senior clerk who will decide their fate. Such treatment is not acceptable. ART is for life and even if one hasn’t got the consultation fee, the service must be given. Other centres offer ART services for free or for a nominal fee of a dollar,” said Mr Takaona.

In 2000 the country was gripped with a mammoth pandemic of HIV and President Mugabe declared it a national emergency. In 2004 selected centres began to distribute anti-retroviral therapy and today the service has been decentralised even to rural clinics.

Mashonaland Central has 141 ART centres. Another province which has reached universal access is Manicaland Province. This is because of the MSF project in Buhera district which has seen all the 29 clinics in the district dispensing ART.

Some Buhera district ART centres now order directly from the National Pharmacy thereby removing bottlenecks.

Marondera Provincial Hospital has an OI clinic which services 7315 ART patients. It has 16 outreach sites and the provincial hospital has no clients on the waiting list. However, they grapple with the large number of clients as many refuse to be transferred to their nearest clinic.

Mrs Nicky Nhapi who collects her medication from the hospital said she was in no hurry to be transferred to the local council clinic in Rudhaka. She does not like collecting medicine from her local clinic. She fears meeting people from her neighbourhood.

Mrs Nhapi’s dislike of being transferred to a local clinic could be due to stigma and discrimination. Mrs Nhapi’s teenage daughter who was born HIV positive said she found it difficult to be attended to at the OI clinic.

“I do not like the idea of an OI clinic. Why should we not be treated at the general outpatients like everyone else? By being labelled OI it smacks of stigma and I do not like it. My mother can’t collect my medication on my behalf and I have to come in person. Since she collects her medication she should be allowed to collect on my behalf. I am not ill but I end up missing school collecting medication after every three months,” said Mrs Nhapi’s daughter.

The girl also complained that they are not given priority treatment even when they are in uniform and are supposed to be in school.

“My teacher always asks why I miss school. I tell her that I have a special condition. I would be grateful if the hospital allows my mother to collect medication on my behalf when I am not ill,” said the girl.

Ms Shingi Matogo said she viewed the OI clinics differently.

She saw the need for the specialised service hence she did not query it being a stand-alone unit.

“Coming to the OI clinic means I receive streamlined treatment.

“The nurses at the OI are dealing with one issue hence they handle it efficiently. Those who are not feeling well are referred to a person to a doctor.

“The rest of the clients who would have come to collect ARVs are attended by the nurses and leave in no time.

“I am happy with the treatment I have received so far at the OI clinic and would not ask to have an integrated clinic. This would compromise the specialised service I get,” said Ms Matogo.

Mrs Olive Mutabeni concurred with Ms Matogo but raised the question why OI’s were housed next to mortuaries.

“Being a retired nurse I see the need to offer anti-retro therapy services as a specialised service. My question only lies in the location of the OI clinics. At Harare Hospital it is next to the mortuary, could they not have placed it at any other unused building?” said Ms Mutabeni.

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