A Visit to Tseda Health Center

Community volunteer Chekula (left) and Tsigareda (right)

This morning Zerai, SCOPE’s current fellow, and I traveled out of Gondar to the Tseda Health Center. Tseda is a small rural village that lies beyond the chaotic, crowded market town of Azezo, about 30 km south of Gondar. Forgive me if this post begins to sound a bit technical, but I’m writing it also to help organize what we learned about the clinic and the HIV-related services it provides.

Tseda town

 First, let me say that I happily survived the 60 km round-trip in the Ethiopian version of a matatu. On the way to Tseda, the vehicle reached a high-point of 21 passengers plus 3 infants tied to their mother’s backs, one large sack of potatoes, 6 njera baskets and two 10-gallon water jugs. I especially enjoyed the metal post digging into my tail bone the entire way but thankfully, the road was newly paved and very smooth. Chigeryelem, as they say in Amharic (no problem . . . )

 The woman who arranged our visit was Tsigareda, one of the four women we met with at the Diocese last week. She works at the clinic as a counselor to the HIV+ women enrolled in Tseda Health Center’s ART (anti-retroviral therapy) program. Tsigareda is just lovely and was quite willing to show us around and tell us all she knew about the ART program which is being funded for 5 years by an NGO called MSH (Management Science for Health Care—note to self: look it up.) A second NGO with which I am not familiar (HAPCO) provides nutritional support for HIV+ pregnant women starting at the 7^th month of pregnancy until the baby is nine months old; however, the clinic does not have a nutritionist whose services they sorely need. 

ART records room

This clinic draws from a patient base of 17,000 people (aside from the ART program, the clinic also offers general medical services for the community as well as one delivery room staffed by a day-time midwife—one of the HIV+ pregnant women seen in the ART clinic was delivering while we were there) and we are told that they see many more people in the ART program than they originally expected—partly because some women travel far from their local health center in order to avoid having their HIV status known by their neighbors. As a counselor, Tsigareda spends a lot of her time making sure women are compliant with their follow-up visits as well as with their meds; we are told that Tsigareda is VERY convincing and so far there has not been an HIV+ patient who has disregarded her advice to follow up!

Tsigareda and the delivery room

We spent quite a long time speaking with Sister Negese, the RN in charge of the ART clinic. There are currently 80+ adults enrolled in Tseda’s ART program, 30 of whom are being monitored until their CD4 count falls low enough for them to start therapy. There are also 21 children receiving ART and 4 HIV+ pregnant women. Patients on ART are seen in clinic every month, at which point they are weighed, receive a complaint-related exam, an AFB smear for TB and a blood smear for malaria (present in the lower-lying Tseda area.) Most of the time, it is a woman who shows up at the clinic for testing and though the Negese and the counselors try to get the other family members in for testing, that is a great challenge. She told us the story of one woman who became pregnant by a married man with children and when she came in for a prenatal visit she tested positive. The subject of her tryst refused to be tested because it would reveal his infidelity—in the meantime, his wife and perhaps all his children are at risk (who knows who got the virus from whom?) Tseda has an ART Association—a support group made up of HIV+ women who meet regularly; these women also work an irrigated piece of land to grow produce to supplement their family’s diets. A second important support network is the Mother-to-Mother group that meets weekly. This group is made up of both HIV+ and – women, the purpose of which is to encourage pregnant and non-pregnant HIV+ women that if they are compliant with testing and treatment, they can give birth to healthy, HIV- babies.

Sister Negese's exam room

There are a gazillion other more technical details I will discuss with the SCOPE board, so enough for now. Suffice it to say that these women are doing a ton, but there is a ton more work to be done and we’re hopeful SCOPE can be a positive influence.

Coffins for sale in Gondar