This is a guest post from the US Centers for Disease Control and Prevention
Far from the bustle of Windhoek, Ms. Anneli Haingura and Ms. Clothilde Mutjida, Development Aid from People to People (DAPP) field officers, walk through the small town of Sauyema, just outside Rundu. They pass a young girl pounding millet in the yard, a grandmother enjoying an afternoon nap, a couple of six-year old children playing a game. They greet each person with a warm smile and chat like old friends, but this is their first time here. Their bright red T-shirts and bags are their introduction—everyone knows they are DAPP Field Officers.
Anneli Haingura and Clothilde Mutjida, providing post-test counseling with the couple. Photo credit: Veronica Davison
They are in Sauyema to provide home-based HIV counseling and testing to interested individuals and couples, part of a pilot project supported by the Ministry of Health and Social Services (MoHSS) and the US Centers for Disease Control and Prevention (CDC). Their clients are Mr. Johannes Sinoge, 32 years old, and Reginalda Liwaneuka, 26 years old and a mother of two. They sit together, facing Anneli and Clothilde. The field officers introduce themselves and explain the value of couples HIV counseling and testing, speaking Rukwangali, one of the languages spoken in the Kavango region.
Once Clothilde clarifies the purpose of the visit and Johannes and Reginalda consent to be tested, Anneli takes out the testing kits and describes the process for obtaining a sample. The couple is shy and quiet, but experienced field officers, Anneli and Clothilde are patient and kind, putting them at ease.
Getting the blood sample for the test is easy—just a simple finger-prick. The results will be ready in 15 minutes. While they wait Anneli explains that the results could be both negative, both positive, or discordant, meaning that one might test positive and the other negative. She discusses the importance of accepting the results and supporting each other, especially if they are discordant. Clothilde demonstrates how to use a male condom and reminds the couple of the importance of consistent and correct condom use. When they are ready, Clothilde shows Johannes his results, then Reginalda hers. Clothilde provides post-test counseling and answers their questions carefully. Once they have all the information necessary they are given a packet of condoms and a referral to a local health center.
What is most striking about the visit is how different it is from most visits to a health facility. The clients enjoy the comfort of being in their own home and the attention of skilled providers who are free from distractions. They have each other to lean on and two experts to confer with for as long as they want. Home-based HIV testing with DAPP field officers is a unique service, one that values privacy, convenience and quality.
The field officers recognize these benefits and their value to clients, which is why they are willing to work on evenings, weekends, and holidays, whatever it takes to reach people. “When we test people at their homes we can spend as much time as we need with a client,” says Ms. Alberthina Kasiki, a field officer in Oshakati. “We can reach people who do not usually go for services at health facilities, like men, and people who have never before been tested,” explains Ms. Natalia Lucas, also a field officer from Oshakati.
Anneli Haingura conducting an HIV Test after the couple’s pre-counseling session. Photo credit: Veronica Davison.
But they also understand that home-based HIV testing would be impossible to implement, had they not worked so hard over the last eight years, since DAPP began its work on HIV. Mr. Matheus Kaitungwa, a field officer for Oshana region offers a reason for their success. “We have worked with these communities since 2005. We have developed relationships with individuals and families. They know us and trust us. They know that we choose to be out there with them and they have welcomed us into their homes.”
Five hundred 500 kilometers east of Sauyema, at Ngweze Clinic in the Caprivi region, another pair of DAPP field officers is preparing to visit someone at home. Ms. Melody Chipadze and Ms. Charity Kabuba Ntema are reviewing a list of HIV-positive patients who have not been coming in to pick up their medication from the pharmacy. These people are known as defaulters.
One of the people on the list is Ms. Carel Siambango, a 33-year-old mother of two and someone well-known to the field officers. They walk to her homestead and find her busy cleaning her yard. She knows Melody and Charity, and feels comfortable talking to her, because they discovered that she was no longer taking her medication and encouraged her to restart. They are here to make sure that she has continued her treatment and is doing well. “They told me I have been on treatment for a long time and there was no need to stop,” she says. She was pregnant when she defaulted and they urged her to take her medicine to both care for herself and protect her baby from becoming infected with HIV.
Now she has a two-month-old son and an eight-year-old daughter, both of whom are HIV-negative. The field officers, along with Ms. Naemi Shoopala, Maternal and Child Health Specialist for CDC-Namibia, speak to Carel about the importance of being around to take care of her children.
“Wouldn’t you like to see your children finish school, get good jobs, and support you one day?” they ask. Carel gives her son, swaddled in her lap, a squeeze and kiss on the forehead. She acknowledges that she wants to see her children grow into adulthood and that she must lead a healthy life to do so. Melody encourages her to ask her partner, a taxi driver, to be tested as well. Part of positive living is being able to speak with your partner about your status and to take steps to protect him or her, the field officers explain.
As they pack their bags to go, Carel proudly declares that she will stick to her treatment and tell her HIV-positive friends to do the same. “Those people have families who need them too. If they die, who will take care of their children? There is no need for this country to be full of orphans,” she says.
DAPP field officers are proud of their work with Carel, and of their counseling and testing session with Reginalda and Johannes. They spend their days walking distances, often in extreme heat, to provide services to people in need. Through this work they have established strong links between health facilities and communities, and strengthened systems for follow-up care. Their compassion, dedication, and determination are driven by a deep calling and commitment. Truly at the front line of the battle against HIV/AIDS, they are contributing to saving thousands of lives and to making Namibia a healthy nation.