Yesterday was a day full of adventures. As part of one of our proposed projects, we set of to find popsicle sticks. The project we are working on was that to measure patient adherence for liquid medications. A similar project had been done a few ago in Lesotho, where a tongue depressor was used as a dipstick and held against a reading card to determine the level of liquid remaining in the bottle. However when we tried to insert the tongue depressor into the bottle, we found that the bottle neck was too small for the tongue depressor.
Thus, we set out to find a smaller stick that would fit properly – a popsicle stick! But that was much more easily thought of than found. We accordingly went to town to find these sticks which are commonly available in the US, but trying to find them in Mbabane was a huge ordeal. We tried both grocery stores in town, an office supply store, an ice cream shop, and even a hardware store with no success. Finally, two and a half hours later, we tried a small shop in a deserted, outlying area of town where we finally found wooden coffee stirrers! I have never been a coffee drinker, but I certainly appreciated them in that moment!
Another project we have been working on is to develop an algorithm to assist in the national roll out of the dosing clips. Apparently many of the clinics have already trained the staff on how to use them. We developed a method to calculate roughly how many clips of each size would be needed by each clinic base on the number of babies born at each clinic each month. Children of different ages require clips of different dosages (and thus different sizes of clips) so that was taken into consideration as well. Hopefully this will help CMS (Central Medical Store) have some idea of what to do when they receive orders for “a few clips.”
Below is a picture of Mbabane, the site of our grand quest:
We got a chance to meet with the Swaziland director of the Clinton Health Access Initiative (CHAI) to discuss the national distribution and implementation of the DoseRight dosing clips. We got a number of excellent ideas of where we can help out, such helping make job aids of how to use these clips for the rural clinics, creating a distribution algorithm to easily calculate the number of clips a clinic would need to order based on the number of births they have, and designing surveys to gather feedback regarding the clips when we actually go to the clinics. We also briefly discussed the liquid ARV adherence method that we are developing . It turns out that previous BTB interns in Lesotho actually have developed a similar liquid ARV adherence method, so we suggested that we see how the technique works for Swazi medications. If we can get a method working, perhaps CHAI will adopt it to implement it throughout Swaziland! Now with our plates full, Caren and I are very excited and can’t wait to get working next week!
Another excellent advancement- our dosing clip study was approved by the Rice IRB! We are now one step closer to actually being able to conduct the study before leaving.
Adventure time- this weekend, we hiked Sibebe Rock, which is the largest granite rock in the world! It was my first time hiking, and it was a great experience. Following a map of rocks with yellow splotches of paint along our trail, we hiked and enjoyed some breathtaking scenery!
Sorry for the long delay in blogging! First for a bit of fun… We went to Bushfire, which is an event put on by Young Heroes, an NGO that works to raise funds for kids education. The event is an international arts and crafts festival, so there were many little craft booths set up by NGOs who were selling crafts on behalf of the women who had made them, and there were also many booths set up by gogos (grandmas) who actually were selling the arts and crafts that they themselves had made by hand. We did quite a lot of shopping from the gogos- it was so nice to see how much happiness they had when you bought a small craft from them! Seeing that was probably my most favorite part of Bushfire. Apart from the arts and crafts though, there were concerts, poetry recitations, and more going on throughout the day. Bands from all over Africa had come, and we got the chance to see the Swazi legend Bholoja sing folk songs!
Alright- now back to business. During the beginning of the week, Caren and I worked on a family planning brochure for the patients, based on the contraception methods that Ann talked to us about us. One of the most popular family planning methods here is a tiny implant that can be placed under the skin of a woman’s upper arm. It releases progestin hormone for 3-7 years (depending on the brand and the weight of the woman using it) and requires no follow-up doctors visits regarding the matter during those years!
We also started brainstorming to come up with ideas on how to monitor the patient adherence to liquid ARVs, such as Nevirapine and Kaletra. One cool idea we had was to use a plastic straw, place it in the medication, and cap the other end of the straw with your thumb in order to hold the liquid in the straw for a short period of time to measure the height of the liquid on a measuring card. Now we just have to find straws to see if it will work!
This week marked the leaving of one more of the BIPAI doctors, so the clinic is currently only staffed by only three PAC doctors (PAC stands for the Pediatric AIDS Corps). BIPAI Swaziland COE was originally started to be staffed by 10 doctors, so things have been pretty busy around here.
During this crazy week, we were able to develop a brochure regarding family planning services offered at the clinic. Family planning is very important here because families tend to be very large (I met a boy here who has 8 brothers and sisters) and with 25% of the adult population HIV positive, family planning is essential to containing the spread of HIV. Family planning services include the pill as well as monthly or bimonthly injections, a five-year implant, and a ten-year intrauterine device. We submitted our draft to the family planning nurse, who is from Kenya, so she can edit it for accuracy. We hope to be able to distribute these in the waiting rooms so that women can go into their appointments well-informed and with specific questions in mind, thus allowing the doctors to be able to spend less time teaching patients about it and allowing them to see more patients in their extremely limited time.
We also had a chance to meet with the Swaziland director of the Clinton Health Access Initiative and discussed the country-wide roll out of the DoseRight dosing clips. The clips arrived in country last Monday, and very soon, the distribution will be underway! Demonstrations, monitoring methods, and ordering guides will need to be developed, and this is where we will be coming in.
Today, we also had a chance to climb up Sibebe Rock, the world’s largest open granite peak (pictured below). While it was a struggle getting up to the top, the view was absolutely breathtaking. Feeling very accomplished, we descended the rock looking forward to getting started on new projects!
