Care for caregivers at new centre

A new centre in Botswana is piloting some innovate strategies to address the emotional and medical needs of HIV/AIDS healthcare providers. The Tshedisa Institute in the capital, Gaborone, is the brainchild of several doctors working in the local private and public health sectors, who recognised the need to provide healthcare workers, exhausted and overworked by the country's HIV/AIDS epidemic, with more support. Dr Ava Avalos has worked at the Princess Marina Hospital's Infectious Diseases Care Clinic (IDCC) since it opened in 2003. Now one of the largest HIV/AIDS clinics in the world, the IDCC provides ARV treatment to over 14,000 patients as part of the national programme. "As the IDCC grew, we could just see how doctors and nurses were feeling overwhelmed," recalled Avalos. "We had tried to do some interventions here for patients, like dance classes and support groups, and we realised what we also needed was something for the healthcare providers." Avalos said many caregivers were also not coming forward for HIV testing and treatment because they were reluctant to share long queues at the IDCC with their patients and feared stigmatisation by their co-workers. A place was needed where nurses and doctors could be tested and treated quickly and confidentially, as they were often waiting too long before seeking help. A private practitioner offered the use of a building within walking distance of the IDCC to accommodate the centre, while Rotary International helped pay for renovations and the planting of a therapeutic garden. Doctors, counsellors and therapists have volunteered to contribute their time to the institute until more funding can be found. The centre opened last month and so far only has about 50 clients, but once the word has spread, "I think we'll be swamped," said Phildah Cele, who counselled HIV/AIDS caregivers and patients for several years before working as a volunteer at Tshedisa. Healthcare workers have been dealing with fewer patient deaths since Botswana's national ARV treatment programme started in 2003, yet "the level of suffering they're exposed to day in, day out is really hard for most people to comprehend. The reality is, it's not a normal thing, and it's not something human beings should have to cope with without support,” Avalos commented. Like every other country in the region, Botswana has a shortage of healthcare providers in the public sector, adding to the burden of those working with HIV/AIDS. Staff shortages often create a vicious cycle in which overworked doctors and nurses succumb to stress and burn out at an even higher rate. "It's not just the job that's stressful," said one of the nurses at Princess Marina's IDCC, "it's that we need more money and more staff." Avalos said healthcare providers often coped well with work-related stress until something happened in their personal lives: a sick relative or an abusive spouse could act as the tipping point that made stress at work unbearable, but at Tshedisa they could talk to a clinical psychologist, join a support group or participate in various therapy classes, including dance, art, poetry and drama. Stigmatisation of HIV-positive people was surprisingly high among healthcare workers, said Diana Dickinson, the doctor who donated the building and now volunteers at the centre. Nurses and doctors among her patients were also most likely to default on treatment. Cele has also noticed the difficulty HIV/AIDS healthcare providers have in accepting their positive status: "With HIV, it's easy to talk about it until it knocks at your own door, then it's another issue all together. They don't disclose [their status] to their co-workers." Part of Tshedisa's strategy is to offer training to organisations interested in developing their own 'Care for the Caregiver' programmes. The institute receives no funding from the Ministry of Health, but Dickinson hopes it will eventually come on board and the centre will serve as a pilot project that can be duplicated in other parts of the country.