Letter From Epako
Oxfam Canada's Executive Director Robert Fox writes from Namibia
Anna says she's feeling much better, much stronger, since she started treatment. But frankly, she's looking pretty frail and her features are badly distorted by swollen sores. As we speak, her three-year-old son bounces about, a bundle of energy, and her nine-year-old returns home from school, eager for lunch.
Anna's mother tells me how important the home care is, and how much they rely on the food they receive - food that's critical if Anna's drugs (anti-retrovirals or ARVs) are to work. Food that's vital to keep her grandchildren from going hungry.
Too old to shoulder such a burden alone, she doesn't know how she would manage without the volunteers who come each Wednesday to help fetch water, wash clothes and clean, and who bring eggs and vegetables - but most important, bring company and comfort, advice and support.
As I take my leave, I wish Anna renewed health and vigour that she might see her sons one day graduate from school.
Anna lives in Epako, a "location" or shantytown outside Gobabis in the Omaheke region of Namibia. It is the largest of many such communities in which a remarkably successful community health project is making a real difference in the lives of people with tuberculosis and with HIV/AIDS.
The Omaheke Health Education Project (OHEP) started with a simple idea. People can't be cured of TB if they don't take their medicine. And to take their medicine - every day, at the same time, for six or more months - they need another person to act as a treatment supervisor or buddy, and they need the support of their community.
OHEP ensures every patient has someone who confirms they've taken that day's handful of pills, checking under their tongue to ensure they've all been swallowed. Each day they record the drugs have been taken, for the six- or eight- or twelve-month duration of the treatment required.
Seeing treatment through to the end is key, not only because it's the only way to cure TB but because if you don't complete the cycle, the pills lose their power and the strain grows more resistant.
OHEP also supports persons like Anna living with AIDS, many of whom have TB or are all the more vulnerable to it. Here too it is critical that ARVs be taken every day.
The active support of the community is also key. Through a network of field promoters, OHEP has supported the creation of community health committees who take the lead at the local level in health promotion and mobilizing community resources to tackle TB and HIV/AIDS.
Committee members go door to door offering information and counsel. They track people with persistent coughs and ensure they are tested. They distribute condoms and give advice on their proper use, storage and disposal. They recruit volunteers to provide home support and help break down the stigma attached to TB and HIV.
ARVs and TB drugs don't work so well on an empty stomach. Recognizing many in their community were too ill or too poor to secure the food needed for their treatments to have effect, committee members organized the funding, got a plot of land from the municipality, purchased 200 laying hens and began producing and distributing eggs to bolster diets. They then planted vegetable gardens, taking full advantage of the hens' droppings to fertilize their plots.
The community health committees reach out to the different ethnic and religious groups to ensure no one is alone. They work to reduce risk, to ensure treatment and to provide support. And they are having a major impact, filling a critical void in Namibia's public health system.
OHEP has been hugely successful at improving the cure rate for TB and reducing the number of patients who stop treatment before its conclusion. As well, the project has greatly increased early detection and treatment of TB, reducing its punishing toll. It has also helped improve the quality of life of persons living with AIDS and that of their families and care-givers. And it's working to change the conditions, the attitudes and the behaviour that put people at risk.
Oxfam Canada has been supporting OHEP since its inception in 1999. From the outset, the goal was to strengthen the Namibian Ministry of Health so that it could take up this approach to care, building on African expertise and demonstrating a model that could be replicated throughout the country.
Most of the funding for the program now comes from the UN Global Fund and we are looking at ways to ensure the program can be sustained over the long term. But there is no doubt that the active support of Oxfam donors has been critical to the success to date of this ground-breaking initiative. And there's no doubt that for Anna, her family and her community, that support has made a tremendous difference.