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New dawn of hope – care for children and adolescents in Harare, Zimbabwe

Author: Sr Tando Ndlela, Island Hospice and Healthcare
27 January 2017

Island Hospice and Healthcare has been working in Mufakose, Harare, through a specialised palliative care clinic called New Dawn Of Hope which focuses on children and adolescents.

The clinic meets the needs of children and adolescents living with HIV by providing medication, one-on-one counselling, referrals and follow up home visits through trained social workers and nurses.

Children and adolescents living with HIV face a number of stressors as they go about their daily lives.  

These might include disclosure of HIV status, maintaining adherence, orphanhood, stigma and discrimination, access to information on how they should adhere to their regimen, transition to adulthood, poverty, loneliness, depression and the need for autonomy (Mavhu et al 2013).

In some cases they are not told the truth as to why they take medication (Mavhu et al 2013) resulting in challenges during adolescence.

Juannetee’s story

Juannetee* started coming to the clinic when she was seven years old, having presented with a swelling of the neck which we suspected to be tuberculosis (TB).

We referred her to the hospital where she received treatment for TB. She improved greatly and then started on anti-retrovirals (ARVs).

She attended the clinics religiously in the company of her aunt for a number of years and adhered to her treatment. Unfortunately her aunt died suddenly and she started coming on her own to the clinic.

Her condition started to deteriorate and that is when we realised that there was something wrong, as she was no longer taking her ARVs.

Each time we wanted to engage her in the discussion about her medication, she would start crying with tears flowing down her cheeks. She did not want to hear those questions about ARVs.  

One of our social workers was engaged to work with her and the community caregivers were all involved in her care.

She gradually resumed her ARVs but there were complications arising from the period that she had defaulted on her medication. Juanetee is currently going blind.   

A recent visit has been done and Juanetee was at home having not gone to school. Her sight is getting worse, so she can hardly focus.

Her little body is slowly becoming frail from ill health. Her memory is also failing, which is indicative of disease progression.  

Our plan is to continue to encourage her to take her ARVs, build a strong support system and refer her to higher level clinics for further management as she now requires second line medication.

One of our social workers, is providing counseling to help Juanetee come to terms with her impending blindness, and is working with the rest of her family for further social support.

Working with adolescents with HIV and their families to support adherence to treatment

Our work at the New Dawn Clinic shows that adolescents living with HIV should know their status early in order to adhere to treatment.

This means working with their families to assist in disclosure of HIV status. The involvement of their family is key to adherence, as in the case of Juanettee who was assisted by her aunt to adhere to treatment.

We have also learnt that the period of adolescence may cause some teenagers to default treatment mainly because of the struggles that come at this point in life.

Some of the adolescents do not understand why they are taking ARVs. They feel well physically and do not understand why they have to take medication daily. 

Our observation is that those children/adolescents who start taking their medication early appear to be confident and understand the importance of adhering to their regimens. 

Clinics such as New Dawn are vital for adolescents so that they access comprehensive services that cater for their physical and psychosocial needs.

As the number of adolescents living with HIV grows due to the efficacy of ARVs in managing disease progression, clinics such as New Dawn of Hope are vital in giving services that support children and adolescents in their endeavour to improve their quality of life.

Find out more about Island Hospice and Healthcare on their website, follow IslandHospiceZW on Twitter, Instagram and Facebook, and donate to support their important work via Global Giving: https://www.globalgiving.org/projects/island-hospice-and-healthcare/

*Name changed
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