Blue Roof Clinic

My first couple days of rotations took place at the Blue Roof Clinic in Wentworth, which is a very impressive HIV care facility and the only stand alone HIV clinic in Durban. It is also in the heart of the epidemic, where the surrounding area has a 41% HIV prevalence rate! That number was almost unbelievable to me. I am just barely starting to get an idea of how bad the epidemic really is. During a talk with the director today I discovered that during the second president’s term, following Nelson Mandela, ARV’s were denied to HIV patients (for free at least) and led to the deaths of about 1 million people during this time at the height of the epidemic. One million people! Another incredible number…it’s no wonder that people always cite HIV as one of the major drains on the economy. Considering that there is still such a big population of individuals that are HIV positive, and even still transmitting the disease, and considering also that ARV’s are taken for life, and that the government provides them for free to all individuals…definitely a major expense. 

 

 

 

At the pharmacy today, they explained to me that although they would like to give patients who are adherent a 2-month supply of ARV’s they can’t, because there is a medication shortage problem now and they do not have enough stocked. So that means patients must return to the clinic more often, and some travel as much as 2-3 hours to get here, to escape the stigma in their communities. So clearly medication shortage is a barrier. But beyond medication, Blue Roof is not free, which makes a difference because the patient population is much more adherent to medication, is more health engaged, etc. Patients pay for services on a sliding fee scale, ie. visits, labs, etc. In contrast, basic primary care is free and provided by the government and seems to be of decent quality. The fact that Blue Roof still has 3,500 patients who travel from well outside of Durban (there is no defined catchment area for the clinic) to attend this clinic in particular is a testament to the amazing service and quality of care provided here.

In terms of my comparison of this clinic to the HIV clinics in Kenya, I noticed that Blue Roof is much more organized and structured. There seems to be a lot more involvement of the government in the HIV prevention and treatment effort in South Africa than in Kenya, and at least corruption is much less apparent to me thus far. Or at least the system of accountability seems to be better here. There is a good patient flow - patients come sign in at the entrance, wait to be called for a pill count, after which they are assessed by a nurse, and then sent to pharmacy to pick up medication. All patients receive a free meal provided by Keep A Child Alive. However, care seems to be much less comprehensive in comparison to Kenya, which had TB clinics, maternal & child health clinics, social work, and psychosocial treatment services all provided in one facility. I wonder if there are integrated clinics elsewhere in Durban or the rest of South Africa...

Other than that, I have met the other students and went out exploring the city a little. Durban is right on the eastern coast and has amazing beaches. We also went to the Moses Mabhida Stadium which was built for the 2010 World Cup, so iconic :)