n Southern African Journal of HIV Medicine - The Madwaleni HIV / ARV programme : community ARV services




Richard Cooke and Lynne Wilkinson sought out a deep rural hospital in the old Transkei area of the Eastern Cape to attempt to set up a holistic HIV programme including access to antiretrovirals (ARVs). They looked for a hospital difficult to access by road, where the majority of the people were unemployed and where HIV-positive people currently have minimal health and social support. <BR>They identified Madwaleni hospital, a 220-bed district hospital built as a missionary hospital in the early fifties. It is approximately 30 km south-east of a small town called Elliotdale (approximately 80 km south-east of Mthatha). District statistics indicate that the hospital serves a population of approximately 256 000. <BR>Madwaleni is approximately 110 km (including 30 km of dirt road) from its referral centre, Nelson Mandela Hospital Complex (NMH) in Mthatha. Madwaleni has a small operating theatre, an X-ray facility and a laboratory, and patients are referred to NMH for all specialist consultations, and for surgery other than minor operations and caesarean sections. By car or ambulance this route takes approximately 1 1/2 hours, but for patients who are referred and need to use public transport, it takes closer to 2 1/2 hours. <BR>Madwaleni has a total of 5 doctors (including HIV / ARV programme doctors) and 117 nurses (including 46 professional nurses) at the time of writing in 2006. It has a small nursing college on site. <BR>At the beginning of 2005 Madwaleni's HIV programme, as at many rural government hospitals, was run by a single nurse and included HIV voluntary counselling and testing (VCT) for people coming to the hospital and specifically requesting to be tested, a small HIV support group started the previous year, prophylactic treatment (when available) for those patients requesting assistance, prevention of mother-to-child transmission (PMTCT) counselling and provision of nevirapine to some of the HIV-positive women accessing the hospital's services, and provision of formula feed (when available) for mothers who chose to formula feed upon receiving PMTCT counselling.


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