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Keeping it real: facilitating response to critical issues

23 August 2010

InterHealth umbrella organisation, Affirm, explore community connections for expanding HIV related care and prevention in Kampala and local communities...

Earlier this summer, country coordinators from Zimbabwe, Tanzania, Rwanda, and Kenya together with key clinical programme staff from Uganda, gathered for a day, following to explore community connections for expanding HIV related care and prevention.

At the Mildmay Workshop ‘Human Capacity for Response to HIV’, the question of ‘identity’ was opened by asking each other about an aspect of family and friendship life that is significant. We all commented on our concerns and hopes for excellent relationships with our children, friends and colleagues. We saw that some strengths, or concepts are transferable within and between cultures–capacity for care. Community, change, and hope are some other examples.

Following the workshop Mildmay made a ‘SALT’ visit to people living with HIV in their homes in kampala and local communitities. Small teams of about 4 people formed, each with a ‘bridge’ person from the Uganda Mildmay team who was familiar with the situation of each family.

‘SALT’ is a methodology that means Support (and stimulation); Appreciation (of human strengths for response –care , community belonging, change, hope); Learning (and listening-through asking strategic questions about concerns, and hopes, and ways of working that can be shown by people living with HIV, and their families and friends); and Transfer (family to family-community to community-health worker to organisation).

Read more about the SALT methodology

SALT is a disposition that usually needs to be mentored , to help a clinically minded team shift from the usual dominance of clinical expertise and intervention, so that some form of ‘community conversation’ can happen as an integral part of the visit.

The de-briefing and what we learned

On return each team debriefed. Most spoke of the surprising response of the person living with HIV and their relatives -emotions shared, relatives engaged, care and prevention issues opened, vulnerability and capacity revealed. Read about the example below that illustrates this.

Motivating families living with HIV

Talking and eliminating the stigma

One visit was to a woman aged about 31 years, who had been a law student until found to be HIV positive. She has lived in her family homes since then, supported by her 11 siblings, and maintains contact with her academic mentors and friends. She knows the Mildmay team very well, because they visit frequently –and she initially joked with them.

As the questions turned toward her family response and links to friends, she started to weep-and eventually explained that she was feeling she has been a burden to the family. Each of several siblings spoke quietly and authentically, assuring us and her that there is no burden –they are together. She recovered her dignified poise and said, ‘Stigma kills us –even with tablets, but love and understanding makes everything work. Care, prevention, family links, peace of heart, and better response to treatment can be an immense help.

Later, as all teams reflected together on what we had learned, Moses from the Uganda team received a text from her, to say that she loved the visit, and please come again. She really felt the love of the Mildmay team and the new visitors. She said the interaction was very motivating to her.

Here are the roots of integrated care, treatment, and prevention. Respecting and stimulating people to the extent that ownership for care and change is opened and deepened. Then people living with and affected by HIV can take another step toward a shared future with hope.

When I asked the Mildmay team if the experience was new for them they said “Yes, she has not expressed herself like that before”. The difference is in the listening and the shared learning, and living out a journey together.

The group discussed the fact that facilitating local response is the key to expanding care and prevention. Mildmay may not need to do any new intervention. Taking another step may simply mean adding listening time to each visit to each home and local community. Care will deepen, treatment will work better, and prevention outcomes will be seen.

Affrim - A community of practice for facilitating response to critical issues
Read about other stories of response
 

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