- INTRODUCTION
The first two cases of HIV and AIDS in Nigeria were identified in 1985 and were reported at an international AIDS conference in 1986. In 1987 the Nigerian health sector established the National AIDS Advisory Committee, which was shortly followed by the establishment of the National Expert Advisory Committee on AIDS (NEACA).
In 1991, the Federal Ministry of Health made their first attempt to assess Nigeria’s AIDS situation. The results showed that around 1.8 percent of the population of Nigeria was infected with HIV. Subsequent surveillance reports revealed that during the 1990s HIV prevalence rose from 3.8% in 1993 to 4.5% in 1998.
In 1999, the President’s Committee on AIDS and the National Action Committee on AIDS (NACA) were created and in 2001, the government set up a three-year HIV/AIDS Emergency Action Plan (HEAP).
In 2010 NACA launched its comprehensive National Strategic Framework to cover 2010 to 2015. Some of the main aims included in the framework are to reach 80 percent of sexually active adults and 80 percent of most at-risk populations with HIV counselling and testing by 2015; ensure 80 percent of eligible adults and 100 percent of eligible children are receiving ART by 2015; and to improve access to quality care and support services to at least 50 percent of people living with HIV by 2015.
- EXECUTIVE SUMMARY
In Nigeria there is a distinct lack of HIV testing programmes. In 2007, just 3 percent of health facilities had HIV testing and counseling services, and only 11.7 percent of women and men aged 15-49 had received an HIV test and found out the results. In 2009 there was only one HIV testing and counseling facility for approximately every 53,000 Nigerian adults.
Some reports have suggested that health care facilities offering HIV testing in Nigeria do not follow international standards about confidentiality and ethics. In one particular study, over half of people living with HIV reported that they did not know they were being tested for the virus and around one in seven health care professionals admitted to never receiving informed consent for HIV tests.
This NACA project that incorporated free medical outreaches at Bomadi General Hospital, Bomadi with RAHI Medical Outreach providing the medical manpower has helped tremendously to increase patients confidence in HIV testing programme. The shame of stigmatization if tested positive was completely eroded as patients benefited from other clinical services during the outreach.
Bomadi community used to be a beehive of activities for commercial workers especially oil workers who have to use bomadi as a transit point from or to offshore oil installation locations. It is therefore expected that prevalence of HIV aids in this community will be high. However this was not so from available statistics; of the 2964 clients tested, only 10 were reactive to determine reagents which was further confirmed with unigold.
This disparity will need further research to give an insight. Furthermore, cases of under-aged pregnancy were noticed in bomadi community as lots of young girls of secondary school age are drop-outs due to unwanted pregnancy.
3. PROFILE OF DELTA STATE AND BOMADI LGA
Delta State was carved out of the former Bendel State on August 27th 1991. The state was created following agitations for the creation of separate distinct states by the Urhobos and Anioma regions. The then Military President, Gen Ibrahim Babangida (Rtd) created the state using the name “Delta” advanced by Niger Delta region as “Asaba” another name advanced by the people of Anioma for the capital of the proposed “Anioma state.” Delta state was once integrated in the Mid Western state from 1963 to 1976 and later Bendel state, from 1976 to 1991. The name “Bendel” (Ben-Del) meant Benin-Delta to reflect the integration of Benin and Delta provinces.
Delta is an oil producing state of Nigeria situated in the region known as the Niger Delta, South-South Geo-political zone with a population of 4,098,291 (Males: 2,674,306 Females: 2,024,085 (see Federal Republic of Nigeria, Official gazette, No. 24, vol. 94, 2007.) The capital city is Asaba located at the northern end of the state with an estimated area of 762 km2, while Warri is economic nerve of the state and also the most populated located in the southern end of the state. The state has a total land area of 16,842 km2.
Bomadi Local Government area is an Ijaw local government area in Delta State, Nigeria. The town lies on the bank of the Forcados River. It has eleven communities, namely: Ogriagbene, Esama, Akugbene, Bomadi, Kpakiama, Ekamuta-gbene, Azebiri, Ogodobiri, Okoloba and Kalafuo-gbene.
- PROJECT JUSTIFICATION
The intent and philosophy of this voluntary counseling and testing coupled with a free medical outreach is to provide free, specialist care to patients in need and residing in rural communities with limited access to health care facilities
Apart from providing much needed care to patients, it also afforded members of community, the opportunity to be screened and advised on prevailing health conditions.
To an individual living in a rural community of Bomadi, access to medical care is both difficult and expensive and in most cases, almost near impossible. The inhabitants of Bomadi and environs are subsistence crop farmers and fishermen that rely on dugout Canoes for their activities.
- GOALS AND OBJECTIVES
- To provide free voluntary counseling and testing to members of Bomadi Local Government Area and environs
- To provide free disease screening services to the people of Bomadi Local Government
- To provide the people with the highest possible level of medical and surgical care.
- To provide dental prosthesis to patients with missing teeth.
- To educate the rural folks on basis of health promotion and wellness
- This free medical outreach has also enhanced the image and high esteem held for physicians in the minds of the rural population of Bomadi
- It was also noted that this free medical outreach holds the very real potential to significantly address the MDG’s pertaining to child and maternal morbidity. Unnecessary deaths from post postpartum hemorrhage and stoppage of female genital mutilation are two examples that were addressed through this outreach.
- IMPLEMENTATION STRATEGIES
- Pre visit to Bomadi by our field director and some volunteers
- Face-to-face meeting with community gate keepers (Political Leaders, Youth Leaders, Women Leaders, Religious Leaders and traditional rulers.)
- Review and assessment of the clinical focus and profile of patients.
- Deliberation on advocacy, publicity , resource mobilization and strategies for the outreach
- Assessment of the human resources need and requirements for the medical outreach
- Assessment of the communities and supplies requirement as well as equipment including existing facility in the general hospital at Bomadi.
- Share the challenges experienced in preparation for the outreach.
- Micro planning sessions /refresher training sessions for the VCT counselors.
- Plan for the post outreach patient management.
- ACTIVITIES
PLANNING
- Several micro planning sessions were held where responsibilities were assigned to various team leaders earlier nominated.
- An advanced team was sent to the community as part of the planning process.
- Envisaged challenges were discussed and solutions proffered
- CHOICE OF COMMUNITY /FACILITY
Our organization, RAHI Medical Outreach uses special selection criteria to select communities and ensure that they will achieve the maximum benefit. The chosen communities are those that in dire need of health care attention.
They are also communities without standard healthcare facility, thus our choice of Bomadi General Hospital.
Also Bomadi is accessible to both land and riverine transportation. Bomadi is strategically located as it can be easily accessed by other neighboring communities of Ojobo, Kpakiama, Tuomo , Ogbogbabena, Torugbere, etc. Community demography was also compiled at this stage.
- COMMUNITY ENTRY
- In this stage of planning our team was introduced to the community gate keeper.
- This stage of planning is very critical as it afforded us the opportunity to interact with key players in the community.
- Community mapping/Ground planning.
During this stage, a working plan was developed. We also designed ground plan volunteer placements and time tables.
- Setting up of auxiliary team.
This team is made ups of implementers, interpreters and community volunteers.
- IMPLEMENTATION
PUBLIC HEALTH EDUCATION
There were constant daily health education on HIV/AIDS prevention, personal hygiene, oral health awareness, hand washing, malaria, STI and water born diseases.
This session was handled by public health nurses.
- VOLUNTARY COUNSELING AND TESTING
Voluntary counseling and testing was carried out by ten counselors.
They were deployed to carry out pre and post test counseling. Reactive clients after confirmatory test were referred to Institute of Human Virology Nigeria center at Bomadi General Hospital for further evaluation.
- MEDICAL EMERGENCIES
An eleven year old boy was rushed into the facility on account of burnt injury from stored premium motor spirit (petrol). The fire was said to have started when the boy attempted to light up a kerosene stove while the mother was away in the market.
A diagnosis of second degree burn was made and our volunteer doctors/nurses in collaboration with the hospital medical staff was able to manage the boy without referral.
The boy is currently recuperating from the incident.
A 48year old woman presented to us on the second day (18th February 2017) on account of severe abdominal pain, bleeding par vaginal. Diagnosis of leiomyoma (Uterine fibroid) was made. She was billed one hundred and fifty thousand naira for the surgery in a private clinic.Though she did not have money, a relative opted to take her to the local money lender in order to borrow the money.
Succor however came her way as myomectomy was done for her at no expense. She was very grateful to the team.
- FREE MEDICAL CARE
The free medical outreach was flagged–off by representative of Hon. Member representing Bomadi/Patani Federal Constituency (Hon. Nicholas Mutu), Hon. Donbraye Omoro, who is a Special Adviser to the Governor of Delta State on security.
Five departments were mapped out for patient care;
- TRIAGE – Various vital signs like BP, Temp, and weight were carried
- GENERAL OUTPATIENT UNITS– Patients with HTN, DM, PUD, enteric fever, plasmodiasis, Osteoarthits were attended to.
- DENTAL UNIT
The people of Bomadi benefitted immensely from the free dental treatment component of the programme. The major dental issue in Bomadi is acute on chronic apical periodontitis. Oral hygiene awareness of members of the community is very poor. Most members of the community (about 90%) have never visited a dentist in their entire life.
The closest dental clinic is at Ughelli which is about one hour thirty minutes drive. Again because of the poverty level in the community and associated high cost of dental treatment, most persons are not able to access dental healthcare services.
Over 90% cases of missing teeth were recorded. These missing teeth were due to a cultural practice among the Ijaw ethnic nationality. Most members of the community file their anterior teeth thereby destroying the protective enamel layer and exposing the teeth to noxious substances leading to destruction of teeth.
- DENTAL PROSTHESIS– For fabrication of missing teeth
A hospital staff who functions as the ambulance driver (Mr Challenge Olodje) also benefited from the outreach. For the past 26years, he has been living without teeth in his upper quadrant of the jaw (maxillary endotolous).
This absence of teeth in the quadrant greatly affected his nutrition as he has to rely strictly on liquid for nutritional needs. Succor however came his way when an upper full denture was fabricated for him.
He was full of appreciation for the organizers of the medical outreach.
- OPTHALMIC UNIT– visual acuity test/ refractive error correction.
This unit experienced high turnout of patients. Most patients presented on account of refractive errors. They were given prescribed glasses both for sight and reading. 60% of patients were diagnosed with cataract and pterygium.
However cataract surgery could not be performed as it was beyond our scope of engagement.
Minor cases like foreign bodies in the eye, bacterial and viral infections were also recorded. Over 1500 cases were recorded at the eye unit by the end of the three days outreach.
- REFERRALS AND FOLLOW UP
Conditions that could not be treated were referred to Delta State University Teaching Hospital, Oghara.
- DATA ENTRY
Data was collected and necessary corrections were made on field
- FOLLOW UP
Follow up was to be done by community heath monitoring committee after our exit.
- CHALLENGES
- TERRAIN
The difficult terrain (riverine) introduced other ancillary cost to the approved project cost. In the course of community sensitization/mobilization, speed boats were chartered to access the creeks in order to ensure effective mobilization.
- UNDUE POLITICAL INTERFERENCE
The people of the constituency were overbearing as they see it as an opportunity to extort money from the implementers with the mindset that their representative has doled out large chunk of money to the implementers.
- TIME
The time (three Days) was grossly inadequate as the members of the community pleaded with our team to extend the outreach by one week.
- LESSONS LEARNT
- In future, more funds should be allocated to riverine communities.
- The burden of HIV/Aids is not restricted to urban centers alone. Rural communities have their fair share too.
- The prevalence is lower than what we expected .
