World Wide Orphans Clinic

Today we started out visiting the World Wide Orphans Clinic. We got a little lost getting there as Bekah had never been to that part of the city before. I found it funny that we stopped and asked a couple of police men and they couldn't give us any directions. Bekah explained they really only know the small neighborhood they are assigned to and they are all on foot. We arrived and we met by Dr. Sophie Mengistu. We had a wonderful time talking to her about the care her clinic provides families with HIV. They started with just caring for a group of kids with HIV and their program has grown by leaps and bounds. They care for kids at most of the major orphanages which are home to HIV + orphans. They have a care center attached to their program with about 40 kids with HIV which is not associated with the other orphanages. They have patients from the community and have started providing care to the adults in those children's lives. They have an outreach program with a few locations because as she said "Most people will not come to this clinic for testing due to the stigma so we bring the testing to them." They provided 16,000 HIV tests last year alone. She showed me the VCT (Voluntary Counseling and Testing) logs and every page has about 50 names and on EVERY page in the column where you indicate the HIV test was positive there were at least 3-4 + tests. It made me think of our own CHIP clinic in Denver and how much our outreach program has grown and how many tests we provide each year- and how few we actually get as positive. They have a soccer team for the children, a summer camp program (where they work with the

Hole in the Wall Gang Camps- just like we partner with in Colorado for our New Round Up River Camp near Vail Colorado!) they also have drinkable water from a spigot outside their clinic which anyone can access. That was really cool. I also saw boxes of plumpynut and other nutritious lentil based food for families and the orphanages. (I took a photo of the plumpynut and might make a tee-shirt for Jennifer Dunn!)

The highlights of the day spent with her were reviewing case studies of HIV+ kids who have come home and what type of care and testing we provide them in the US and how what happens to them here in ET before arriving has an effect on their long term care. She was very interested in seing genotypes and looking at viral loads on medication and what changes we made to medication after kids come home. We talked about PK (medication level testing) and how the HIV medication levels can really cary by child and also when used in combination of other medications. We talked about how they make decisions based on symptoms and CD4 count. They actually do have the ability to get HIV RNA PCR testing (viral load testing which measures the amount of HIV virus in the blood- this is a test we use liberally here in the US which is not available in many parts of the world- particularly those countries where HIV is very much an epidemic) but because it is so expensive - it is not used often. I would love to see this test become more widely available because they would know much sooner if a child is failing a treatment regimen and that would help a child long term.

I was able to look at their new electronic database and even offer some suggestions based on the database we have at CHIP. I met the Phil Ferrero of WWO. She is a nice and as smart as our Phil. I was able to look at a few charts and found

the record keeping to be meticulous and very very comprehensive. I wished I had brought with me a copy of the medical records we receive on ours kids- because I got the impression she thinks we may have more information than we are actually getting. I have to say- these records would hold up to any site monitor visit- including one from Patrick Tshumper! We talked about TB treatment and the standard protocols as well as immunizations. She was curious how many kids come home showing that they had Hep A in the past (I think its almost all of them.) (She figured). It was a lot of medical stuff which is probably pretty dull for many of you reading this- but some of what I was impressed with was the connections they have made in the community and the other support programs they have in place. I met with the pharmacist who not only dispenses the HIV meds but provides adherence counseling..on average this can take about 45 minutes. (I asked if they are having issues with their teens not taking meds- the answer- no- kids in Ethiopia have to listen to their parents until they are 18). (It made me wonder how many kids from like 15-18 they had in their program still living with a parent because I think not wanting to listen to your parent when you are that age is pretty universal...it was implied that is not the case and may not be...I am a little cynical...certain developmental stages can't just be skipped!) :)