It’s a wrap! The fifth PATA forum has come to an end. Twenty-five weary but happy treatment teams are heading home, heads packed with new ideas and hearts hopefully lighter, thanks to the opportunity of sharing their cares and concerns with colleagues Random conversations with delegates, invited speakers and our local partners from Wits ECHO are agreed that they have enjoyed quality time at this PATA Gauteng forum. Presentations have been of the highest quality, discussion has been LOOKING FORWARD: Grace Phiri, Rose Mathaha, Limakatso Maphotsa and informed and passionate. Teams are Manyatso Penane from the Queen Elizabeth II Hospital in Lesotho discuss which tasks coming away with a sense of they want to set themselves in the year ahead. accomplishment. Each team has set itself a set of quality improvement tasks collect, this will save many organi- We thank our facilitators, the and we look forward to reports on the zations the trouble of reinventing these translators, our session conveners and progress they are making. to meet their own needs. chairs and all the experts who gave us This forum has produced a rich The PATA steering committee is such excellent plenary presentations. harvest of training and educational tools indebted to Melanie Evans (conductor of We thank our participants for their from MSF, PHRU and TARSC. PATA note), Jenny Watermeyer (presenter, enthusiasm, which fueled the process. will be creating a web page listing all data projector rescuer and master class We wish everyone safe journeys home available tools. This will be the start of a leader), Vuyiswa Mboyi, Lil Hobbs, and success with the tasks they have new resources project we hope to Natalie Renaud, Ashley Petersen and chosen. develop with the help of David Lucia Fundisa Matshoba for their hard Hamba kahle, Fambai zvanaka, Goetghebuer of MSF. work, their efficiency and dedication. Hamba kuhle, Poitu vanga, Ibowan, If the PATA website Without this team no-one would have Murabeho, Adeus, Au revoir, Seyeso, (www.teampata.org) can serve as a enjoyed this seamless conference. Totsiens, Goodbye. – Paul Roux storage venue for every resource we The invaluable input of Expert Patients PATA initiated its Expert Patient delegates were able to find out more from them.” Expert Patients have the Programme in 2007 which now includes clinics who benefit from the support of opportunity to learn new skills and 47 clinics and 200 Expert Patients in 14 Expert Patients. More PATA affiliated become role models in the community. countries. clinics present at the 5th PATA Forum such All clinics taking part in the program- They are trained to support the as PIH (Rwanda) and Baylor (Swaziland) me receive funds to pay, train and manage medical staff with clinical and admini- told L’Equipe PATA how they now rely on Expert Patients. Clinics are asked to strative tasks, such as weighing and their Expert Patient team. submit quarterly update reports to PATA measuring patients, pill counting, and to Terri Litty from Baylor Swaziland for monitoring and evaluation purposes. run support groups. stressed that “Expert Patients are invalu- The programme is funded and co-mana- At the speaker’s corner, PATA able. The clinic could not function without ged by One to One Children’s Fund, UK. The patients are the experts Jenny Watermeyer Jenny Watermeyer is a speech therapist, communicator and struggle to understand and remember all the information researcher from Wits University and spoke yesterday they are given, e.g. the name of drugs, dosage instructions morning to PATA delegates about the importance of etc. Misunderstandings can have terrible impacts on patients communication. and on their treatment. Communication is sometimes forgotten when health With this in mind, Jenny continued by explaining to professionals face so many other challenges. Jenny found PATA delegates what concordance is. Concordance is about that patients misunderstand health professionals and how health professionals interact with patients. It is about recognised that communication is hard, but offered PATA “connecting” with patients. Patients are expert in their own delegates some ideas to improve communication at the life and health professionals must learn to negotiate by clinic level. The context in Africa is very different to the using the patient’s personal context and by referring to the rest of the world. For instance, in the USA or the UK, needs of patients. patients are now encouraged to be assertive, to question Communication is not a set of rules for all clinics and what medical professionals tell them. But this is not always all patients. Health professionals must identify specifics appropriate in Africa. “Context is key,” stressed Jenny. within the environment of their clinic and use simple Multiple languages (there are 11 official languages in strategies (pictures, props, body language). It is also crucial South Africa and many more are spoken), cultural that health professionals check that patients understand by differences, lack of professional interpreters, migration, asking them to demonstrate or explain as well. poverty and discrimination are just some of the many “Show your patient that you are human, that life is also obstacles faced by health professionals in communicating difficult for you,” she said. “We need to work with what we with patients. Health professionals need to be aware of have. Focus on communication, on connecting moments differences and to adapt to their patients. They need to with patients, maximise every opportunity and consider familiarise themselves with the situation their patients are in where patients are coming from.” as much as possible. If we see patients as experts, this will facilitate “This is obviously a real challenge when medical communication. Jenny had two key take home messages: 1) professionals have 5 minutes with each patients, and 50 All health professionals should be concerned about more waiting to be seen outside,” said Jenny. communication and not only counsellors; and 2) Don’t However, it is crucial to acknowledge that patients make any assumptions. PATA facilitators play a very was a first timer as a PATA PATA important role in the workshop facilitator and was deeply sessions, making sure the impressed by “the seriousness and facilitators discussion are focused and that all participants are able to express commitment shown by people to the task at hand”. impressed with their concerns and share their solutions. She realised that no one was at the forum for an easy ride and forum We asked this year’s PATA facilitators what was, in their appreciated that people come from “different perspectives, opinion, the highlight of the backgrounds and have access to workshops. They all seemed very different levels of resources, but impressed by the level of there are a lot of common threads” participation and how hard- that connect the teams. working the participants were. Sara Stulac (PiH, Rwanda) is Gertrude Guveya (nursing also a member of the PATA sister from Zimbabwe, in the Steering Committee and attended photo left) is a member of the all 5 forums. Again, Sara found that PATA Steering Committee and the workshop sessions were the has participated in all 5 PATA highlight of the forum, making forums. Gertrude realised from PATA so unique. She was pleased the workshop discussions that to observe passionate discussions nurses do so much of the work in among doctors and to see everyone healthcare delivery. She so eager to participate. commends the spirit of teamwork in all teams and noticed a real PATA would like to use this improvement in the multi- opportunity to thank all disciplinary workshops compare facilitators who have given their to past forums. time and support to make the 5th Melanie Pleaner (AFCI, SA) PATA Forum a successful event. Our continent in colour! CLINIC THOUGHTS: Job Shimankana Tabane Hospital, Rustenburg, South Africa “A sense of teamwork was instilled at the forum. I really appreciated the discussion about disclosure. Before I didn’t know whether I was doing the right thing or not.” – Queen Lebelo (at left in the photo above) “We’ve been neglecting the psychosocial needs of our teenage patients. We need a special clinic maybe for those aged between 14 and 18 years. We’ve learnt a lot and it’s time to return and implement it at our clinic – the Auntie Stella and Say & Play kits will definitely be used.” – Tebogo Tshengiwe (centre) “The adolescent focus helped us a lot. We’ve got a problem with teenagers, but we didn’t know how to deal with it. We feel very privileged as a big hospital with the resources we The beautiful embroidered wall-hanging made by the women have, especially compared to what many of the other clinics, from the Keiskamma Clinic in Hamburg, South Africa. from neighbouring countries, have to make do with. – Madria Geissler (right) PATA’s Melanie Evans and Barbra Kaim Maseabata Ramoeletsi (left) and Katlego Mahamo (right) from (TARSC) unwrap the stunning painting the Baylor Centre of Excellence in Lesotho share a laugh while presented to PATA by Avisa from Mozambique. working on their goals for next year. CLINIC FOCUS: Groote Schuur, Cape Town “No matter where people come from, whether they were from urban or rural areas – they all had similar issues to deal with in their clinics. But they also had very good ideas and solutions to these problems. We can implement some of these in our clinic. The forum was great for team building too.” – Thania Hisham (in the back, second from right in the photo) “Training, training, training – it is clear that we need more adolescent-specific training.” – Phumla Tyulu (in the back, at left) “Some of us work with kids and others work with adults, but we need to begin specialising in adolescents too.” – Fatima Noor (front row, second from left) Also in the photo: Vuyiswa Mboji, Michelle Brown, Lucia Matshoba and Vaughan Stannard. Delegates were very accommodating and open. It I’d like to encourage was enlightening to hear the kind of things people are up to and how similar our approaches to everyone not to working with children with HIV and AIDS are. falter in our efforts. Victor de Andrade I’m still humbled and in awe of kids living with Keep working hard. HIV and AIDS and their families. I have a - Facilitator The sky is the limit. continued respect for their determination, their strength and their resilience and I’m humbled by the work that delegates here at the forum are doing in teams and in their clinics. Dr Batanayi Muzah – Nyangana RC Hospital, Namibia Dreams may be slow in coming, but they will come. It took us four years Grace Phiri, QE II to get a TV in our clinic! Hospital, Lesotho Let’s press on, let’s be part of the I liked meeting people from different countries solution, always. and it was great to work together. But it was difficult to control the Dr Prithiviraj number of handouts – QE II Hospital, Lesotho teams were able to take. It was also hard to read Apologies & Correction people’s handwriting on Apologies to the Mpilo Clinic team (Zimbabwe) who in the registration form to yesterday’s paper were misquoted. The clinic is starting update the clinics’ paediatric patients in line with the World Health Organisations (WHO) recommendations at 6 weeks of age. We regret the error contact details! and are extremely grateful for the work that the Mpilo team continues to do. Contributors to this newsletter during the past week: Vuyiswa Mboji Lil Hobbs, Nathalie Renaud, Ashley Petersen, Victor de - Team PATA, Kidzpositive Andrade, Melanie Evans, Paul Roux, Elizabeth Obimbo, Francis Ateba, Dean Solomon and Toast Coetzer. Thanks, everyone! Time to pull up the soapbox Eight clinic teams were asked to present at the Speakers’ Corner yesterday morning. After providing a brief overview to contextualise their clinics, the speakers then moved onto ‘Be Proud, Be Brave’ where they shared the successes of their clinic. They told delegates what they are proud of and what motivates them in their work. They also shared current disappointments in their workplace. The fantastic work being carried out by individual clinics scattered all over Southern Africa is a true testament to the commitment of team members in providing quality, ongoing care to their patients. This is despite the often difficult working circumstances. Speakers noted the importance of forming partnerships between clinics, experts and teams. Goals must be achieved through a committed approach. We must accept that progress takes time. We also have to learn at the hand of our failures. As Dr Prithi succinctly summarized: “An elephant can’t be eaten in one big bite, it takes one bite CLOCKWISE FROM TOP: Dr Batanayi at a time…” Muzah (Nyangana RC Hospital, In the same way we must work on Namibia), Rosemary Nyirenda (Tisungane developing the ‘little things’ which Clinic, Malawi) and Nyathi Kaluma will grow into larger outcomes in time. (Mpilo IO Clinic, Zimbabwe). How we care for each other at Baylor Clinic, Botswana To start proceedings off, Eunice Mangwane That is: taking care of their emotions. broke into song: “Be bright in the corner, where “We have morning sessions; I liked Eunice you are! Be bright in the corner, where you are!” yesterday when she started off with a song. At Then Bakani July Johnson asked participants Baylor clinic, every single day come rain or shine, to raise their hands and say something to one of we have a song in the morning. We all sing in the their team members. Only one hand was raised: morning. We have a special song, singing for the Rita from Newlands clinic (Zimbabwe). She patients. Of singing together, smiling together, we turned to a colleague and said: “Cordelia, you are binging each other closer. are wonderful . You are a joy to work with.” “We also have what we call birthday celebra- “Aren’t you concerned?” Bakani challenged tions. We have one Friday when we all eat toge- participants. “Aren’t you concerned that only ther and celebrate all the birthdays for that month. one person raised their hand? At Baylor, we Sometimes we do group socializing. Maybe we go have what is called challenge clinic, intensive to Linga Longer (a pub). Everyone pays for follow-up clinic. I can’t handle it on my own. I themselves, but we still go. can also get stuck as a social worker. “If you don’t do this in the clinic, then you “A lot of us are going through grief and will take these issues home. By meeting with each bereavement counselling with our team. Some of other more often, it gives us a chance to discuss us are HIV positive, and others are grieving for things with colleagues. issues in their families or with their friends. “Management will never take care of you “One thing that we believe in as a team at socially, but you can come up with your own Baylor clinic, is that for me to take care of you, I ideas. Let’s find comfort in our own teams. We have to do my job. And if you are not doing have our own personal lives. Bakani July Johnson spoke “If you keep a happy face, then our patients about caring for the carers at what you are supposed to be doing in your clinic, you are not doing the right thing for your team. are going to appreciate us.” Baylor Botswana. On Day 2 of the PATA forum, Melanie Pleaner (AFCI) read out a story in the plenary session about geese flying in a “V” formation. Making the connection between clinic teams and the geese is evident. Like geese, the more we come together, unite and focus the more effective we can be in our work. Supporting our team members during good times and bad and working together towards a common goal are essential. We look forward to hearing about the ongoing progress of your clinic. Here is the text from her presentation: Why do geese fly in a “V” formation? As the geese take flight from their point of departure, they lift off from the water, haphazardly, crying and squawking. Yet, in a matter of seconds, a line begins to emerge from the mass of brown feathers. This line straightens, arches slightly, and then, as on cue, bends sharply to form a perfect V shape. The flock of geese fly in “V” formation for a very pragmatic reason: a flock of geese flying in formation can move faster and maintain flight longer than any one goose flying alone. Whenever a goose falls out of formation, it suddenly feels the drag and resistance of trying to go it alone and quickly gets back into formation to take advantage of the lifting power of the bird immediately in front. When the lead goose gets tired, he rotates back in the wing and another goose flies point. These geese cry and squawk from behind to encourage those up front to keep up their speed. Finally, when a goose gets sick, or is wounded by gunshot, and falls out, two geese fall out of formation and follow him down to help and protect him. They stay with him until he is either able to fly or until he is dead, and then they launch out on their own or with another formation until they catch up with their group. . FACT: flying in “V” formation, the whole flock adds at least 71% greater flying range than if each bird flew on its own.
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