A Community Based Program of home care for People Living With HIV/AIDS.

Assistance for those villagers with full blown AIDS, or potentially fatal secondary infections related to advanced suppression of the immune system is a crucial to the Kenyan Imani Project goal. Villagers do not have enough food (let alone proper nutrition), no sanitation facilities or clean water to drink. Their diet consists almost completely of maize flour which is made into a doughy mixture called Ugali. Diarrhea and dysentery are enormous problems in the villages as most water comes from the Sabaki River (which is also used for bathing, washing, and waste disposal).

Medications are not available to villagers unless they have access to monetary resources, and most villagers are unemployed or make just a few schillings each day. This is barely enough to feed their large families (typically seven to ten children).

Specific objectives in implementing a system of home based care were initially begun months ago by Imani Project volunteers. Volunteers visited families, identifying families where there was a seriously ill person. The appropriate level of need was assessed, and family circumstances were documented. Volunteers continued to visit families in their home villages, creating a caring atmosphere and gaining the trust of the families, caretakers and People Living With HIV/AIDS (PLWHA).

For the past three summers, Marlene and the volunteers spent many hours visiting families in the villages and giving out CAREKITS. CAREKITS are now being made in The Imani Project office in Masheheni Village. A guide for using the CAREKIT written in Kiswahili was included in each kit. The items were put inside a plastic bag with a zip lock closure.

CAREKIT contents:

• Gloves
• Triple Antibiotic Ointment
• Alcohol Swabs
• Personal Care Clothes
• Hand Sanitizer
• Candies for moisturizing mouth when is person unable to eat/swallow
• Ibuprofen for minor pain (200mg capsules) with instructions for usage
• Ibuprofen for more pain (500mg capsules) with instructions for usage
• Anti-diarrheal medication
• Condoms and illustrated guide for effective use

After the CAREKIT is initially given out and explained to the patient and caretaker, home visits continue and supplies are replenished as needed.

Villagers are unable to go into Malindi town to be tested for HIV status at the Liverpool Volunteer Counseling and Testing Centre (VCT). The test if free, however the bus ride costs 30 Kenyan Schillings. The Kenyan Imani Project has coordinated with Malindi VCT to request a mobile van to go out to the villages and provide the testing. If a person tests positive at the VCT, they are referred to Malindi District Hospital where are asked to pay 1500 Kenyan Schilling (equivalent to US $20.00) for a more comprehensive blood test. Antiretrovirals are are free to villagers if the medication is available at Malindi District Hospital. Currently, the hospital sells antiretrovirals to HIV+ patients who can pay, but as supplies diminish, they give prescriptions instead of medication. Villagers who receive prescriptions cannot afford to fill them. As far as we know, there are a few villagers taking ARV's at this point in time. We are hoping to work more closely with the hospital in the hopes of providing more free antiretrovirals.

Villagers realize they are HIV+ when they begin to get sick time after time, and can't seem to rebound. They may start showing classic symptoms including vomiting, nausea, fever, diarrhea, lesions and substantial weight loss. Many eventually succumb to malaria and TB, or pneumonia. Diarrhea and resulting dehydration is especially dangerous for children.

The Kenyan Imani Project is teaching the SODIS method of water purification. This is a very simple technique which can be easily done at the family level involving removal of 99% of bacteria in unclean water by exposure to sunlight (UV radiation). Imani Project volunteers teach this method to individual families, providing them both plastic water bottles and directions written in Kiswahili. Since villagers have no resources to purchase plastic water bottles, The Imani Project is procuring them from a resort hotel in Malindi.

The villagers were extremely concerned about their loved ones who were sick with HIV/AIDS. We did not see evidence of ostracism or shunning, but rather a growing and pervasive sadness. Death has become a way of life for these villagers.

The goal of the Community Based Home Care Program is to make available basic medical supplies for those who are living with HIV/AIDS, and educate caregivers to respond to physical, emotional and spiritual needs of the PLWHA.

Accomplishments during the past year have been:

1. Drastic reduction in deaths from HIV or secondary infections.
2. Assembling of CAREKITS in-country
3. Continuing supply of water bottles to expedite implementation of the SODIS water purification system.
4. The Imani Project has provided funding for fifteen villagers to be trained as Community Health Workers. Community Health Workers are able to dispense medication (when available) at village dispensaries.