 |
 |
 |
 |
 |
 |
 |
 |
||
|
  |
||||||||
|
Team Thailand, Chiang Mai
Phase I -- Situation Analysis The Thai Team was fortunate to be able to draw on relevant data concerning the capacity and availability of HIV and AIDS services in Northern Thailand gathered by Team members. For the situation analysis, the team collected qualitative data through focus group discussions with HIV-infected individuals and their families, as well as with community health volunteers, community leaders, Buddhist monks, health personnel, and members of NGOs in the region. Data from interviews with health workers, care givers, and PLWHAs revealed a perceived neglect of holistic care for terminal patients. Team examination of care included of end-of-life issues of pain management, physical management, mental and spiritual care, ethical aspects of care, and the legal and socioeconomic aspects of care. Based on examination of this data, the team targeted four areas for improving care in two districts of the Chiang Mai province: treatment, care, counseling and social support. Treatment and Care In the northern region, capacity for clinical care and treatment was limited by poor management of health services and lack of properly trained health workers. OI treatment and care guidelines were inconsistent and impractical, and the hospital referral system was not functioning effectively. In this context, home visits by health workers, though limited in coverage and effectiveness, became critical to care. Existing referral systems among health centers, hospitals, NGOs, community-based organizations, and groups or networks of PLWHA, however, were largely ineffective because of lack of collaboration between the agencies. When ECI began, it was the only multidisciplinary or multi-sectoral initiative related to HIV/AIDS care in the region. The process of coordinating diverse groups to improve existing structures was an early challenge for the Team because of the lack of services, as well as the lack of experience in working together. Counseling and Social Support At the beginning of the AIDS epidemic in Thailand, counseling was intended to be provided to PLWHA and their families by qualified professional counsellors. More than half of PLWHA surveyed by the ECI Team, however, said they had received inadequate counseling for issues ranging from emotional support to coordination of end of life issues. In the context of home-based care, counseling is more often provided by non-professional care workers such as religious leaders, traditional healers, community volunteers, or other HIV-infected persons. The Team’s analysis revealed a need to improve knowledge and skills for all kinds of health workers, especially the knowledge and skills for home-based counseling and counseling of the dying. The situation analysis also indicated gaps in social acceptance and social support for PLWHA in certain communities. Most PLWHA surveyed reported that their needs were adequately respected and their dignity and rights adequately protected, however, nearly all participants agreed that knowledge and skills in protection against discrimination should be strengthened among caregivers and community members . Phase II & III- Research and Implementation Two districts of Chiang Mai province were selected to be the target areas of study and intervention. Phrao district is a rural area located 100 kilometers away from the city of Chiang Mai, and Doi-Saket district is a suburban area located 30 kilometers from the city. In these areas, the Team focused on linkages between enhancing HIV/AIDS care through health institutions and the community sector. Thai AIDS Care Team members recognized correlation between economic stability, self-reliance, and community cohesiveness in rural northern Thailand. Poverty, particularly in farming communities, and a lack of community support contributed to poor care and quality of life and stigmatization for PLWHA. The Team works to simultaneously improve clinic- and hospital-based medical care, and to teach affected communities the skills necessary to develop their own plans for self-sustaining projects. Team members work with local leaders to create "empowerment" programs to teach methods of income generation and self care. This work is one of many ECI -built partnerships through which academic research is translated into concrete HIV/AIDS interventions. Enhanced Care in Institutional Settings Guidelines for Treatment and Care One intervention involved a collaboration with the Ministry of Health to standardize OI clinical treatment and care. The protocol was developed in 2000 through a series of workshops, and was designed for use at all levels of health care, including community hospitals. The team also worked with the Ministry of Health to draft and implement guidelines and a training program for HIV/AIDS counseling in health care institutions. In addition, a study was designed to enhance the Universal Precautions Systems (UPS) used by health care providers in Chiang Mai. Medical staff participated in developing of these guidelines, resulting in a high degree of acceptance among medical workers, and quantifiable improvements in standard procedures. Guidelines for care of the dying were developed based on study data, and health personnel were trained to provide counseling for dying patients based on these guidelines. The study found that the guidelines were a useful resource for care providers, and the Thai Team recommended further research to improve the quality of end-of-life care .
The Thai Team’s first major initiative in the community sector was the People Research & Development (PR&D) project. PR&D was developed to enhance community capacity in problem solving and development, and was founded on the philosophy that community empowerment is the key to high quality of life. PR&D considers an individual’s potential capabilities rather than his or her problems. The Thai Team was successful in implementing this process to enhance the role of community-based organizations (CBOs) with new knowledge and technology managing their own resources. Through self-evaluation, community members verbalized new ways of thinking about sustainable community development. In this way, the PR&D approach has been successful in helping communities affected by HIV/AIDS gradually change their development paradigm from one of dependency on external sources to one of self-reliance. Stigma and Discrimination To assess current levels of discrimination and stigma, Thai Team activities were conducted with a particular attention to the cultural and legal aspects of HIV and AIDS related stigma and discrimination in Chiang Mai province. Data was collected through individual interviews and focus group discussions with PLWHAs, affected families, and members of target communities. Health care personnel were approached separately, and programmatic, policy, and legal frameworks related to HIV/AIDS care in the region were also assessed. Based on the study’s findings, the first step was to increase knowledge of PLWHA in relation to national and regional legislation. Guidelines for the protection of human rights in all Team HIV/AIDS care activities were established and grounded in the cultural and ethical bases of Thai society. Quality of Life Improving quality of life of PLWHA was the ultimate goal of the AIDS Care Team in northern Thailand. Baseline data on quality of life including physical, mental, social, and spiritual well-being was collected from PLWHA in the 6 target sub-districts in Chiang Mai province, as well as PLWHA from other regions who volunteered to participate in the study. The study suggested that physical health, employment, acceptance, and support from family and community were perceived as critical elements of good quality of life. Based on this data, the Team developed an action plan that includes community empowerment and improved social services. A repeat evaluation of quality of life will be performed to evaluate project effectiveness. The study indicated to the Thai Team that in addition to addressing the symptoms of HIV-related disease, other living circumstances should also be prioritized to enhance quality of life . Impact of ECI Participation in the Thai Team’s projects has helped communities to recognize and value local wisdom, culture, and relationships in addressing HIV/AIDS related issues. To this end, the Team conducted several training sessions focused on teaching skills that would enable individuals and communities to develop self-sustainable sources of income and food production. After the training sessions were completed, a group of PLWHA surveyed by the Team reported greater self-confidence due to recognition of their knowledge and experiences by local leaders and health personnel. The group had obtained skills to provide more effective home-based care for their friends and families, and had also learned how to access care through the established referral system. Most PLWHA collaborators who worked with the Thai Team reported that they have learned new ways of thinking, especially about HIV/AIDS, self-care and self-reliance, human rights, and the role of relationships in improving community health. With the support of health centers and hospitals, and with health personnel acting as facilitators, some PLWHA groups have begun to share their knowledge and skills with groups in other districts outside the ECI sites. In response to the PLWHA enthusiasm for self-care, hospitals have tried to provide opportunities for PLWHA to participate in their own care, especially through the referral system and OI treatment policy. Hospital personnel reported that they wanted to learn more about the activities of the communities participating in ECI projects, in order to form future collaborations between community groups and health care facilities. By working with the Thai AIDS Care Team, health personnel have learned new ways of thinking about problem solving, community partnership, and community health as indicators of quality of life. They have also experienced and learned more about human rights aspects of HIV/AIDS work and care, which they have applied in their work. Encouragement and support for ECI collaborations and projects from the Provincial Public Health Office and the Office of Communicable Disease Control region 10 were important contributors to this change. The Future of ECI Thailand The programs begun by the ECI team in Thailand are already serving as models for future HIV/AIDS care initiatives. In May of 2003, the Team presented their research and results to government stakeholders, and members are currently working to document the progress of the Team’s work over the last 5 years. Plans are already underway for a Center for Excellence in HIV/AIDS Care to be housed at Chiang Mai University’s faculty of Nursing. In addition, proposals have been submitted to the government of Thailand and the Global Fund for AIDS, Tuberculosis and Malaria for expansion of the community programs that the Team helped establish into provinces that lack AIDS programs. Internationally, the Thai AIDS Care Team has worked with a multidisciplinary team from Sichuan and Yunan provinces in China to help them to develop the "China HIV/AIDS Prevention and Care Project." The Team is now working with Chinese collaborators to plan a model of care based on the ECI Framework to be implemented in China. The South East Asia division of WHO Nursing programs also contacted the Team to design a training course for nurses in 2004. Several international training programs on HIV/AIDS prevention and care have been carried out by Faculty of Nursing, Chiang Mai University. To date, 233 participants from 17 countries have been trained. Lessons learned from the ECI experience were shared with representatives from several countries where care programs are just beginning, including Afghanistan and East Timor. Despite this international attention, however, strong community relationships continue to be the hallmark of ECI Thailand. Team members remain in regular contact with their rural partners, and are often asked to participate in decision-making and special events. |
||||||||||||||||||||||||
|