BOTUSA News

Living Longer and Healthier in Otse - A new approach to palliative care

The center has recruited around 23 volunteers
The center has recruited around 23 volunteers, some of whom are living with HIV/AIDS, to visit, register and care for clients.

The Otse center has trained community members in how to grow their own vegetables
The Otse center has trained community members in how to grow their own vegetables, and even provides seedlings and manure to help them get started.

OTSE - After years of attending funerals nearly every weekend in this AIDS-ravaged village, the retired nurses of Otse have noticed a change in the last year: their weekends are suddenly free.

The numbers of people dying from AIDS related diseases has dropped dramatically, the nurses say, and the reason has to do with a combination of factors including availability of ARVs, good adherence to treatment and a caring community.

Nurses and volunteers at Otse Community Home Based Care, which provides palliative care to people living with HIV/AIDS, say that the nature of their services has also changed. Eight years ago when the center was opened, nurses focused solely on end-of-life care. At that time there were approximately 120 patients per year and a 99 percent death rate among HIV/AIDS patients.

The center provides training
The center provides training, through the Flying Mission, in crafts production and sewing.

With the introduction of ARVs in Botswana in 2003, the Otse nurses have expanded their scope of work to include long-term care, adherence support, family counseling, nutritional advice and rehabilitation. In 2006, there were just three patient deaths from HIV/AIDS-related illnesses, the center reports.

"We are not going to funerals like we used to, and people are not dying like they used to," says Center Coordinator Amanda Bome, flipping through her client registration book to show the drop in mortality. "We are now looking after people who are up and about and feeling better."

Otse Village, located off the main road between Gaborone and Lobatse, may be best known as the home of Otse Mountain, the highest point in Botswana. But the small village of 5000 people, with an HIV prevalence of about 27 percent among pregnant women, is quickly gaining a reputation as a success story with a new palliative care approach. Kitchen gardens are springing up in every corner of the village, patients who were considered on their death beds are now walking about and the Otse CHBC center is now buzzing with skills workshops and information seminars.

Supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the Otse CHBC was formed by retired nurses who were moved by the growing burden of care on families in their community due to HIV/AIDS. In 1999, their voluntary initiative was registered and resulted in a community owned palliative care project.

The project has grown to include 23 volunteers, many of whom are living with HIV/AIDS. They go house-to-house in Otse to screen for sick people and to train caregivers in nutrition, symptom management, drug adherence support, counseling and referrals. Care extends to the whole family, and volunteers also screen homes for special needs of children and to encourage voluntary HIV testing for everyone.

Mavis Modisane
Mavis Modisane, the Palliative Care Program Coordinator for the Otse project, flips through a client registration book from the center which shows a significant drop in mortality over the last eight years.

The Otse center has trained community members in how to grow their own vegetables, and even provides seedlings and manure to help them get started. There are now around 400 kitchen gardens in the village. The center also provided training in crafts production and sewing.

Mavis Modisane, the Palliative Care Program Coordinator for the Otse project, said the center currently has more than 500 clients who visit the center and who are visited by volunteers and nurses at their homes.

One of the challenges for the center, Bome says, has been scaling up pediatric palliative care. Currently the center is caring for 15 children, and there are no organizations providing psycho-social support for orphans and vulnerable children in the area. Outreach to surrounding farms has also been a challenge due to inaccessible roads and lack of transportation.

But the center has gone far in helping reduce the burden of care for families as well as reduce the crowding in health facilities in Otse.

"We are proud of the work we are doing here," said Bome. "The results show for themselves: More people are living longer, healthier lives. What more could we ask for our community?"