South Africa: scaling up care for community caregivers

Children play jumprope on a dirt road.

Children, including ten-year-old Itumeleng, play with friends in a township near Johannesburg, South Africa. Photo: PATH/Lynn Heinisch.

Editor’s note: This is the first of a three-part series of blog posts by PATH’s president and CEO Steve Davis about his experiences visiting PATH programs in three African countries this July.

In an impoverished township 35 miles east of Johannesburg, I met Dimakatso Sibeko. Wrapped in a wool blanket, the grieving 42-year-old mother sat in the dirt, leaning against the wall of her neighbor’s home, surrounded by other women. Last week, she buried her two-year-old daughter. A year ago, she buried her husband.  All she has left is her ten-year-old daughter, Itumeleng.

Woman and daughter in the sun.

Sibeko and her daughter Itumeleng. Photo: PATH/Lynn Heinisch.

While PATH is best known for our innovations in vaccines, drugs, devices and diagnostics, the only way these tools will have their intended impact is in the context of strengthened systems and services.

In fact, many of our programs focus on system and service innovations (PATH’s fifth platform”). Here in South Africa, we’re designing models and building evidence to improve the lives of orphans and vulnerable children like Itumeleng.

House-to-house community caregiving

Sibeko’s family lives in a makeshift settlement, bordered by a brick wall with barbed wire on top. Small, dark shacks with corrugated tin roofs crowd together on red dirt, with streams of water and sewage running down the streets where children play.

As part of PATH’s project, a community caregiver named Nomakhwezi Bafo visits Sibeko’s family a few times a month. She believes that Sibeko’s daughter and husband both died from AIDS. She says Sibeko is on antiretroviral drugs but doesn’t take them consistently, because she lacks food to eat with the medicine and can’t afford to travel to the clinic.

“The only thing I am sure of is the poverty. They had nothing. We used to find them eating pap [corn porridge] given to them by a neighbor,” Bafo said.

Steve Davis speaking with PATh staffer.

PATH staff member Yolanda Moyo described the toll that this work can have on the caregivers’ psychosocial well-being. Photo: PATH/Lynn Heinisch.

Bafo provides psychosocial support to 15 area families raising orphans and vulnerable children. Some of them are widows like Sibeko; others are grandparents, aunts, or neighbors who care for children who have lost parents; some are children who are heads of households. Bafo walks miles each weekday, checking on the families, listening to their needs, and referring them to resources when possible.

“It’s very emotional. It takes everything in you. When you meet with these families it takes you back to your past and it haunts you,” Bafo said. “You need to be professional. You need to be strong for them. They’ve got nothing.”

Caring for the caregivers

PATH partners with a community organization that provides training on psychosocial well-being for caregivers like Bafo so that they are better equipped to care for and protect children. This training is provided in all nine South African provinces, helping caregivers to hone their coping skills and access resources to support themselves and the families.

A workbook with blue ink and illustrations.

Part of the curriculum delivered to caregivers. Photo: PATH/Lynn Heinisch.

“They’ve got emotional burnout and pain. People are dying and they don’t know what to do,” said Sibongile Tloubatla, a psychologist who trains the caregivers. “They come back to visit the family after two days and the person has died. And how do you handle children who are in pain?”

Caregivers themselves can become traumatized and depressed, she said, so they learn in training how to manage the stress.

“They look after other people but they don’t look after themselves,” Tloubatla said. “We help them take care of themselves, so they can be effective in their work.”

Designing the best program for national scale-up

Given PATH’s emphasis on large-scale impact and partnering with the countries where we work, we will continue to test our models, design best approaches, and then transition this program to the government of South Africa late next year, so that it can be scaled up. In preparation, we are conducting studies on the effectiveness of the approach.

An estimated 2.5 million South African children have lost one or both parents to AIDS. The lives of the families I met this week are stark illustrations of the cyclical link between poor health and poverty. Some 20 percent of South Africans, roughly 10 million people, are unable to purchase enough food for an adequate diet. This extreme poverty both contributes to and is compounded by the AIDS crisis.

Talking with Bafo, Tloubatla, and the women who run the program, I was once again so impressed and inspired by the dedication, intelligence and compassion of community leaders and volunteers who are working so hard to improve the lives of children devastated by AIDS and poverty, and the people who care for them.

With the scope of the challenge, their one-by-one impact seems like a drop in the bucket. Yet, we all know that for any individual, just one person can make all the difference in the world. Our task then, is to leverage these results to have the greatest possible impact.

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If polio is on the run, why do we need new tools to help prevent it?

A baby held on mother's lap opens mouth to receive a drop of polio vaccine.

An infant receives oral polio vaccine in India, which was declared polio-free earlier this year. Photo: PATH/Gabe Bienczycki.

Guest contributor Laura Anderson is an editor at PATH.

In the past 25 years, global immunization efforts have eliminated polio from most regions of the world. Over the last two decades, the number of cases has dropped by more than 99 percent, bringing in sight the goal of eradication—no one with polio, anywhere.

This week, PATH and our partners announced a new contribution to this effort. A grant from the Paul G. Allen Family Foundation will help expand use of two new polio detection tools: a system to make it easier to check for polio in waste water and a simplified diagnostic test to find the virus in people.

Why do we need new tools when we’re already so close to wiping out polio? Dr. David Boyle, a PATH senior researcher, explains.

Not missing the polio virus—anywhere

Especially now, when eradication is within sight, we need to be sure we’re not missing the virus anywhere. Polio is very contagious, so a new epidemic can start with just one infection. Just this May, the World Health Organization (WHO) issued a formal warning that the virus is spreading internationally from Cameroon, Pakistan, and Syria, where conflict and other factors have interfered with elimination efforts. That puts progress at risk: it could spark new epidemics if leaders don’t step up to stop polio.

Aggressively looking for the virus allows us to adjust our strategy, catch outbreaks early, and respond quickly. It also tells us whether immunization strategies are working. Basically, we’re always asking, “Is the virus really not here or are we just not seeing it?” There’s no way to treat polio, so it’s important to keep people from getting it in the first place. Continue reading »

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What’s tiny, transformative, smart, and now 5 billion strong?

Guest contributor Laura Anderson is an editor at PATH.

Man holding a small bottle between his thumb and forefinger. A sticker on the vial features a purple circle.

Is the vaccine good to use or not? Vaccine vial monitors show health workers at a glance. Photo: PATH/Mike Wang.

Imagine you are a health care worker. Should you use or discard the vaccine at right?

For years, health care workers had no way to decide. Then, nearly two decades ago, PATH and our partners developed and introduced the tiny, powerful vaccine vial monitor (VVM).

VVMs change color as they are exposed to heat, letting providers know at a glance whether heat-sensitive vaccines have been damaged or can still be used for immunization.

As of 2014, 5 billion VVMs have been used, saving lives by ensuring vaccines are still potent when they are given.

Five billion is an enormous number. That many VVMs, end to end, would circle the globe. It’s more than two VVMs for every one of the 2 billion children on earth.

Woman in pink smock fills a syringe from a vaccine vial. A young girl looks on.

Thanks to vaccine vial monitors, health care workers, like this one preparing to vaccinate a young girl in Laos against Japanese encephalitis, can quickly see if the vaccine has been exposed to excessive heat. Photo: PATH/Aaron Joel Santos.

And our impact continues to grow. In the next decade, we estimate that VVMs will allow health care workers to recognize and replace more than 200 million damaged doses and deliver at least a billion more doses in remote settings.

Thanks to the vision and tenacity of PATH and our partners, we did what no other group could: unlock a simple, transformative innovation and drive it to lifesaving scale.

Exemplifying our role in leading global health innovation, PATH was selected as one of 30 leading American innovators for the US Global Leadership Coalitions’s (USGLC) 2014 Innovations in Smart Power Initiative, in which the VVM was selected as a top life-saving innovation.

Infographic showing VVM sticker changing color from heat exposure, with text, 'Vaccine vial monitors: saving lives, one dose at a time. As of 2014, 5 billion VVMs have been used, saving lives worldwide by ensuring vaccines are still potent when they're given.'

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Bike messenger: unlocking new voices to stop HIV/AIDS in Uganda

We share our deepest condolences with those who lost loved ones on Malaysian Airlines Flight MH17, including many colleagues on their way to the International AIDS Conference in Melbourne, Australia. In recognition of their dedication to the fight against HIV/AIDS, the conference is continuing.

Among our other activities at the conference this week, PATH staff are hosting a July 24th session on our Arise program, which gives vulnerable communities in Africa and India the tools to reduce their risk of HIV. For Mary, an Arise community case worker in Uganda, that meant regaining the most powerful tool of all—her own voice.

Mary Achaido standing next to her bicycle on a dusty road.

Mary Achaido, a case worker with PATH’s Arise program in Uganda, educates women and men in her community about family planning and HIV services. Photo: Pathfinder International.

If you see Mary Achaido sailing by on her bicycle, or hear her talking confidently with members of her Ugandan community, it’s hard to believe that just three years ago, she wasn’t sure her voice could matter.

For Mary, who struggled under the stigma of HIV, the change came during a community meeting. There, she heard that PATH’s Arise program needed case managers to help improve women’s access to family planning and prevent new HIV infections in their communities. The program particularly wanted women and men living with HIV. Mary joined immediately. “I wanted to relieve myself from the stigma of being HIV-positive,” she says.

Closing the gap in family planning

In Uganda, where many communities have only recently emerged from decades of conflict, it can be difficult for women to obtain family planning tools and information. Only 30 percent of married women use contraception; many more would like access but are restricted by a lack of supplies, education, and services. Women with HIV, who also have to navigate stigma, antiretroviral treatment, and HIV prevention, face even greater barriers.

Arise is closing that gap by building a confident cadre of community and clinic-based outreach workers to engage women living with HIV and their husbands and communities. Because many of these workers are themselves HIV-positive, they have the perspective to build trust and spark meaningful conversation. It’s a simple, powerful approach that is breaking longstanding barriers.

The role also supports the workers’ own health, explains Betty Inyakoit, a program supervisor. “When the project started, many [workers] were weak and stigmatized. Now, all of them are strong. . .able to ride bicycles, able to talk to their husbands, and all [have begun to use] family planning.”

A long way home

During her case management training, Mary learned about HIV counseling, family planning, and integrated care. Today, she uses that expertise (and a trusty bicycle) to raise awareness of HIV and AIDS through discussions, meetings, and home visits with other women living with HIV.

Of course, the work isn’t easy. For Mary, a long bicycle ride to a client’s home in blistering heat is just another day on the job. Sometimes, she has to stand up to strong resistance to family planning, particularly from men. Still, she loves her work and says she’ll continue to serve her community even after the Arise program has ended.

A healthier community

Since 2010, Arise has trained more than 85 community health workers and given thousands of Ugandan women and men access to family planning, empowering them to care for their health, prevent new infections, and plan when and whether to begin a family. The results are powerful. With every mile Mary pedals—and every discussion, meeting, and educational event she and her cadre make possible—Uganda moves closer to a future free of HIV.

Arise—Enhancing HIV Prevention Programs for At-Risk Populations—is made possible through financial support provided by the Canadian Government through the Department of Foreign Affairs, Trade and Development Canada, and via financial and technical support provided by PATH. Our work in northern and eastern Uganda is conducted in partnership with Pathfinder International and the National Community of Women Living with HIV/AIDS.

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How the right contraceptive can change a woman’s life

Backs of three women walking on a dirt road.

Women, no matter where they live, should have access to contraceptives that meet their needs. Photo: PATH/Eric Becker.

Guest contributor Sara Tifft is director of PATH’s Sayana® Press pilot introduction and evaluation project. Sayana Press was launched today in Burkina Faso.

Portrait of Sara Tifft.

Sara Tifft. Photo: PATH/Patrick McKern.

It’s about choice. All women, no matter where they live, should have access to a range of contraceptive options that allows them to make an informed choice and meets their needs—for the sake of their own health and the health of their children and communities. Because when a woman finds the right contraceptive, it changes her life.

Today in Burkina Faso, in the heart of West Africa, a new form of contraceptive is being launched to do just that. Sayana Press, which PATH helped to develop, has the potential to reach tens of thousands of women who want the choice of an injectable contraceptive, but who live far from clinics where the injections are given.

Sayana Press combines a lower-dose formulation of the widely used contraceptive Depo-Provera® with the BD Uniject™ injection system. Uniject, which PATH developed, is a small, prefilled syringe that is easy to transport, easy to use, and designed to reach people wherever they live.

Meeting a need in family planning

Almost a quarter of married women in Burkina Faso want to use family planning to space their children or to stop having them altogether but don’t have access to a form of contraception that meets their needs. These women well understand the value of family planning. Continue reading »

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What is PATH? A longtime colleague weighs in

When Gretchen Shively began working at PATH in 1988, the organization had fewer than 100 employees and most everyone worked in Seattle. More than 25 years later, our staff tops 1,200 in 40 cities worldwide, and every single one of us has access to something called the Internet.

Portrait of Gretchen Shively.

PATH has changed since Gretchen Shively joined the staff in 1988, but our core values remain constant. Photo: PATH/Patrick McKern.

It is safe to say that during a distinguished career culminating as associate leader of our Technology Solutions program, Gretchen has seen some change—within the organization and without.

As Gretchen prepares to end this phase of her career with PATH (she’s promised to help us out occasionally on a consulting basis), we asked her to reflect on what’s remained consistent about PATH—what it is that makes us who we are, no matter the decade. Here’s some of what she said:

I started in 1988 and the first day I remember people talking about it being the tenth anniversary of PATH and what they were going to do to celebrate. In those days, PATH was really very anonymous. We were just this little organization that happened to be in the Pacific Northwest because the founders, two of whom lived here, didn’t see any reason to locate anywhere else.

Affordable, appropriate, available

Blue moped with a cardboard box labeled "SoloShot" straped to the back.

The SoloShot™ syringe, here being transported on the back of a health worker’s motorbike, is an example of affordable, appropriate technology designed at PATH, and in this case licensed to manufacturer BD. Photo: PATH/Gabe Bienczycki.

So, when I joined, we were really small, we were really focused, and our name—which we used, even though it was very long—was Program for Appropriate Technology in Health. And that meant something to people. It defined us: we were an organization that did things in the background to get technologies into use and influence global health. It felt like there was a defined mission—even though at the time, we didn’t have a written mission statement. Nevertheless, we still had a consistent and driving theme.

Fast forward to now: I think we are still an organization that works to get affordable and culturally relevant and acceptable technology solutions into the hands of people who can benefit from them. We have retained that focus on appropriate technology. It’s gotten bigger and expanded to encompass more, but it’s still about identifying needs that can be met by technology and delivering on solutions. For me, there may have been changes around that mission, but PATH hasn’t changed at its core.

Thank you, Gretchen, for your invaluable service, and best wishes for all that comes next.

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How does military service provide unique training for global health work?

Guest contributor Katelyn Creech is a communications assistant at PATH.

Nate Sanders, wearing US Army fatigues, stands in front of a sand-colored wall.

Nate Sanders’ Army Reserve unit was deployed to Kuwait soon after he started a new job with PATH. Photo: courtesy of Nate Sanders.

In November 2013, Nathaniel “Nate” Sanders started a new job at PATH making sure our facilities in Seattle run smoothly. Just a few months later, his Army Reserve unit was called into service.

“I am currently deployed in Kuwait with the 595th Transportation Brigade in support of Operation New Dawn and the withdrawal of troops, trucks, and equipment from Afghanistan,” Nate explained via email from overseas. “I will be deployed for one year total with nine months here in Kuwait.”

When he returns, says his PATH Performance Leader Mary Cooke, his job will be waiting for him.

Outstanding patriotic support

Mary, our global facilities team leader, recently was honored with a Patriot Award from Employer Support of the Guard and Reserve (ESGR), an agency of the Department of Defense. The award recognizes individuals who “provide outstanding patriotic support, leadership, and cooperation to their employees, who like the citizen warriors before them, have answered their nation’s call to serve,” said John Glynn, ESGR employer outreach director in Washington State.

“Supportive supervisors and employers are critical to maintaining the strength and readiness of our nation’s National Guard and Reserve units,” he said.

Benefits to both soldier and employer

Supporting employees who are members of the National Guard and Reserve may be the right thing to do, but it also benefits PATH, our chief human resources officer Kathy O’Driscoll points out.

Mary Cooke holds a framed Patriot Award certificate.

Mary Cooke displays her Patriot Award from Employer Support of the Guard and Reserve. Photo: PATH/Patrick McKern.

“PATH is proud to provide employment opportunities to past and present members of the armed services,” she says. “We have strengthened our partnership with organizations that support veterans to ensure greater visibility of PATH job opportunities. The US military provides service members training and experience working in low-resource environments around the world. Those experiences are valuable to PATH’s work driving innovation to ensure health equity.”

“I want to thank PATH for all the support and flexibility during and prior to my deployment,” Nate told us from Kuwait. “The ability for me to deploy in support of the country’s mission and to have the support of PATH is unparalleled and greatly appreciated.”

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CDC official visiting PATH sees innovation in immunization

A man holds out a plastic box to a woman, who takes it in one hand.

Rebecca Martin of the US Centers for Disease Control and Prevention and PATH’s Pat Lennon examine a prototype of housing for the FoneAstra milk banking monitor during Dr. Martin’s visit to our headquarters. Photo: PATH/Patrick McKern.

Guest contributor Dr. Rebecca Martin, director of the US Centers for Disease Controls’ (CDC) Global Immunization Division, recently visited our Seattle headquarters.

Diseases know no borders. A person with measles in an airplane today can lead to an outbreak of measles in the United States one week later—something that’s been happening in record numbers this year.

To achieve its mission of working 24/7 to protect Americans from threats to health, safety, and security, CDC focuses on improving global health. The vision of CDC’s Global Heath Strategy is a world where people live healthier, safer, and longer lives through science, policy, partnership, and evidence-based public health action. Continue reading »

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Let them play: PATH takes on early childhood development

Man smiles down at baby in his arms, who reaches her arms up to him. A woman in the background looks on, smiling.

To build cognitive, physical, social, and language abilities, we must reach children by age two. Photo: PATH.

My husband has a running joke. When our son complains, my husband puts on his best old man voice and says, “When I was a boy, all we had to play with was rocks.” My son rolls his eyes, while I picture the toddlers I saw in a Zambian township crowded with AIDS orphans. The little guys were playing with rocks—they had nothing else.

Portrait of Matthew Frey

Matthew Frey. Photo: PATH.

Children, it’s clear, have to play—but rocks only go so far in stimulating their busting-to-learn brains. So when I heard that PATH was piloting early childhood development (ECD) programs for the youngest Africans, I was intrigued. ECD has typically been housed in education ministries and preschool programs, not global health organizations. To learn more, I sat down with Matthew Frey, who leads our ECD work, shortly after the Conrad N. Hilton Foundation awarded PATH a grant to roll out the work on a bigger scale.

Q. Why is PATH integrating ECD with health?

A toddler sits on a mat in front of a young woman. He holds a pan and a wooden spoon.

Toys don’t have to be elaborate. A pan and a spoon can stimulate a young child’s interest. Photo: PATH.

A. Early childhood development encompasses a range of interventions—child care and stimulation, nutrition, health, child protection. In the last few years there’s been growing recognition that trying to influence development starting with preschool is too late. To build cognitive, physical, social, and language abilities, we must get to kids by age two.

The health sector is the only way to reach these very young children at risk and their caregivers. PATH’s approach is to piggyback onto existing systems, training community health workers and nurses who are already giving health advice and services to parents. We add skills in tracking developmental milestones and counseling parents in caring for and stimulating young children so they develop to their fullest.

A recent study in The Lancet showed just how powerful this is. Community health workers in Jamaica made weekly home visits over a two-year period to encourage parents to play and talk with their children. Twenty years later, these kids had a 25 percent greater earning power than the controls. It’s just amazing. Continue reading »

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Why do newborns need an action plan?

A smiling mother holds a newborn wrapped in a red blanket.

Work on innovative policies and sound implementation plans sounds technical, but the point is easy to understand: help newborns survive. Photo: PATH/Amy MacIver.

At the end of this month, O’Brien Mashinkila, PATH’s Zambia-based policy and advocacy officer, will join 800 global health professionals, policymakers, business leaders, and advocates at the Partnership for Maternal, Newborn, & Child Health Partners’ Forum in Johannesburg, South Africa. There, he and his colleagues in global health will discuss the final push to achieve the Millennium Development Goals (MDGs) and set new targets for women’s and children’s health after 2015.

Portrait of O'Brien Mashinkila.

O’Brien Mashinkila. Photo: courtesy of O’Brien Mashinkila.

As O’Brien prepared for the forum, he answered a few questions about the success his home country has had in setting policy that will help babies survive the first days and weeks of life, and what the upcoming global meeting could mean for newborn survival.

Q: Now that Zambia’s national Integrated Management of Childhood Illness strategy includes newborn care, what lessons do you hope to share with partners at the forum?

A. We were able to achieve this policy change in Zambia because key stakeholders recognized a gap in newborn care and set out to fill it.

While the implementation of the strategy began in the mid-1990s, Zambia did not have a national strategic document to guide its scale-up. PATH collaborated with the government and other partners for over a year to develop the Newborn Health Care Scale-Up Framework and to integrate newborn care into the national strategy. Continue reading »

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