Located 35 kilometers from the district hospital and 230 kilometers from the specialist doctors of Bangkok it is necessary that we cope with the everyday medical requirements of BaanGerda ourselves. The isolation was a major challenge when we started treating children with ARV. It is of paramount importance that any non-professionals caring for sick children on ARV should be able to consult a doctor with experience of ARV at any time. We would have benefited considerably had we been positioned closer to a cooperative hospital with a resident pediatrician, and recommend that any project providing care for HIV positive children should consider the location of their project with this in mind.
We are fortunate to have the medical support and professional advice of a bilingual HIV specialized pediatrician, Dr. Jintanat Ananworanich. She visits BaanGerda every two months to examine both adults and children. She authorizes the initiation of ARV treatment and supervises the monitoring. If necessary we will take a child to be treated by her in Bangkok. We accept that the district hospital has limitations with regards to care for advanced HIV infection in children.
Treatment success is dependent on following ARV treatment directions strictly. On the whole we have had a very positive clinical response to ARV in our community. What we lacked most was general advice about how to start up a system of administering ARV in an environment unsupervised by professionals; thus, we put our system in place mostly through trial and error.
We realized, quite late, that it is necessary to train a member of staff to oversee medical procedures. For the first six months our initial foster parents managed everything themselves. In hindsight, we realize that we should have sought some onsite supervision earlier on. We then found an English volunteer who could speak Thai and later employed two Thai nurses. These staff received additional training in pediatric care specifically for children suffering from HIV & AIDS infection.
The village maintains an infirmary center with six beds. Serious cases are referred to a local hospital (and sometimes to Bangkok). Blood samples are taken routinely for all HIV positive members of the community and sent to Bangkok for analysis. Medical records are maintained for each child and weight changes and lab values are meticulously recorded. Lab results are very important to arrive at the proper dosage of ARV and track the health status of children.
The medical department distributes medication to each house, and a parent is responsible to parcel out the medication for each child every day. The kids take medication every day at regulated times.