Sunday, February 25, 2018

Research Project


That last two weeks have been busy at the hospital treating patients and going out for outreach to draw blood on our kids in our research project.  Many of you have asked about the research and so I am going to give you a short summary that was written by one of the researchers:

Community Based Antiretroviral Therapy (CBART) Project

At

 Chidamoyo Christian Hospital- Hurungwe District, Mashonaland West Province



Implemented by Biomedical Research and Training Institute (BRTI)



February 2018-January 2020



-------------------------------------------------------------------------------------------------------------------------

The Biomedical Research and Training Institute (BRTI) is a not-for-profit making research and training institution founded in 1995 to promote the health and quality of life of the peoples of Africa through research and training in the field of biomedicine. Zimbabwe, like other Member States of Southern Africa Development Community (SADC), adopted the 2013 WHO HIV treatment guidelines, which include HIV viral load (VL) monitoring for people receiving antiretroviral therapy (ART). VL indicate how well a person is responding to the HIV medicine (ART). However, Zimbabwe only has viral load monitoring equipment at provincial hospitals yet would like to ensure that 90% of all people on ART to have the HIV medicines suppress the HIV to undetectable levels in their blood. Studies that have been conducted in the region as well as in the country have shown that maintaining undetectable viral load among adolescents is more difficult than in other age groups. It is against this background that BRTI health research scientists, Dr Junior Mutsvangwa, Dr Shungu Munyati and Dr Justen Manasa with assistance from Prof David Katzenstein, applied for and received funding from Gilead – an American pharmaceutical company, to conduct a research project whose aim is to reduce virologic failure rates among children and adolescents who are on antiretroviral therapy (ART).



The project is being conducted at Chidamoyo Hospital in Hurungwe District of Mashonaland West Province and is divided into two broad components: (i) laboratory and (ii) ethnography. The first component (laboratory) seeks to monitor virological failure, drug resistance and toxicity on the target population using mobile health technologies. The second component (ethnography) hopes to find out community factors that help or hinder treatment adherence. After seeking clearance from the Medical Research Council of Zimbabwe (MRCZ) BRTI investigators have started working with both Chidamoyo Hospital and Chinhoyi Provincial Laboratories. Highlights of the project interventions include the following activities:



a)     digital data collection and near point of care Viral Load monitoring

b)    lower cost test for HIV drug resistance (genotyping) for individuals with persistently high Viral Load



Project Benefits to the community

i.     The project avails HIV diagnostics that capture electronic records of laboratory tests, and provides mobile collection of patient information, enable electronic tracking of blood samples, linkage to care, treatment(s) and viral load differentiated care. These interventions take advantage of the unique functionality of mobile and wireless devices. Data is captured on Tablets or smart-phones at the point of care in dispersed rural communities and can use compressed 3G cell phone connections to relay and update patient data. Real time acquisition of patient data, rapid transmission of aggregated/summary data to district and provincial level managers of ART programs, will be achieved despite limited broadband capability at the point of care. This facilitates near real-time data collection to provide feedback and digital records to the pharmacy, laboratory and clinical services to achieve and maintain virologic suppression by assessment of VL differentiated care and switching to more effective regimens in a community setting – drug resistance or drug toxicity is detected and managed earlier.



ii.         Chidamoyo Hospital is one of the few health facilities in the country which offers Community based ART – a situation where a health facility reaches out to the community with HIV testing and treatment facilities.  This approach reduces stigma and discrimination among people living with HIV. As the adolescents and children are enrolled and take part in the project, there is peer to peer support to adhere to ART. The project activities also strengthen and ensure family and community support for people infected and affected by HIV.

Sustainability

Modern biomedical research, training, public health institutions and health service providers are increasingly using digital communication and new on-line and digital tools to address the HIV and TB epidemics. These new methods to monitor responses to ART will enhance the effectiveness of community-based adherence interventions and appropriate treatment switches to maintain virologic suppression.     



As the project is implemented, there will be capacity building of staff and facilities at Chidamoyo and the Provincial Hospitals and these skills and equipment will remain in the province after the life span of the project.



The ethnography component of the project involves interaction with Village Health Workers and community leaders (political, religious and traditional leaders) who will always be part of the community and will continue the supportive role long after the project.

Hope this explains what we are doing and the work we are in now is visiting our 8 outreach clinis to draw blood on or 21’s and under kids.  We think this will be a big help in treating or kids, kids in Zimbabwe and throughout the world.  We have already drawn 135 kids and hope to have 600+ kids on the program.

On Friday morning we were happy to see a container that had been sent at the end of October from CA arrive.  We are so happy and can't wait to have the time to unload it.  This really helps our patients to get a lot of their supplies free.  We are so thankful for our many people who help collect things and take them to Gene and Sue Beckstead and for their great help in collecting and sorting everything and putting it in the container and getting it sent.  Thank you to all of you!

Packing up to go to ART outreach


 Drawing blood at Magororo

 Magororo Outreach

 Testing Urine with Lab Assistant from BRTI Labs

Drawing blood at Magororo

 Outreach at Nyamutora

 Kids getting their meds after their blood drawn at Nyamutora

 Nyamutora Outreach Clinic


 Container arrives



Thursday, February 15, 2018

More visitors and lots to do!


After seeing off most of the US visitors on Sunday the 28th of January, I returned home to Chidamoyo to welcome on Tuesday our research team from Harare.  Nine people arrived and stayed through Friday morning.  We had David from Stanford, CA and Dr. Anat from Tel Aviv, Israel and then 7 people from BRTI Laboratories in Harare that are helping us with the research.
Our research proposal is to study our 21 and unders on ART medication for AIDS.  We went on our first run at Chiroti outreach center on Thursday the 1st of February and drew 22 kids.  We worked out a lot of kinks in what we have to do—get consents signed, draw blood and do urines on all kids and give them their medications.  It was a cloudy day and started to rain in a very holy roofed shed.  Dr. Anat was holding an umbrella over me while I drew meds for a while!  Quite exciting.
The team left Friday morning and left Happiness from BRTI to work with our lab to do the tests on the bloods.  She stayed until the next Tuesday.
Two college graduates who arrived on the 17th of January, Claire and Erin from Illinois via University of Kentucky continue to work at the hospital and help in the research project.  They were very helpful and most excited to do anything.  We kept them busy even helping with our celebration and then at the hospital.  Claire wants become a Physician Assistant and Erin a Medical Social Worker.  They both will start Graduate school this next year.
They left for 5 days in Vic Falls before leaving on the 14th of February to go home after a month with us.  We miss them. 
On Monday a team of 6 Ohio State Medical students who are doing a month in Harare came to be with us for a “bush experience” for a week.  We had Sola, Martins, Tanve, Kenneth, Van, and Chris.  We kept them busy helping the doctor, making rounds, helping in surgery and with different procedures.  They did everything from Lumbar Punctures, to Incision and Drainage and VIAC (visual inspection of cervix), to examining outpatients.  They seemed to really enjoy their time and did some hiking around to see the area.  They left on Sunday afternoon and I was suddenly all by myself!!
We have had amazing rains in February compared to our drought in January.  It was hot and dry during most of January and for our celebration and travels afterwards.  However, on January 31 through the 13th of February it rained everyday and hard!  Of course, our electricity went off on the 31st and only came back on the 14th!!  We did enjoy seeing crops come back to life in most areas and also be a lot cooler for us.  It still continues to be a bit cloudy and a few drops on and off, with more rain forecast every day.  People are happy!
We have been excited by some great progress our hospital has seen in helping us to provide quality medical care for our patients.  In mid-January we were one of 25 hospitals in the country to be chosen to get 4 Samba machines that measure viral loads.  This has been so helpful in getting quick results to know if our patients are failing their ART drugs. The tests takes 90 minutes.   We are also using them to test our research bloods.  We are very grateful we were chosen for this project and know this will help our patients in the long run.
We also received word this week that a grant that we applied for from the Japanese embassy was approved and they are spending almost $100,000 to get a digital X-ray machine.  No more buying films, fixer, developers and envelopes.  What a cost saving this will be to our patients and us!  Now we can take several views too without wasting films and money.  We will have a signing ceremony with the Embassy in Harare on May 9th and then we can start the project.  We are so excited!
Through our research project we also have been able to get a new centrifuge, a new fridge/freezer for the lab and a file cabinet as well as lab help to get the samples run quickly and efficiently.  We are thankful for that.
After no electricity for 12 days we finally got it back on Wednesday night in time for our Bible Study.  We had all been going to bed early because of no electricity, now we stay up to get some things done!
Michael Mereki returned to school in South Africa on Sunday.  He finishes his degree in November.  His sister Carolyn is waiting for her visa to join him in school any day.
After so many visitors and so much to do it has been nice to relax and catch up on some work at home and the hospital. 

 Erin and Claire saying goodbye after devotions with Major

 Erin and Claire with Kathy

 Caroline from Harare explaining the research project

 Team from BRTI labs with Dr. Anat and Dr. Katzinstein

Drawing bloods at Chiroti with umbrella helping us

 Kenneth examining a patient

 Tanve doing a lumbar puncture

 Sola examining a patient

 Tanve with a Pediatric patient

 Kenneth and Tanve checking urines on our research kids

Martin drawing blood on a research kid

 Van drawing blood on research kid

 The OSU Medical students with Kathy as they left Sunday

 The new Samba Viral Load machines


The staff and students from OSU and Claire and Erin

Friday, February 9, 2018

Happy 50th Chidamoyo Christian Hospital


The week leading up to our 50th Anniversary celebration was full of joy in seeing old friends return to celebrate with us.  On the 16th of January we welcomed Bill and Reba Harrison and their daughter Julie.  They served at Chidamoyo from 1972-1977 then in Harare from 1978-81.  Julie was just 4 years old when they came.  They had not been at Chidamoyo since 1981 so they enjoyed seeing all the changes and seeing how large the plants and trees and grown around their old house and the mission.

On the 17th we welcomed 2 students from Illinois (via University of Kentucky) Claire and Erin who have come to spend a month with us.  Claire is working towards becoming a Physician Assistant and Erin a Medical Social Worker.  They have been busy learning Shona, making rounds and helping with outreach clinics and our research projects with kids.

On the 18th of January we welcomed Ziden and Helen Nutt and their grown children, Tom and Carolyn.  Ziden and Helen were the first missionaries who started Chidamoyo Mission and he built the hospital and raised all the money for it from 1964-1968.  He was the one who planned the first dedication of the hospital on January 20, 1968 and he gave the key note speech for the rededication celebration.

On Friday the 19th my great friend and Chidamoyo Alumni, Carolyn Hall arrived from Pretoria, SA where she works for CDC.  She came to help us celebrate and we were so happy that everyone came.

With 10 American visitors (all ex-missionaries) and Carolyn and our doctors and their wives and Major and his wife we had a wonderful dinner Friday night and were able to recall some old memories of times at Chidamoyo.  We had wonderful fellowship.

On Saturday we spent the day decorating, moving chairs and preparing for the big day the next day.  Holly had a group of the ladies making flowers for the dignitaries to wear the next day in the afternoon.  The used local flowers and greenery and they looked great!

That evening we had local people that joined us to spend the night—Mashoko Hospital sent 6 people Dr. and Mrs. Bungu and their Matron, administrator, chaplain and Mr. Chikwait.  We had 2 from ZACH—our mission hospital organization and Dr. R. Ndhlovu who came representing Dr. Dale Erickson our first doctor here in 1968.  He was coming and then his wife got sick so he could not come.  Dr. Ndhlovu is a nephrologist who works in Harare and at University of Zimbabwe and has worked with Dale when he comes to help at the Medical School here.  Dr. Shield Kajese our doctor from 2010-2014 also came.  We had a big Braii (BBQ) and fed 38 people that night.  We ended the evening by seeing a film Ziden made in 1968 showing the hospital from start to finish.

Sunday morning we started with breakfast for 35 at my house and then on to get ready for the service.  We started at 0930 and it went until 1:45 p.m.!  We had speeches from our Minister of State Shamu, Chief Dandawa, Dr. Bungu representing Churches of Christ Medical work in Zimbabwe (AS HE IS), Mrs. Chitembere, Chairperson of ZACH, Dr. Mutisi representing the Provincial Medical Director, and Minister of Parliament Gandawa.

The local high school and primary schools sang, did traditional dances and poems for all the guests. 

We did a responsive reading of rededication using the same words from the dedication in 1968 and then Ziden Nutt handed the keys over to the hospital to Dr. Nura Isala, the Medical Superintendent.

We had a special presentation of a Plaque from Countryside Christian Church in Wichita, KS to honor our 50 years of service to the people and churches of Zimbabwe.  Mrs. Chitembere presented it to me.

The hall we held the celebration in had over 1000 people packed inside and then another 2000 outside!  People were sticking their heads in the windows and standing up in the back just to get in.

The day was very warm and the special guests got a tour of the hospital and then lunch in our dining room while the community—over 2800 people went to the church to eat—sadza and beef!  We killed 3 cows, 20 chickens and provided drinks for over 300!  It was a day to remember and everyone has been praising how well it went.  We are thankful to all who came and were a part of this special day.  Thanks for many emails to congratulate us!

We had 22 people for dinner and breakfast the next day and then the 10 Americans and Major and I left for 2 nights at Rhino Camp in Kariba and then drove to Harare for a night and then to Victoria Falls for 2 nights.  Harrisons left from Victoria Falls on Saturday the 27th and the rest of us flew back to Harare (having an Adventure of almost missing our flight!) and Nutts and Holly left the next day.  Bob and Cathy Walker left on Tuesday the 30th—but I came home on the 29th to work and I had a group of 9 arriving on Tuesday!

Wow, it was a quick and crazy time.  Not much sleep, but lots of fun and great fellowship with many.  The hospital looks so great—freshly painted and the yard neatly trimmed.

Bob Walker, Reba and Bill Harrison, Kathy, Julie Harrison, Cathy Walker, Karolyn (Nutt)Schrage, Helen and Ziden Nutt and Tom Nutt

Bill Harrison, Zebedee Togarepi, Ziden Nutt

Bill Harrison, Mollie Nyoni, Reba and Julie Harrison

 

Ziden Nutt and Kathy discussing the program



Cathy Walker and Kathy




Ex-missionaries and crowds at celebration



Honorable Minister of Parliament Gandawa

Honorable Minister of State Shamu



 

 

 
 

 Presentation from Dr. Bungu and wife on behalf of Dr. David Grubbs and wife to Chidamoyo Administration--picture of hospital from 1991

 Chief Dandawa

 Mrs. Chitembere presenting an award from Countryside Christian Church, Wichita, KS to Kathy

 Dr. Murenje and wife with Kathy

 
 

Reba Harrison leading the Responsive Reading



The hospital newly painted



Harrison family on way to Kariba by Baobab tree


Hippo at Rhino Camp

Kariba Dam

Elephant at Rhino Camp

Kathy and Holly Dack at Rhino


 The group of 12 at Victoria Falls

Group at Vic Falls 

 Flame Lily--National Wildflower of Zimbabwe

 Victoria Falls

 

Nutt family at Vic Falls entrance