“I Put Myself in My Client’s Shoes”

Merinah Komuhangi is too modest to tell people how good she is at her job as the senior clinical officer of the antiretroviral therapy (ART) clinic at Kabale Regional Referral Hospital in southwest Uganda. The hospital is supported by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) through USAID RHITES-SW project.

According to Merinah, the COVID-19 pandemic has put the ART clinic in the spotlight because of tuberculosis (TB). TB a common opportunistic infection for people living with HIV who do not have a suppressed HIV viral load; is the leading cause of death for people living with HIV. Along with providing HIV services, the ART clinic links people with symptoms of TB to testing and treatment.
Because some of the symptoms of COVID-19 and TB are similar (coughing and fever), stigma for people coming to the ART clinic has been heightened, which raises concerns for Merinah.

“Our clients are already struggling with the risk of HIV/ TB coinfection, so we don’t want them to miss necessary drugs for either,” says Merinah. “We are afraid of COVID-19, but we can’t forget TB. If we do, it will be worse.”

We are afraid of COVID-19, but we can’t forget TB. If we do, it will be worse.

Early on in the COVID-19 pandemic, Merinah and the ART clinic team created an isolation tent away from other patients for those presenting with TB-like symptoms. At the entrance of the hospital everyone’s temperature is checked, and handwashing is strictly enforced. Patients presenting with high temperature are taken to an isolation point for further assessment by the clinicians.

Merinah says that since the shutdown in Uganda, as many as half of the clients are missing their appointments for drug refills. “ART clients may think that they are more at-risk,” she says. “If they have some flu or cough, they may not come.”

Merinah and the other health workers are determined to fight on behalf of their clients.

“The team takes time to review ART files and get the peers to call those clients who missed their appointments or unable to come to the clinic, those who are far are directed to facilities close to their homes. The health workers also at the end of their shift divide the multi-month drug packs for refills and drop off medicines for patients in their neighborhoods. Our goal is to have clients retained on treatment and maintain viral suppression for the clients to be healthy.”

The ART clinic is following MOH guidelines and calls up clients to come in a few at a time.

“For those who need to be screened, we ask them to sit four meters away,” says Merinah. “I wonder whether they think we don’t care about them, yet we do; but we must ensure social distancing to prevent COVID-19.” Clients are also educated about COVID-19 and how to keep safe.

I put myself in my client’s shoes. They have a chronic illness and they walk many, many miles sometimes to get here.

“I love my work, and usually I put myself in my client’s shoes,” says Merinah. They have a chronic illness and they walk many, many miles sometimes to get here.”
“Merinah is a favorite,” says Peter Ngambaneiwe, a youth peer volunteer. “She treats us as equals. And she knows all of our (more than 200) children by name—where they come from, and what school they are in. She never lets a client drop off their HIV treatment.”