Four hundred kilometers to the west of Abidjan, and one hundred kilometres east of Liberia, at the Societe des Caoutchoucs de Grand-Bereby rubber plantation (SOGB), Elizabeth Glazer Pediatric AIDS
Four hundred kilometers to the west of Abidjan, and one hundred kilometres east of Liberia, at the Societe des Caoutchoucs de Grand-Bereby rubber plantation Foundation (EGPAF) has proposed initiating a model for HIV prevention and treatment in rural African communities. Over the past year, EGPAF has partnered with the SOGB plantation health clinic to provide HIV education, prevention of mother-to-child transmission (PMTCT) testing, and care and treatment services to 30,000 plantation workers, family members, and people in the surrounding villagers. In December 2005, EGPAF employees Dr. Joseph Essombo, Christophe Grundmann, Charles Joseph Diby, and I traveled to the SOGB plantation to propose a more comprehensive, family-based model of HIV/AIDS care and treatment for the clinic.
The SOGB rubber and palm plantation sits in the hills above the costal village of Grand-Bereby. A bumpy, three-hour drive brings us from San Pedro’s industry and beach resorts, through the sprawling slums of the Bardo, and into Côte d’Ivoire’s thick eastern jungle. In the midst of this jungle, on 35,000 hectares, lies SOGB.
Far from grim, SOGB plantation contains an active and vibrant community of 4,000 workers and their 16,000 family members. The site supports 18 villages, nine primary schools, three markets, and even a soccer stadium where five SOGB teams host their matches. Also on site is a sophisticated HIV/AID care, treatment, and prevention program, where EGPAF hopes to introduce a model program for fighting HIV in rural Côte D’Ivoire.
Clinic director Dr. Ya Bessy is responsible for the program’s day-to-day operations. Dr. Bessy leads us on a tour of his medical facilities and speaks with pride about his program: “My medical staff is very small. There are only five trained medical technicians at the SOGB clinic, yet we serve over 30,000 patients. We care not only for the plantation population, but also the 10,000 people in the surrounding villages.”
The clinic’s staff obviously shares Dr. Bessy’s passion. The facilities are simple but orderly: the buildings are sound, the rooms and offices are clean, the grass and hedges are trimmed, and the walks are swept. Nothing appears neglected or ignored.
But it is the clinic’s patients that are on Dr. Bessy’s mind. He’s excited to talk shop, and his topics range from diarrhea remedies to python bites. His demeanor becomes more contemplative when we begin our discussion of HIV. Seven to fifteen percent of Dr. Bessy’s patients are HIV-positive and he expects those percentages to increase. In an attempt to prevent an infection increase, EGPAF is already providing the clinic with various HIV prevention and treatment services.
Inside SOGB, Dr. Bessy has assembled a system of 18 “health huts” to serve the plantation’s 18 villages. Each “hut” is staffed by a trained community health worker (CHW). The CHWs provide HIV education and counseling and enroll pregnant women into antenatal care (ANC)/PMTCT programs.
So far, the program has worked well. Dr. Bessy has identified over 200 cases of HIV infection, and has convinced nearly half of the infected to enter into an HIV counselling and treatment program. While encouraged, EGPAF’s team sees the current system as only a first step in a progressive program of HIV prevention. They would like the next step to be a more comprehensive testing and treatment program that targets all medical patients and their families.
At SOGB, and throughout Cote d’Ivoire, only patients who volunteer for AIDS testing and willingly enter into a program are treated. Without a patient’s consent, a medical officer will not test for HIV. With Côte d’Ivoire’s high HIV infection rate, testing may seem an obvious choice, but due to guilt and other cultural barriers, the majority of patients refuse testing.
EGPAF would like to reverse this process. Dr. Essombo has encouraged Dr. Bessy to integrate routine HIV testing for ALL patients visiting the SOGB clinic. Those who test positive would immediately receive counseling and be strongly encouraged to begin treatment. Likewise, the patients’ family members would receive counselling and be encouraged to be tested for HIV.
In the villages, the health huts would act as SOGB recruiters ― encouraging all pregnant women to participate in SOGB’s ANC/PMTCT program. Once in the program, these women, and their families, would follow the same screening, counseling, and treatment procedures as the clinic’s patients.
Because of the success of Dr. Bessy’s clinic and the close-knit makeup of the SOGB community, EGPAF believes the model for a new, aggressive testing policy in Côte d’Ivoire should begin in the hills above Grand-Bereby. Now, Dr. Bessy must decide if the SOGB community is ready to change HIV testing in Côte d’Ivoire.