www.aids2014.org nurses: stepping up, stepping forward, stepping beyond. treks to nepal denise...
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www.aids2014.org
Nurses: Stepping up, Stepping forward, Stepping beyond.
Treks to Nepal
Denise Cummins
Clinical Nurse Consultant
MPH, PhD Candidate
Sydney District Nursing Service
Sydney Local Health District, NSW, Australia
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Visiting Nepal since 2003
Varied agencies: • Life Giving Life Saving• Ausaid collaboration• Peace Freedom Rehabilitation• Nava Kiran Plus ( three workshops)• Nepal Hospice• APN Kendra
• Changes over the years…..
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Volunteering…
• Clinical skills, workshop, outreach, mentoring
• Fund raising, The Polly’s• Nurses have so many varied skills and are
willing to share and learn from others….
One person can make a difference
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Demographics
• Population: 30 million• 75% agricultural labour workforce• 25% live below poverty line• Life expectancy: 67 m, 69 f• Literacy 62% m, 34% f• GDP $700-$1500
Unicef country information
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General Health
• Vector borne disease: Japanese encephalitis, malaria, and dengue fever
• Food or waterborne diseases: bacterial diarrhoea, hepatitis A, and typhoid fever
• Infant mortality rate• Heart disease and TB (11%)
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HIV Information
• First infection 1988• HIV prevalence 0.3% (39000-65000)• 8% children <15 years• 5000 deaths
• Concentrated epidemic: people who inject drugs, MSM and transgender people, FSW and male labour migrants
National Centre for AIDS and STD Control Nepal; Country Progress Report on HIV/AIDS Response, Nepal, 2014
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YET
• HIV prevalence is declining after reaching the peak during 2002 – 2003
• 4 of every 5 HIV infections are sexually transmitted
• Survey of comprehensive knowledge of HIV amongst adolescents 2008-2012:
25% F, 33% M
National Centre for AIDS and STD Control Nepal; Country Progress Report on HIV/AIDS Response, Nepal, 2014
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HIV Services
• 200 testing sites in 75 districts
• 70+ Mother to Child sites
• 18 CD4 & 1 viral load sites
• 44 ART sites ( M: 4709, F: 4129, 30 transgender, 638 children)
National Centre for AIDS and STD Control Nepal; Country Progress Report on HIV/AIDS Response, Nepal, 2014
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Nava Kiran Plus, 2003
• NKP - 25 districts and provides care to 300 people daily
• Core actions: provide treatment, care and support related services and advocacy
• Orphanage
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2013 Field Trip
• 3 nurses from Sydney• Palliative care, HIV specialist• 4 sites: NKP, Nepal Hospice, APN
Kendra, Peace Freedom Project
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NKP 2 day workshop
• Collaboration via email for content• Participants from NKP and Women’s
Refuge Service• Badal
• 24 Participants (12 m, 12 f) and a few children!
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ProgramDay 1
• Ice breaker activity• Quiz
• Being HIV positive • HIV information• Medication adherence• Dealing with side effects
• Hand massage
Day 2
• Recap • Mental health• Depression and anxiety• Cognitive impairment• Pain and pain
management• Panel Q&A
• Celebration
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Evaluation- Positives
Increased knowledge on:– HIV and HCV– HIV and HCV medications (e.g. adherence, how drugs worked)
– Viral load and immune system– Depression and cognitive impairment– Interaction and activities good– Ongoing commitment
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Evaluation- Negatives
– Wanted longer workshop
– Group discipline
– Medical terms difficult to understand
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Lessons learnt
• Expect unexpected• Language and literacy• Participants personalising information• Interpreters
• Nurses experience….
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So why do it….
• Challenge yourself• Cultural exchange• Share your skills• Make a difference• Make friends• Adventure