In 2002 Meg Spencer Traveled to:
Thailand

Meg Spencer Registered Nurse Ballarat, Australia

BACKGROUND:

Rayong is a province in the eastern region of Thailand. It has the highest number of HIV and AIDS cases in the south of the country.

The Camillian Social Center (CSC) in Rayong Province Thailand was opened in 1996 to care for people living with HIV/AIDS. It began with two buildings, one a Palliative Care Unit (PCU), and the other a Mothers and Childrens Unit. The center is run by the Camillian religious order of Thailand, in the spirit of their founder St. Camillus de Lellis, who began his work in Italy in 1550 to care for the poor sick. CSC cares for people of all ages from babies to the elderly, regardless of their race, or religion. The age of most of the adults living at the center is between 20 and 40 years of age.

The center now has four main objectives:

1. To educate and train the community about HIV/AIDS, and assist them to develop communication skills to care for and support the patients.

2. To provide treatment, symptom management, care and support to people infected and affected with HIV/AIDS in the eastern provinces of Thailand.

3. To care for orphaned children with HIV/AIDS, by assisting and providing medical treatment and education for them, as well as supporting those orphaned children affected by HIV/AIDS.

4. To provide a counselling service via a ‘Network’ for HIV/AIDS patients and to liase with NGO’s in the region and the country.

MY EXPERIENCE:

I came to learn about the center from a friend who had met Fr. Giovanni Contarin (Director of CSC) at an AIDS conference in Melbourne, Australia. I offered my skills of basic nursing and teaching in Palliative Care and made plans to work there for a period of 3 weeks after a 4- week trip to work in Calicut, India at a Pain and Palliative Care Clinic.

The center itself is well set up, accommodating up to 80 people living with HIV/AIDS, providing a range of services to assist the people to live and work in a caring and accepting environment.

The center has a PCU with 9 beds that is staffed predominantly by well HIV positive patients who provide general nursing care for the patients and this care is overseen by international volunteers that come and offer their services for periods of time. These volunteers administer and dispense the medications for all the people in the center, and this is overseen by a visiting Thai nurse from Medecins sans Frontieres who visits twice a week. There is also a Belgian doctor from Medicins sans Frontieres that visits once a month. Therefore the nurse does the majority of the prescribing for the patients. As many are on antiretrovirals and TB medications, the volunteers have had education in the regimes required for the management of HIV and TB.

As my experience is predominantly in Palliative Care, I discussed with Pi Non (Thai Nurse) and the volunteers what topics they wanted the teaching sessions to be based around. Once the topics were confirmed we had a teaching session every second day with the volunteers and twice a week with Pi Non.

Our first session was on Pain, specifically abdominal pain, which the majority of the patients seemed to suffer. As Tramadol was the strongest analgesic available to them at the center, pain control was a constant challenge. Morphine is available in the hospital, however minimally used, but not prescribed outside. Very often we would refer the patients to the local hospitals for assessment and management, but the care received varied greatly from minimal assessment and medication change to hospitalisation. It appeared to depend on the assessing doctor and perhaps their view and expertise on HIV/AIDS.

Other topics taught and discussed were Pressure Area Care, Nutrition and Hydration, Care of the Dying, Wound and Mouth Care, Self Care, Talking with the patient about dying, and Nausea and Vomiting. Support and debriefing was a major component of the work with Pi Non as her job role and responsibility was enormous. On the other four days of her working week she worked in the slums of Bangkok in a women’s and children’s annex.

The center encouraged those living there to be involved actively in the everyday running of the center. They were offered jobs around the center ranging from yardsman-type duties to working in the kitchen cooking and serving the meals, or being involved in the ‘Network’ and education of the community. They were paid for this work by the center and part of their salary was given back to the center to help pay for the antiretroviral medications.

Of the 80 people at the center, 24 were children ranging in age from 3 to 15 years. 19 were HIV positive and 5 had one or both parents with HIV/AIDS or they had already died as a result. Those who were HIV positive received antiretroviral medications from the center, and all were clothed, fed and educated within the center.

The center was a community within a community, and all who resided there felt well cared for, supported and above all accepted. The acceptance of these people however did not flow over into the Thai community. Although the community education programs given by the center about HIV/AIDS and its transmission was helping to improve that acceptance, the fact that people were still being referred to the center because no one would serve them food in the markets due to fear of contracting HIV/AIDS, indicated there was a long way to go. Thankfully the Thai government has been quite active in facing the challenge of HIV/AIDS in its country and more community awareness education is being offered. It is also focussing on research into HIV/AIDS, especially on vaccines that are currently being developed and trialed.

The center’s concern for the peoples’ social and emotional needs was always apparent. The children had many outings to ensure their lives had a level of ‘normality’. We identified that often the patients in the PCU had not left the center since they had arrived, so we organised a trip to the beach and some lunch. The patients had a great day, as did the HIV patients who cared for them everyday, and not one of them had a fever that night which was a miracle in itself! So they now plan to have a monthly outing for the PCU patients and their carers. Another initiative for their psychological and spiritual care was a fortnightly coffee morning for the PCU patients, where the patients had an opportunity to talk as a group about death, dying and other problems/issues they are facing.

From this experience, I learnt a lot about what could be done with limited resources and it reaffirmed to me the value and importance of ‘community’ to patients, especially to this particular group of people who have been isolated from their families. I have tremendous respect for the Cammillians and all of the patients and volunteers at the center and gained far more than I ever imagined from the experience.

I encourage anyone who wants to volunteer their time in this type of work, to consider the CSC as it is an excellent example of dedication and care that needs to be supported and encouraged. The CSC has a web site set up and maintained by a UK expatriate supporter of the center.
The address is http://www.camillianrayong.8k.com

Submitted by: Meg Spencer RN