Missing the Target #5: Improving AIDS Drug Access ... - CD8 T cells

Many health care workers are inadequately trained. As a result, patients areoften treated poorly, which contributes to high levels of stigma and discriminationtoward PLWHA in health care settings and in general. The following account ofunacceptable behavior was provided to the report’s authors by an observer:Yesterday I was waiting outside the counseling room for my shift. A doctor called apatient’s name, but unfortunately that person had already left for home. The doctorstarted yelling and threw the patient’s profile to the floor and kicked it. Everyone inthe room felt very uncomfortable.Health care workers are also greatly overworked, which also may contribute totheir inability or disinclination to offer high quality care. One observer noted thefollowing in a discussion with the report’s authors:“I am working as a peer counselor. In my hospital we have provided treatmentto more than 4,000 patients. There are only six doctors here (three in themorning, and three in the afternoon) providing medical counseling and care,and each of them must see 20 to 30 patients a day. Many of the patients havesignificant problems that require lengthy examinations and consideration. Ithink it is difficult for the doctors to provide good service to all patients due totheir workload.”Other treatment and care limitationsCAMBODIAThe MoH is trying to implement a new health system policy based on regional care.For example, patients are now required to obtain treatment in their own province;they cannot access public sector care in other provinces. As part of that shift, thegovernment is planning to require many internal migrants receiving care in PhnomPenh to return to their home provinces for treatment services.This new system has both positive and negative implications. On the one hand, itmay help spread more extensive and higher quality health care across the country,as long as adequate numbers of personnel are available. On the other hand, manypeople seek care elsewhere because they do not trust their local health facilities.They may have had negative experiences in obtaining appropriate care locally;some, too, may go elsewhere to avoid stigma and discrimination in their homecommunities. Removing these obstacles will be a difficult challenge for public healthofficials. One patient’s account touches on many of the issues involved:“I come from the Svay Rieng province. We have an ART clinic, but I do notwant to visit the clinic there because I was told the clinic is new and thatdoctors are poorly skilled regarding treatment. Also, I do not want my neighborto find out about my HIV status. I wanted to go to Phnom Penh, the capitalcity, but I was rejected. They said they could not receive any more new patientsbecause they had no space...only those from the city could go to clinics there.I do not know what to do now.”47