Baan Gerda Seminar

Baan Gerda: The story so far Please visit www.baangerda.org

Background: HIV situation in Thailand Thailand has an estimated 30,000 HIV infected  children. The actual figure may be far higher. Antiretroviral therapy (ART) is free  6,500 children currently receive through the  Ministry of Public Health The majority of children present for treatment with  advanced HIV disease

Challenges in paediatric services Prevention, diagnosis and treatment of children  with HIV: international priority Evolution of HIV treatment in Thailand has been  rapid since 2001 Diagnosis  Management of OIs  ART is clinically and socially complicated even in  this community Inadequacies in capacity of health facilities to  provide ART

Baan Gerda Ideology It is the duty of adults to fulfil the rights of  children Entitlement to medical care is a fundamental  human right Commitment to delivering ART to children in a  loving environment until it is possible for vulnerable children to survive in their own communities

Philosophy To create families   Teach good manners, discipline & duty  Non-religious  To support and love one another

Financing BG We support 75 Children, 18 caregivers, 10 other  staff members Financing – approx. 12,000 Euro per month (Baht:  Source of funds – child sponsorships and initially  from European contacts Increasingly from Thai donors  Costs vary significantly from month to month 

The early days of Baan Gerda First children arrived in 2001 (via Wat  Prabaat Namphu hospice) We had no experience and very little  knowledge. Our greatest challenge! ART initiated for first 10 residents in 2001  Few regimens available, some imported  Dramatic intolerance with generic ddI 

Baan Gerda grows New children arrived every few weeks  Most arrived in a very poor physical and  psychological condition But some turned out not to have HIV at all…  Many had suffered stigma, bereavement, and  neglect Many were emotionally withdrawn for a long  period

Daily life 8-9 children of varying ages per house  with two care-givers Food prepared from a central kitchen  Meals either in communal hall or at home  Medication is taken at home – including  OI prophylaxis

Ever-changing population We have lost 12 children to AIDS  Some children have returned to their  communities Others were sent back again  Unfortunately many parents feel unable to  stay with us Some parents have had to be asked to  leave

ART at Baan Gerda Our children use several ART regimens  Our first line is NVP/3TC/d4T (or AZT)  Resistant cases take Kaletra  Children with concurrent TB take EFV and  later switch to NVP

Drug issues Medicine and hospital bills initially a major  expense We have many resistant cases  Limited PIs now free by government  Concern about future imported drug costs for  second line treatment failure

Challenges: Parents Finding parents  Keeping our parents  Preventing conflict and power issues  ART training  Giving them a reason to stay: paid craftwork 

Solutions: Communal hall Important for the organisational structure  Reduces power issues and conflict  Ensures privacy in the houses  Activities 

Multi-purpose hall

Seasonal flooding

Challenges: local medical infrastructure Local health personnel – frequent  changes in medical staff Lack of knowledge about HIV  Busy staff  But, not necessarily stigma 

Solutions Expert advice  Well trained staff  Keep staff informed about developments  in paediatric HIV practise Take full responsibility of the medical,  monitoring and psychosocial needs of the families Keep a good stock of general and  antiretroviral medicines

Health issues Most of our kids are now stable on their  treatment Often they come to us with very low CD4  and no records of past medical treatment Health conditions often rare and difficult  to diagnose without specialist help Difficult cases sent to Bangkok  Many children have below average growth 

Education Since 2002 the children have been accepted in local  schools All children attend if they have good health  Our children are in classes mixed with non-HIV  infected kids, stigma and teasing is rare but not unheard of Most of the kids do relatively well, however some of  them had many years without education

Stigma Attitudes for PLWHA have changed in the  past 10 years Thai attitudes to HIV  Community responses  School  Families 

Activities Life at Baan Gerda is a bit easier than it was…  Annual visit to the beach  Orff music lessons  Outings in the holidays

Music lessons

The Future Many kids now reaching adolescence – sex  education and social responsibility are important issues now Preparation for the world outside Baan  Gerda: higher education, careers, independence Children who grow up and leave Baan Gerda  will always have a home here.

Finally Thailand has made great advances in the provision of ART, and we are aware that the best place for most children to be is their home community. However, we would hate to turn away a child with HIV, and unfortunately children are still being turned away from their homes.

But, sometimes, a child comes here just too late…

Thank you for listening

Baan Gerda Seminar

by BaanGerda on Nov 27, 2007

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Baan Gerda Seminar — Presentation Transcript