December 1, annually is world HIV/AIDS day. It is a day set aside, globally, to reflect on the unprinted effects of that yet incurable pandemic and strategize on the better way to chart its prevention and management, especially among the third worlds.
In Nigeria, the Federal Ministry of Health through some agencies like National Action Committee On AIDS (NACA), alongside many NGOs, joins the rest of the world in marking the event using some programs mapped out to sensitize and conscientize the teeming Nigeria populace on how to prevent, treat or manage the health monster. On TV screens, I have followed their activities of the day over the years.
But this year, I was opportuned to witness firsthand what they do and how they do it.
At a marketplace, I spotted a group of youngsters (probably volunteer healthcare workers) in a makeshift booth with a public address system calling the people to embrace regular testing as a way of knowing their status. “If you test negative, try and stay negative. If you test positive, know that it is not the end of the world; engage the antiretroviral therapy.” This of course is (or do I say should be) the customary message of free testing and counseling exercise in every campaign against HIV/AIDS as they run tests for members of the public. And I decided to go closer. Within 5 minutes of observation, I lost it out with them on a number of issues and key factors. First, medical diagnostic tests are affected by many variables that must be taken into account while carrying out the tests. Of all the factors that affect the validity, precision, accuracy, reliability or reproducibility of Lab test, none is as slick as temperature. Most of the kits and reagents employed in the processes are thermolabile (sensitive to temperature changes). These NGOs don’t seem to appreciate this scientific fact. The HIV rapid diagnostic strips of choice is usually the Determine brand. That’s what NACA uses too. The manufacturer’s temperature specifications for its storage is fridge temperatures (2-8 degrees Celsius). While its run temperature is room temperature (18-25 degrees Celsius). Hence ice-parks are usually used to maintain the temperature if cooler van is not affordable, while on a survey screening or outdoor pilot studies.
I was aghast to see some of these advocates run the tests and issue results with reckless abandon under a blazing ambient afternoon temperature well above 36 degrees Celsius.
That’s how pitiful our domestic health care provision for the common man is. How reliable are those results? The known fact is that issuing out false positive or negative results were inevitable there. But in a country where measurement means almost nothing, anything can go.
If data means anything to us in the fight against HIV/AIDS pandemic, then we should be mindful of how results are generated from the Labs.
Whoever was in charge of the exercise must have instructed them in line with the product instruction leaflet on how to interprete the result from the test strips. But he failed to detail them on the effect of variables such as temperature and time of run on the result.
Inability of our health workers to conform to standard operational procedure stipulated in quality management system (QMS) is part of the reason why each time our government officials fall sick, they charter the next available aircraft to Europe and Americas, where systems work and where basic scientific principles for diagnosis and cure are observed.
While patiently observing, I sighted the Leader of the group who must have been a ranked official from the Agency, sitting idle, at the back of the canopy. Beside him is a Lady that looks every inch like his assistant. They were gisting as the man throws his weight around caring less about how the Corps Members were carrying out the tests. Such perfunctory and laissez-faire attitudes to duty has been the bane of both public and private service.
Another unsettling reality I noticed from the exercise is that Nigeria health authorities are still poor with counseling skills. The banner that hung on their table read “free HIV counseling and testing”. This means they should counsel the subjects who volunteer to run the test on various issues relating to HIV/AIDS. These includes: informing them on the epidemiology and pathogenesis of the syndrome. Enlightening them on the four major routes of transmission, teaching them the ABCs of preventing it, conscentizing them on the dangers of stigmatization; and above all, giving them the orientation that HIV seropositivity is not the end of the world, et cetera.
But much to my disgust they did none of the above. One girl among them was busy going about the arena sharing latex contraceptives, while the Corpers were busy needle-pricking the volunteers, running the tests and issuing out results with finese. This is not right. Things need to change if we are to be considered serious and honest in the fight against HIV/AIDS.
At this point, let me pause and wish all our followers and readers in this space merry Christmas and a prosperous new year in advance. Despite all the odds and glooms of this year, we have gotten to its end to the glory of God. We can only hope for the best in the coming year trusting that it will fare better for us and our country than this passing year.
Like Fulton J. Sheen would say; “the beginning of a new year is an opportunity for improvement. It makes little difference what the past has been, for we are not to look back to see if the furrow be crooked. What matters most is the sanctification of the now moment. Time is so precious that God doles it out second by second. If life in the past has been evil, the new year is an opportunity for penance. In such a way is time redeemed. If life, however, has been virtuous, the new year is an opportunity for greater self-perfection.”
This is actualisable if we let Christ the Prince of peace into our lives and allow His principles guide our steps.
Christian theologians teach that “the Christmas message is not that peace will come automatically, because Christ is born in Bethlehem; that birth in Bethlehem was the prelude to His birth in our hearts by grace and faith and love. Peace belongs only to those who will to have it. If there is no peace in the world today, it is not because Christ did not come; it is because we did not let Him in.
May daylight spare us!Ogechukwu writes from Abuja.
