Camp Hope 2009: The Challenge and Promise of ARVs

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The following post is courtesy of Dr. Leah Scherzer, one of the on-call doctors at Camp Hope 2009: 

A group of boy campers from the orange group at Camp Hope.  Photo courtesy of Kim Mehta.
A group of boy campers from the orange group at Camp Hope. Photo courtesy of Kim Mehta.

 Camp Hope 2009: The Challenge and Promise of ARVs

Camp Hope is a camp for children who are seen at the Botswana-Baylor Children’s Clinical Centre of Excellence (which means that they all have HIV).  Fifty children were chosen for the camp. Those chosen were those who are having problems with adherence (ie missing lots of doses of their meds), those who have particularly difficult social situations (ie lack of support, orphaned, etc), those having problems dealing with the stigma associated with HIV, and some children who just really wanted to come. They ranged in age from 9-12 and were mostly from the area surrounding Gaborone, though some traveled much further for the chance to come. For many it was their first time away from home and the first time they were able to be carefree children. The camp was held at a local boarding school, called Maruapula.

The medication sorting table
Dr. Joel (a Pediatrican from Botswana who works at the COE),
Me, Bri, Julia (both are fellow PAC docs),
Kia, with her back to the camera, is a visiting med/peds intern from the states

The children arrived on Sunday and the first major task was collecting and sorting all of their meds so that we could properly dispense them throughout the camp. This was not an easy task, as most of the children are on at least three separate medications which mostly have to be taken morning and night.

Here I am hard at work sorting meds into AM and PM doses

The medication sorting process made us all realize just how much of a burden these medications are. Some have to be taken with food, others on an empty stomach, some need refrigeration, and they all have to be taken around the same time each day. Most importantly one can really not afford to miss any doses. For other illness (like high blood pressure for example), taking around 80% of one’s medication is relatively good and a patient will likely have decent outcomes. However, for HIV, studies have shown that resistance to the medication can develop when people miss more than 2 doses out of 60 doses in the month (aka less than 95% adherence)! And mostly we are not talking about one pill a day. Most patients have to take around 6 or more pills in a day! There is good news though, as many newer combination pills are becoming available. There is now one pill (combining three drugs in one) that can be taken once a day. However, only certain patients can take this medication, and though it has just recently become available in Botswana, it is not available in most of the rest of Sub-Saharan Africa. So on the left is a daily dose of medications for one of the children at camp. If you look closely you will see the pills in the bags and notice that many of them are quite large.

Enough about the medications, camp was really about having fun! I wish I could post pictures of the campers having a truly great time, but we were not allowed to take any pictures of campers in order to protect their privacy. Many of them have not disclosed their status to anyone, including some family members. As a result, no pictures were allowed except for the designated photographer who took pictures only of those children whose parents had signed photo consent for photos to be taken and used only for official purposes. But take my word for it, the campers had an amazing time! They danced, sang, played sports, had cooking classes, did art projects, and even got to go on a game drive. We even made smores (though they don’t have graham crackers here, so we made them on “biscuits” aka cookies). It was so amazing to see them all laughing and playing and just getting to be children. At the end of camp there was a slide show for the parents and a few of the children spoke. One said that many of the children had come to camp with low self esteem and now it was high. One said that she was so sad to “graduate” from camp because she had made so many great friends and wished she could just stay at camp. It was truly moving to watch the children this week and to realize that without Anti-RetroViral medications (aka ARVs, or HIV drugs) these children would not be alive. However, with the medications (though burdensome), you would never know that they had HIV.