A True Professional with Heart

Passionate, caring, practical and professional describe Sister Janine Nel’s approach to her job as head of the TB-ARV clinic at the Prince Albert Primary Health Care Clinic. It is clearly an approach that works - during November the clinic received the award for the best Anti-Retroviral (ARV) team in the Southern Cape-Karoo region in recognition of its excellent achievements in rolling out HAART (Highly Active Anti-Retroviral Therapy) in the area.

Janine has headed the clinic for the last eighteen months, the only fully integrated TB-ARV clinic in the Southern Cape-Karoo region. She spends three days of the week attending to patients at the clinic at the Prince Albert Clinic and on the remaining days runs the Outreach TB-ARV clinic in Leeu-Gamka, Laingsburg or Merweville.

Henry Basson, the Prince Albert Hospital Manager, has high praise for Janine and her achievements, pointing to the fact that the clinic has got more people on to TB treatment - 90 in Prince Albert at the moment – and has an 88% cure rate and a default rate of only 5%. This is largely due to people who never return to the clinic to complete their treatment. Not too many do that. “I know each and every one of my patients and know if they don’t make regular follow-up visits to the clinic,” Janine says. “This is where I work closely with the Home Based Care personnel and discreetly get messages through them to patients to come and see me.”

Discretion, trust and confidentiality are clearly the name of the game when it comes to patients living with HIV/AIDS. According to Janine, stigma still deters people from testing for HIV/AIDS and certainly from disclosing to their families and friends.

Janine’s approach to anyone who is HIV-positive is that they have a chronic illness like high blood pressure or asthma or diabetes and that they have many years ahead of them provided they are prepared to lead healthy lifestyles and where needed, start ARV treatment. She has found that most of her patients are willing to improve their lives and give up alcohol, for example, which has a detrimental effect both on their health and the efficacy of their medication.

It is not possible to estimate how many people in Prince Albert are HIV-positive – many get tested in Oudtshoorn and elsewhere to avoid the stigma of attending the local clinic. However, the TB-ARV clinic provides ARVs to 108 people in the entire area in which it covers. According to Janine, the spread of the HIV infection in the Prince Albert area is largely due to sexual transmission, exacerbated by alcohol and drug abuse. Prevalence is highest in the 20 -30 year old age group, and is evenly spread – 50/50 – among men and women. However, she finds that women are more open to testing and treatment: “They know that they have to be healthy to be able to take care of their children, often on their own without support.” She is particularly saddened by the situation in Leeu-Gamka and Laingsburg, both on the N1, a major trucking route between Gauteng and the coast, where teenage girls have a far higher infection rate. “The hardest part of my job,” she says, “is working with children who have the virus.”

Janine is not fazed by what many people would consider a tough, depressing job. It is clear that while at times she finds it psychologically draining, she loves and lives for what she does. The only thing that she dislikes is the red tape and paperwork that goes with working for a large organisation. Like many of her colleagues working in the same field she feels that ARV clinics throughout the country are the “stepchildren in hospitals.” She is not convinced that a change in the Minister of Health will change the situation. Still, she is passionate about all things medical and has been since her childhood in Oudtshoorn, when she dreamed first of being a vet and then of pursuing a medical career.

She completed her four years’ nursing training at Tygerberg Hospital and as she was homesick, applied for posts in and around Oudtshoorn. She began working at the then Prince Albert Provincially-Assisted Hospital in January 1995 and also completed her primary health care diploma. From August 2002, she ran the Hospital’s mobile primary health care clinic, serving the farms in the Greater Prince Albert area. She received training in HIV/AIDS from Dr Dreyer, who set up the ARV clinic at the Primary Health Care Clinic and was then appointed to head it.

On 5 December, Janine is leaving the TB-ARV clinic and returning to work in the Hospital. She says it has been a tough and very personal decision, influenced by the enjoyment and fulfilment she gets from hands-on nursing. “Doing relief work at weekends in the Hospital has made me realise just how much I enjoy ‘catching babies’ and working on a ward and being there for patients who are recovering from serious illnesses.”

One of Sister Janine’s patients at the ARV clinic told the Friend that she would be sorely missed. “We know that she cares deeply about each one of us. She is an impressive person and does wonderful things for the community.”