It’s 8:00 am, and Alice Otiato is walking through the grounds of Epworth Clinic, in the bright morning sun. “How are you?” she says, smiling and greeting patients and staff. It’s already close to 30 degrees - but her day has only just begun.
She stops at the day clinic and quickly scans the room. This is where patients are assessed. Her eyes fix on a baby, only a few months old, hanging listlessly over her mother's shoulder.
Alice can see the child is seriously unwell. She asks the nurse on duty where the ambulance is.
The nurse responds that it hasn't yet been dispatched. They are awaiting confirmation that the cost of the ambulance (£16) will be covered by health authorities. It is a fee the mother simply cannot afford.
The wait may only take another 20 minutes - but with a life hanging in the balance, every second counts.
Alice is quick to react, reassuring the nurse that Médecins Sans Frontières/Doctors Without Borders (MSF) will pay the fee on arrival.
The nurse promptly calls the hospital. Within 10 minutes, the ambulance arrives, taking the sick child to the central hospital for urgent treatment.
HIV positive patients
The last situation is critical, but it is not an unusual day for Alice, who is MSF’s project coordinator at the Epworth Clinic. The facility is located in the outskirts of Harare, Zimbabwe's capital.
“My typical day at Epworth is busy," says Alice. "You never know what’s going to come up.
"We have a cohort of over 11,000 patients. On an average day we see 350 to 400 of them.
"All of them are different: you have children coming in who are HIV positive, you have mothers, fathers, adolescents - it's a mixed bag.”
She motions towards a large gathering of patients in the outside waiting area, sitting in the shade and out of the heat. They’re here to pick up their medication, watch the daily TB or HIV education sessions, or see a doctor or nurse.
The Epworth Clinic HIV programme
In 2005, during the Harare City clean-up operation (known locally as Operation Murambatsvina), thousands of people were relocated to alternative settlements outside the capital. [[Article-CTA]]
Around 20,000 settled in Epworth, a former farm, on Harare’s outskirts.
Due to growing medical needs in the area, MSF started providing primary healthcare in Epworth that same year, in partnership with the Ministry of Health and Child Care (MoHCC).
The Epworth Clinic HIV programme began a year later, after the discovery that Epworth’s HIV rate (30 percent) exceeded the national average (24 percent).
Florence
Florence, a 40-year-old mother of four, was the first patient to arrive at the clinic and register for the HIV programme. She tested positive for HIV shortly after giving birth to her third child.
“I was always sick, so I decided to go and get tested. I had heard there were MSF staff who were doing free tests at the clinic,” she says.
"Now that I have accepted my HIV positive status, I'm not going to let it change the course of my life."
In the decade since the HIV programme began, Florence is now one of more than 30,000 patients in Zimbabwe who have received free medical care at Epworth Clinic.
In that time, it has grown from one humble stand-alone building, to a community medical hub.
Alongside screening and distributing medicines, the clinic now runs support groups for TB and HIV patients, houses a pharmacy and meeting rooms, and provides counseling sessions.
Florence is a testament to the success of the HIV programme. Her health has improved and her HIV is under control. She says she’s no longer ashamed of her HIV positive status.
“Being diagnosed HIV positive doesn’t affect me anymore, although initially, it upset me," she says.
"Now that I have accepted it, I'm not going to let it change the course of my life.”
As Florence speaks, her son runs in and out of the one room house, playing with the neighbours' kids.
Tanya
Although she has four children of her own, Florence also takes care of her late friend’s 10-year-old daughter, Tanya.
Tanya is disabled and HIV positive. Her mother passed away in 2010.
Tanya and her mother were part of the first group of patients from the Epworth HIV programme. They had started treatment on the same day as Florence.
Tanya, her brother, and her father live next door to Florence.
The bubbly young girl, who has never been to school, requires the aid of a wheelchair or crutches to move around.
“Before she started her HIV treatment, you would not imagine how different she was to the young girl she is now," says Life, Tanya's father. "She was underweight, and not developing properly.
"Once she started treatment, her health began to improve.”
Curious and social, Life says Tanya is desperate to go to school. However, she is forced to spend most days at home with Florence, while her father searches for work.
With no job, and the unemployment rate in Epworth estimated to be around 90 percent, Life is unable to pay for Tanya’s education.
“When the other kids are playing outside my home, I try and use my crutches to keep up," says Tanya. "But they don’t slow down for me because I can’t walk as fast."
Despite the challenges in her daily life, Tanya remains hopeful about her future.
“When I grow up, I want to be a teacher, because I want to teach people and help them read," she says. "Even though I don’t know how to read, I want to teach them that they should.
"At the moment, I can count to 10 and I can write ‘my name is Tanya’.”
She points proudly to a piece of worn paper on the shelf, scrawled with words and numbers.
MSF in Zimbabwe
We have worked in Epworth since November 2006, in partnership with the Ministry of Health and Child Care (MoHCC) at Epworth Clinic.
In the past 10 years, more than 30,000 patients in Zimbabwe have received free medical care at the clinic.
Along with providing general healthcare, the clinic focuses on the treatment of thousands of HIV patients living in and around the community, ensuring they have access to high quality and free medical care.
In the decade since the HIV program started, HIV prevalence in Zimbabwe has reduced from over 30 percent at its peak in 2000, to 15 percent.
Today, over 1,000 HIV positive patients have formed support groups in the community (under the CARGs model).
