In South Africa, physiotherapists and occupational and speech therapists are playing increasingly critical roles in the survival of HIV-infected people.
But, according to one of the country’s leading rural health specialists, Dr. Ben Gaunt, their growing contribution to easing South Africa’s HIV and AIDS crisis is passing largely unnoticed.
“Allied health professionals are often invisible because they operate on the softer edges of healthcare. On the surface, their work is more about enhancing patients’ quality of life than actually saving people’s lives. But their work goes much deeper than this,” Gaunt maintained.
He continued, “Doctors can tend to be a bit arrogant and think they know everything. Actually the honest truth is allied health professionals did a four year (university) degree; they weren’t sitting around just chatting to each other. They’ve got a huge amount of practical and theoretical knowledge and what they bring to a (medical) team is incredible – and what they bring to the patient, more importantly.”
Shannon Morgan, an occupational therapist in Oliver Tambo District in South Africa’s impoverished Eastern Cape province, insisted that allied health workers should be more involved in treating HIV-infected patients.
“Our role in the care of HIV infected people is not recognized and we’re underutilized when it comes to HIV treatment. Funding comes through for this and doctors and nurses get involved in HIV projects but no one involves us,” she stated.
About 5.5 million people have HIV in South Africa, more than any other country. The government is giving antiretroviral (ARV) treatment to more than a million of them, but many more aren’t getting the medicine they need to bolster their weak immune systems.
As a result, they’re becoming seriously ill with infectious diseases, some of which cause severe disabilities. HIV attacks the central nervous system, sometimes causing cerebral palsy and strokes - even in children - leading to paralysis.
“With ARVs they improve and with treatment they improve, but most of the time they won’t get back to the level they were at before, and because HIV affects the brain, they can be impacted in any way – whether it be their hearing, their vision, their movements; they can be paralyzed,” Morgan explained.
Morgan’s colleague Laura Grobicki, a physiotherapist, added, “We see a lot of patients who have TB in their spine and when it affects their spine it can cause them to have spinal cord lesions. So we have quite a few members of our community who are paralyzed and will always have to use a wheelchair and will never be able to walk again, because of TB.”
Many HIV-infected South Africans also develop tuberculosis meningitis, or TB of the brain, which causes strokes. “I’d say 80 percent of the patients I see are HIV-positive, and more and more of them are tiny kids who’ve had strokes,” said Grobicki.
Dysphasia also affects about one in five people with HIV in South Africa. This condition leaves them unable to talk properly, and with a very limited ability to understand others.
Using their unique skills, therapists enable patients to function despite serious disabilities such as these.
Gaunt insisted that allied health professionals are “crucial” to patients’ wellbeing.
At the rural state hospital where he’s head doctor, he employs five of them – including Morgan and Grobicki. But, citing budgetary constraints, most public hospitals in South Africa don’t employ a single therapist.
“At the moment in South Africa there aren’t enough therapists being trained, there aren’t enough posts, and there aren’t enough resources available for therapists,” said Grobicki.
This, said Gaunt, all adds up to a “big mistake.” He added, “I don’t think any facility can do without allied health professionals, especially in the context of HIV. Doctors are basically powerless to help stroke patients, for example. We can only sympathize with them and control their blood pressure. But therapists can teach them to walk, talk and become functional again."
This is certainly the case, but rehabilitation is always a slow process, said Grobicki. “Sometimes it’s a massive success just to get a patient to sit up for a meal. Then I help them to take their first steps with a frame, or on crutches. Then I get them to the point where they can walk on crutches by themselves outside. But it sometimes takes months to get there…”
Grobicki explained that therapists have to spend a long time with patients, when compared with doctors, but she described this as “wonderful.”